544 



DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



In this experiment the injection led to an elimination of 6 gm. of sugar. The action of 

 adrenalin was therefore intensive in all respects, only the raising of the respiratory quotient 

 was wanting. 



I would here mention quite briefly the complications of diabetes mellitus. 

 In diabetes in men, impotence is one of the most frequent complications; 

 only very rarely does there occur increased sexual desire. With the former is 

 often found an atrophy of the testicles. In the diabetic women, men- 

 struation is disturbed only in the severest cases, but on the contrary, con- 

 ception is rare. In men, there is never observed a retrogression of the 

 secondary sexual characters. The deleterious influence affects therefore 

 only the generative part of the function of the sexual glands. The vulnera- 

 bility of the tissues, the falling out of the teeth, the suppurations, diabetic 

 cataract, the furunculosis, the xanthelasma, the pruritus, the rheumatoid 

 pains, the diminution of the reflexes, and the degenerations of the posterior 

 column are here merely briefly indicated. These symptoms are for the 

 most part brought into a relation of cause and effect with the constant 

 hyperglycemia, yet this explanation is for very many of the cases as yet very 

 uncertain. This is also true for the premature arteriosclerosis of the dia- 

 betic with its sequel, diabetic gangrene, which is perhaps the result of the 

 hypertonic condition we have described. 



Let us survey now the alterations of the metabolism in genuine diabetes! 

 First, I would again point out that according to investigations up to the 

 present there are demonstrable neither an increase of the protein decom- 

 position nor an increase of heat production. Why then does a severe case 

 of diabetes become thin? The basis lies apparently in the devaluation of his 

 diet through the limitation of sugar and of ketone-bodies. This is especially 

 true of the omnivorous, irrationally fed, severe diabetic. Such a person loses 

 flesh in spite of the abundant ingestion of the food because a certain part 

 of the material ingested leaves the body unused. In such an individual the 

 heat production can be raised at most by the increased work of digestion, 

 and because he must warm the large amounts of fluids of which he partakes 

 to body temperature. The polyuria conditions a slight loss of heat. This 

 is however an ectogenous raising of the heat production. In the light and the 

 moderately severe diabetic, he who can be made sugar-free very early by a 

 relatively slight restriction of the ingestion of protein and carbohydrate 

 and thus again uses his diet to its full value, there lies no basis for emaciation. 

 The severe diabetic can only be made sugar-free through great limitation of 



