676 DIABETES 



molecule into two 3-carbon substances. ^^ Baumgarten^^ also sup- 

 ported the idea of a "fermentative splitting" which precedes oxida- 

 dation, because he found a greater percentage utilization of certain 

 substances closely allied to glucose (such as gluconic acid, saccharic 

 acid, mucic acid, etc.), than of glucose itself; whereas gluconic acid 

 and glucose, for example, differ only in that the sugar has an aldehyde 

 group where the acid has carboxyl. Similar general ideas have been 

 expressed from time to time by others. The present writer has urged 

 in place of the vaguer terms, the adoption of chemical "dissociation" 

 in the sense which is rapidly finding favor in the field of pure organic 

 chemistry, notably for the explanation of the behavior of aldehj^des, 

 ketones and alcohols. ^^ There can be no doubt that the dissociation 

 of glucose in the body is a normal occurrence. This is directl}' and 

 conclusively shown whenever muscles make lactic acid (CsHeOs) 

 out of glucose (C6H12O6), since in this process no chemical phenomenon 

 is involved save cleavage of the hexose and intramolecular rearrange- 

 ment. The polymerization of sugar into glycogen might be similarly 

 interpreted. Direct proof of a failure of glucose dissociation in dia- 

 betes has not yet been brought, although its absence would explain 

 all the metabolic phenomena more directly and simply than anj'' other 

 single physiologic error which has been hypothecated. It is, moreover, 

 a tangible chemical conception, whereas to say that the bodj' loses its 

 power .to oxidize sugar or to "fix" it as glycogen is merel}" to name 

 effects in physiologic terms. (Cf. Naunyn's diszoamylie.) 



It might be assumed that all sugars upon entering certain phases of 

 the cells (phases especially well represented in liver cells), meet con- 

 ditions which are equivalent to those met in a weakly alkaline solution, 

 favoring reciprocal transformations, and, as A. P. Mathews points 

 out, polymerization; but not conditions conducive to the deeper de- 

 structive reactions. That is, especially in the liver, there may be the 

 equivalent of dilute alkali for all sugars. Glucose, being the least 

 dissociable, represents the form into which all other sugars tend to 

 accumulate. But in the normal body a special glucolytic enzyme 

 (alkali carrier or intensifier?) destroys glucose selectively. All 

 other sugars must become glucose before destruction. In diabetes 

 the enzyme necessary for the deep dissociation of glucose is lacking or 

 inactive. The recent studies of Murlin, Kramer, Sweet and Karver, 

 show that alkali administration (NaoCOa) ma}' increase glucose utili- 

 zation, especially when introduced into the duodenum whore it may 

 neutralize acid entering the bowel from the stomach and thus spare 

 the liver and pancreas from the effec^ts of absorbed acid, l^ndorhill's 

 experiments'^" with bicarbonate feeding in diabetes confirm liiese 

 observations. 



" Glyceric aldehyde and fjlyccrol, accord iiiji; to Schultzen. 

 '» Zcit. f. exp. Path. u. IMianii., I'.K)') (2), oii. 



'■'•' Cf. Nef, lor. cU., and Stieglitii, Ciualilative Chemical .Vnalvsis, New York, 

 1912, I, PI). 28<)-2«)2. 



«» Jour. Ainer. Med. Assoc, 1917 (68), 497. 



