Pathological Metabolism of Diabetes 



Mellitus 



ROLLIN T. WOODYATT 



CHICAGO 



Introduction 



Diabetes is a condition. The diabetic patient is an individual. An 

 individual with diabetes may be of either sex, any age, probably of any 

 race, and he may have any grade of diabetes from the most complete 

 known to a grade so slight that it is not certainly distinguishable from the 

 normal. An individual by virtue of his diabetes is not thereby protected 

 from the deleterious effects of physical or chemical forces, nor is he im- 

 mune so far as we know to any type of infection, nor is diabetes necessarily 

 incompatible with the development of new growths or the coexistence of 

 other anomalies of the metabolism such as exophthalmic goiter, gout, 

 obesity, acromegaly, Addison's disease, etc. On the contrary, diabetics 

 in general are a group in which other diseases abound. The subject of 

 diabetic individuals is as broad as medicine. Only diabetes itself the 

 condition lends itself to special discussion. These platitudes may be 

 forgiven in view of the manifest confusion that is created in the litera- 

 ture by a rather widespread tendency to describe under the heading dia- 

 betes many disease conditions and metabolic disturbances in which the dia- 

 betes itself is not pure or in which indeed it may not even be the most im- 

 portant factor, or in which the diabetic anomaly is given a peculiar ex- 

 pression because of some complication. Thus an inherently mild case of 

 liabetes in the throes of a passing epidemic infection may be classified 

 is a case of ultra severe diabetes and the resultant anomalies of the metab- 

 >lism due partly to diabetes and partly to the infection may be attributed 

 iply to the former. It is not always possible to distinguish between 

 "pure" diabetes and complicated diabetes since the etiology of the disease 

 is obscure. Yet in studying the anomaly of the metabolism, a selection 

 >f stationary and apparently uncomplicated cases will form the solidest 

 isis for departures. 1 



1 In penning the following pages the attempt has been made to adhere as closely as 

 >ssible to the discussion of anomalies of the metabolism that characterize such cases. 



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