53 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



investigations of Wcintraud. In a series of severe cases, I have investigated 

 the nitrogen elimination of the " hunger" day and found values that do not 

 differ from those furnished by normal individuals under like conditions. The 

 severe diabetic, he who rationally fed, remains constantly on a diet rather 

 poor in protein, can indeed enter upon a striking low protein need, and shows, 

 when abundant protein is now administered, a striking tendency to reten- 

 tion of nitrogen. Only in the severest cases, before the fatal coma, does the 

 melting down of protein seem to raise to a high degree. 



Benedict and Joslin calculate the nitrogen elimination per kilogram of 

 body weight in their fasting-experiments, and find that the average of all in 

 these experiments is higher than in normal individuals; yet much might be 

 said in objection to the calculation per kilogram of body weight, as the rela- 

 tion between protoplasm and body-mass becomes disarranged in severe dia- 

 betics on account of the extreme poverty in fat. 



In the severest cases also the high elimination of endogenous uric acid 

 indicates a marked melting-down of muscle albumin (v. Noorden). 



The qualitative alterations of the protein metabolism are, apart from the 

 high ammonia values dependent on the becoming acid, not appreciable. 



We shall here say only a few words about the ketonuria of diabetics. The 

 ketone bodies originate k from the change in protein and fat substance on 

 diminished carbohydrate combustion. The cause of this origination should 

 not be otherwise than in a normal man when he has been fasting or has eaten 

 meat and fat exclusively. Also in this case they are due to the lack of 

 assimilation of carbohydrates. That in the diabetic such considerably 

 high degrees are attained is comprehensible because in him is absent also the 

 sugar originating from the protein, and because they develop so very gradu- 

 ally. If the ketonuria lasts longer and attains higher grades, it gives rise to 

 lipoidemia and to fattening of the liver. In the most severe grades of lip- 

 oidemia the blood may assume a light rose-red color and on standing may 

 express a cream-like dense layer to the surface. 



The alterations in the salt metabolism to be observed in diabetics are 

 associated in part with the formation or the elimination of ketone bodies. 

 Through the formation of large amounts of the ketone acids, alkalies are 

 withdrawn from the body, and as is known, later the alkalescence of the 

 blood sinks and then the calcium equilibrium is minus (Gerhardt and W. 

 Schlesinger) . 



The equilibrium of water in diabetics often shows significant variations 

 on alterations of the diet. If diabetics who formerly had fed without 

 purpose are placed on a diet poor in carbohydrates and protein, they often 

 gain in weight in a short time. It is very probable that this depends not so 

 much on the filling up of the fat deposits and partly also of the glycogen 

 deposits, but much more on the retention of water. In more fully advanced 

 cases the water-contents of the tissues is much reduced. Rumpf found the 



