riiijth'Y or i)i\ni:Ti:s 071 



p-ivinj,^ of siijzar. l-'ollow iiii:- single l;ii'>ic doses there may indeed Ix- a 

 t(Mii])orary fall in the acidosis, but this is never perinaiiently attain- 

 able. One interpretation made of these facts is as follows. In dia- 

 betes there is an acetone body output because sujiar, althouuh brought 

 to the cells, fails to take part in. certain cheniical i-eactions which nor- 

 mally occur between sugars and certain of the breakdown i)roducts of 

 butyric acid and which normally prevent the diabetic acidosis. Hence 

 the bringing of more sugar has little effect. A)id iiere again one 

 might suggest that in diabetes glucose fails to interact with the pi-od- 

 ucts mentioned because tlie glucose is not sufficiently dissociated. 

 Another intei-pretation has been to the effect that the sugar simply 

 causes a compensatory decrease of the fat metabolism, i.e., spare fat, 

 thereby decreasing the formation of the acidosis bodies. The mech- 

 anism of the process is in any case still a theme for research. 



There are numerous other theories of diabetes, for the presentation 

 of which the reader is referred to the larger works. Lepine has long 

 stood for the view that the pancreas secretes a glycolytic oxidizing 

 ferment. Xaunyn's theory pays particular regard to the ability of 

 the body to "fix"' glycogen, while glycogen formation is held to be 

 a necessary preliminary step in the utilization of sugar. The fail- 

 ure to fix glycogen he calls " diszoamylie ," and the other metabolic 

 disturbances he regards as sequences. The complex develo])meiit of 

 this same general idea by von Noorden, with the added element of 

 primary sugar overproduction, has already been alluded to. Pavy 

 saw in the diabetic a failure to assimilate sugar; that is, a failure of 

 the body to incorporate sugar in a colloidal combination which would 

 at once permit of its transportation to the points of utilization, and 

 prevent its prenmture excretion. The assimilation he held occurred 

 in the villi of the intestines, and the lymphocytes he regarded as the 

 morphologic elements which carry the sugar. Cohnheim's theory 

 that the muscles formed glycolytic enzymes, for which the pancreas 

 supplies an essential activator, is without any substantial experimen- 

 tal support at the present writing. Allen proposed that the ])ancreas 

 supplies an "amboceptor" which is essential for the proper colloidal 

 blood sugar combination. 



Bronzed diabetes, the name given to that form of hemochromatosis 

 in which, along with the hepatic cirrhosis, there is an associated 

 fibrosis of the pancreas, and, as a result of this, the sym]itoms of 

 pancreatic diabetes, will be found discussed under the heading 

 "hemochromatosis," chapter xvi. 



Diabetic coma is discussed under "acid intoxication,"" chapter xviii. 



Lipemia, which is observed frequently and most severely in diabetes, 

 is discussed in chapter xiv. 



THE END 



