528 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



It is known that the individual food-stuffs are not equivalent in their 

 action on the glycosuria. Carbohydrates and protein act more positively 

 on the glycosuria than fat, while alcohol, for instance, does not influence the 

 glycosuria. Also the individual carbohydrate and albuminous bodies show 

 differences in their action. Of the kinds of sugar, maltose, for example, acts 

 more glycosuric than glucose, and this again acts more strongly than levulose. 

 However, the individual diabetics do not behave the same throughout. For 

 example, milk-sugar is borne very well by many, others react to it with a 

 severe excretion of sugar. 



Also the individual protein bodies influence the glycosuria in different 

 manners. To mention only a few examples, casein and meat-albumin act 

 more on the glycosuria than plant-albumin and egg-albumin, the latter acts 

 less glycosuric when it is ingested in its. native condition. The founda- 

 tion for this lies partly in the fact that the individual albuminous bodies are 

 drawn into decomposition at different rates. In very severe cases of diabetes 

 the differences vanish, however. Otherwise the individual diabetics act 

 differently with regard to the administration of protein. Especially severe 

 cases often react to increase of the ingestion of protein with a sugar elimina- 

 tion relatively stronger than on the administration of carbohydrates "pro- 

 tein sensitive cases." 



The question whether in human diabetes sugar can be built out of pro- 

 tein has been energetically discussed. On the clinical side it has been shown 

 that severe cases of diabetes mellitus that have been kept for months on 

 exclusively meat-fat-diets, constantly excrete so much sugar that it is hardly 

 possible to refer this to the slight carbohydrate-content of the diet and to the 

 original glycogen-content of the organism. It is further known that in 

 especially severe diabetics the excretion of sugar varies simultaneously with 

 the ingestion of protein. The question of sugar-formation out of protein 

 can to-day be answered with a "yes." On the contrary the question as to 

 what extent the normal or the diabetic organism can build sugar out of pro- 

 tein cannot be safely decided with the methods of investigations of me- 

 tabolism to-day at our disposal. We cannot in this manner make sure as to the 

 origin, as far as ingested food material is concerned, of the sugar eliminated 

 in the urine. It is very probable that the sugar also appearing in the urine 

 in slight cases does not only depend on the change in carbohydrates, but also 

 on that of the protein. Theoretical considerations that I shall not enter into 

 here, speak for the fact that from 100 gm. of protein (about 16 per cent, 

 nitrogen) not more than 80 g'm. of sugar can be formed. From i gm. of N. 

 therefore would come about 5 gm. sugar. 



The question is much more complicated by the fact that we have, too, to 

 regard fat as a sugar-former. At all events, however, the administration of 

 fat does not ordinarily increase the excretion of sugar. On these facts the 

 dietetic treatment of diabetes is for most part built. This is readily under- 



