670 DfAnKTES 



active. Tlie recent studies of Murliii, Kramer,' Sweet ami Karver, 

 show that alkali administration (NaoCO;,) may increase glucose utili- 

 zation, especially when introduced into the duodenum where it may 

 neutralize acid entering the bowel from the stomach and thus spare 

 the liver and ])anereas from the effects of absorbed acid. Underbill 's 

 experiments"" with bicarbonate feeding in diabetes confirm these ob- 

 servations. 



One difference between diabetes melitus and phlorhizin diabetes is 

 that in the former the glycosuria is due to hyperglj-cemia, the sugar 

 loss being an overflow like water escaping from an overfilled tank; 

 whereas in phlorhizin ])oisoning there is ajiparently an hypoglycemia 

 — 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 the 

 results are the same. ^Moreover, 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 hypoglycemia compara- 

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

 doctrine that in diabetes melitus there is a primari) underconsnmp- 

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



Overproduction vs. Underconsumption. — At the present time the chief 

 ex])onents of overproduction are 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 briefly recalled that the chief argu- 

 ments favoring underconsumption in addition to what has already 

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

 is freciuently found to be low, and when carbohydrate food is admin- 

 istered this quotient rises but little, wdiereas 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) ap- 

 pear 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 

 })erson accustomed to a mixed diet is suddenly switched to a full 

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

 with the carbohydrate calories representing less than 10 per 

 cent, and the fat calories more than f)0 per cent, of the total 

 (Zeller "■''). In these cases the restoration of sugar to the diet 

 abruptly and ])ernuinently stops the output of actone bodies. But 

 in severe diabetes the excretion of acetone bodies is less affected by the 



60 Jour. Amer. Med. Assoc, 1017 (OS), 407. 



«i IMpflieal Rword. Feb. 1, 1013.- 



>'- I'^ir tlie literalnre of res])irati(>n sdidies in dialtotes see Josliji. Troalment of 

 Diabetes Melitus, New York, lOlfi; Du Bois, Harvey Society Lectures, 1916; and 

 "Studies from tlie Department of niysiolo<ry of Coniell University, lOl.T ct scq.; 

 |iulilislied in tlie .Areliives of Internal ^Medicine and rejjrinted as Bulletins. 



«:f Arcli. f. I'liysiol,, lOI-l, j). 21:5. 



