270 HUMAN DIABETES 



diminished; in such cases the excess of sugar is changed 

 into fat and deposited as such. A ' ' diabetogenous obesity 7 > 

 of this sort may, if glycosuria come to accompany it, be 

 changed into the ordinary diabetes of the obese, and in the 

 end into a severe diabetes, with development of a progressive 

 loss of flesh. 



Diabetic Lipcemia. Finally among the disturbances of fat 

 metabolism noted in diabetes, diabetic lipaemia 72 presents 

 special interest. While the quantity of lipoid substances 

 in the blood plasma is normally scarcely more than one per 

 cent., in diabetes it may rise to many times this proportion. 

 Cases have been known in whom the blood from the veins 

 looks like chocolate and cream, 73 and in whom the vessels 

 at autopsy appear as whitish cords. In one case more than 

 one-fourth volume was obtained by ether extraction from 

 the blood. 74 Sometimes the fat is present in practically 

 normal amount, but the cholesterin and lecithin are much 

 increased. 75 Upon what the lipaemia essentially depends, 

 it is impossible to say. The fact that it frequently parallels 

 the acidosis, and becomes especially marked in the coma, 

 strongly suggests a connection with tissue disintegration 

 especially some process which sets free the fat. At one 

 time a reduction of the lipolytic power of the blood was sup- 

 posed to be an important factor. In recent times, however, 

 our views have changed essentially in that (as will be dis- 

 cussed more fully hereafter) it has been recognized that the 

 supposed destruction of fat in the blood is really a masking 

 of the fat. We are likely, too, to view with a proper hesi- 

 tancy statements to the effect that diabetic blood containing 

 excessive fat shows a loss in the fat when mixed with normal 

 blood. We did not in those earlier days clearly understand 



"Literature upon Diabetic Lipaemia: C. v. Noorden, Handb. d. Pathol. 

 d. Stoffwechs., 2d ed., 2, 102-104, 135, 1907. 



73 E. Neisser and E. Berlin, Zeitschr. f. klin. Med., 51, 428, 1904. 



74 C. Frugoni and G. Marchetti (Florence), Berlin, klin. Wochenschr., 1908, 

 1844. 



75 G. Klemperer and H. Umber, Zeitschr. f . klin. Med., 61, 145, 1907. 



