732 A. S. WAETHIN 



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Functional insufficiency of the pancreas in the production of this hor- 

 mone leads to a disturbance of the carbohydrate metabolism, manifesting 

 itself in varying degrees of a lessened sugar-tolerance, eventually diabetes. 

 With this there may be associated disturbances in both fat and protein 

 metabolism. 



Pathological changes in the pancreas, particularly involving the islets, 

 occur almost constantly in human diabetes, in the great majority of cases 

 associated with a chronic pancreatitis. The relationship of these changes 

 to the etiology of diabetes is not yet evident. The most common changes 

 in the islands, regarded by many workers as specific in character, are most 

 probably end-results and not primary lesions. The primary pathology of 

 the functional inadequacy remains to be demonstrated. 



If the pluriendocrinal theory of carbohydrate metabolism be accepted, 

 the causes of diabetes must be varied. If the balance of this metabolism is 

 kept by the pancreatic inhibiting hormone and the antagonistic adrenalin, 

 influenced by the internal secretions of thyroid and hypophysis, and regu- 

 lated by the sympathetic system, morbid conditions of any part of this en- 

 docrinal apparatus must give rise to disturbances of carbohydrate metab- 

 olism leading to glycosuria or diabetes. Disease of the pancreas seems, 

 with our present knowledge, to play the chief role in producing such a 

 metabolic disturbance. Back of the pancreatic changes there may well 

 lie morbid conditions of other parts of the apparatus, particularly of 

 the sympathetic system. 



Leaving all hypotheses aside, the only reason for ascribing a special 

 endocrin function to the pancreas is the occurrence of the metabolic phe- 

 nomenon known as diabetes and the established relation between this 

 condition and loss of pancreatic tissue. All that we know positively of the 

 endocrin function of the pancreas is its highly specialized role in the 

 utilization of glucose. 



