THEORY OF DIMiErKS 077 



One difference between diabetes melitus and plilorliizin diabetes is 

 that in the former the glycosuria is due to hyperKlyceniia. the .sugar 

 loss being an overflow like water escai)ing from an overfdle*! tank; 

 whereas in phlorhizin poisoning there is apparently an hy|)(.glycemia 

 —the loss resulting in this case, to carry out the simile, from a leak in 

 the bottom of the tank which keeps the water at a lower level. But t he 

 results are the same. ]\Ioreover, if in diabetes melitus we could meas- 

 ure only the chemically active or dissociated blood sugar, it is possible 

 we should again find for this kind of sugar an liyi)oglycemia compara- 

 ble to that of phlorhizin diabetes. This conception coincides with the 

 doctrine that in diabetes melitus there is a primary nnderconsumption 

 of sugar as opposed to the idea of a primary overproduction. 



Overproduction vs. Underconsximption. — The chief expf)nents of 

 overproduction have been the followers of Kraus, and of von 

 Noorden in whose books "Die Zuckerkrankheit" and "New Aspects 

 of Diabetes" will be found the arguments favoring this idea. A 

 translation of Minkowski's criticism of the latter has been made by 

 Lusk." In this place it may be briefl\' recalled that the chief argu- 

 ments favoring underconsumption in addition to what has already 

 been said are the followng: (1) The respiratory quotient in diabetes 

 is frequently found to be low, and w^hen carbohydrate food is admin- 

 istered this quotient rises but little, whereas in health the administra- 

 tion of carbohydrate food results in a greater rise.''- (2) The acetone 

 bodies (acetone, aceto-acetic acid and beta-hydroxybutyric acid) 

 appear in the urine when for any reason the quantity of sugar burning 

 in the body falls below a certain minimum, as in starvation, or when a 

 person accustomed to a mixed diet is suddenh' switched to a full calory 

 diet composed exclusively of fat, or of fat and carbohydrates, with 

 the carbohydrate calories representing less than 10 percent, and the 

 fat calories more than 90 per cent, of the total (Zeller*'\). In these 

 cases the restoration of sugar to the diet abruptly and permanently 

 stops the output of acetone bodies. But in severe diabetes the excre- 

 tion of acetone bodies is less affected by the giving of sugar. Follow- 

 ing single large doses there may indeed be a temporary fall in the 

 acidosis, but this is never permanently attainable. One interpreta- 

 tion made of these facts is as follows. In diabetes there is an acetone 

 body output because sugar, although brought to the cells, fails to take 

 part in certain chemical reactions which normally occur between 

 sugars and certain of the breakdown products of butyric acid and 

 which normally prevent the diabetic acidosis. Hence the bringing of 

 more sugar has little effect. And here again one might suggest that 



" Medical Record, Feb. 1, 1913. 



^- For the literature of respiration studies in diabetes see Joslin, Treatment of 

 Diabetes ]\Ielitus, New York, 1916; Du Bois, Harvey Society Lectures, 191(i; and 

 "Studies from the Department of Physiology of Cornell University, 1915 ct seq.; 

 published in the Archives of Internal Medicine and reprinted as Bulletins. 



" Arch. f. Physiol., 1914, p. 213. 



