PATHOLOGICAL METABOLISM OF DIABETES 269 



sense. That many cases of severe diabetes with marked glycosuria show 

 low respiratory quotients and no increase of the basal metabolic rate is 

 sufficiently established. Accordingly in diabetes there is no question but 

 that we are dealing with glycosuria due primarily to an underconsump- 

 tion of glucose. Although this is generally recognized, there are those 

 who still maintain that this underconsumption is combined with .an over- 

 production (Magnus-Levy). 



Total Metabolism in Diabetes 



In 1913 Magnus-Levy, reviewing the work of Leo(&), Stuve, Xehr- 

 ing and Schmoll Magnus-Levy, Mohr, Pettenkoffer, Voit, Ebstein(/), Jo- 

 hannson, Du Bois and Veeder, Weintraud, Laves, Benedict and Joslin (a), 

 Falta, Grote and Staehelin, von Mering and Naunyn, concluded that mild 

 cases of diabetes which are still capable of burning a certain amount of 

 glucose do not differ essentially from the normal in respect of their total 

 heat production and gaseous exchange, but that "In severe diabetes on 

 the contrary, the oxygen consumption per kilogram is increased on the 

 average about 20 per cent." Later development by Du Bois of his height 

 weight charts for the calculation of surface area, the study of Allen and 

 Du Bois on diabetes in the Russell Sage calorimeter and the criticism 

 by Lusk of earlier interpretation of the data referred to, lead to conclusions 

 that differ from those of Magnus-Levy in respect of the degree and fre- 

 quency of elevations of the metabolism in severe diabetes. The differ- 

 ences in interpretation arise from differences in the method of calculating 

 the body surface and in the manner of selection of non-diabetic controls. 

 Benedict and Joslin interpreted their results to mean that in severe dia- 

 betes the average increase in metabolism was 10 per cent. They compared 

 emaciated diabetics with emaciated non-diabetic controls. Applying the 

 Du Bois height weight chart to the diabetics and controls of Benedict and 

 Joslin (Severe Diabetes, Table 132) Lusk(e) finds: 



Per Cent 



Average variation from normal of 20 controls 8.6 



Average variation from normal of 19 diabetics +2.0 



According to Lusk, "The increase in metabolism is therefore 2 per cent 

 above the true normal, but 11 per cent above the normal controls (emaci- 

 ated like the diabetics) selected by Benedict and Joslin." Allen and Du 

 Bois on the same basis, summarizing the 26 cases of diabetes mellitus stud- 

 ied exactly by all investigations up to that time, found that 13 showed 

 basal rates within the normal range (of -f or 10 per cent), 9 showed 

 increases of 11 to 23 per cent, 4 showed metabolisms of 14 to 19 per cent 

 below the normal. That in phlorhizin diabetes and pancreas diabetes 



