270 ROLLIN" T. WOODYATT 



in animals the total heat production rises is agreed. Rubner saw an in- 

 crease of 7 per cent, Lusk of 70 per cent in phlorhizin diabetes. Falta, 

 Grote and Staehelin and Martin and Kramer saw increases of 42 per 

 cent in pancreas diabetes. Lusk holds that RuEner was correct in attribut- 

 ing this to the specific dynamic action of the increased quantity of protein 

 catabolized (Elements, p. 474). 



It is quite certain that increased metabolic rates may be found in dia- 

 betic individuals; it is equally certain that an increased metabolic rate 

 is neither an exclusive feature of diabetes nor a necessary accompaniment 

 of the disease even when it is very severe. Excessive protein catabolism 

 may occur even in uncomplicated cases of diabetes if the patient is per- 

 mitted to become sufficiently impoverished in fat and excessive protein 

 catabolism is capable of increasing. the metabolic rate. An increased basal 

 metabolic rate in a case of diabetes, if not due to high protein feeding, 

 should lead to the suspicion of fat starvation, or complications, such as 

 hyperthyroidism, infections or other factors that may lead to a "toxic" 

 breakdown of protein. It is too early at the present time to dismiss this 

 question as closed. With the general introduction of equipment for in- 

 direct calorimetry into the hospitals of this country as the result of the 

 developments of simplified apparatus by F. G. Benedict, Boothby and 

 Sandiford and others, it is certain that records of complete metabolism 

 studies in diabetes will be multiplied in the near future. On my own 

 service at the Presbyterian Hospital, using the Boothby-Sandiford de- 

 velopment of the spirometer principle and the Du Bois height weight 

 charts, a series of severe but uncomplicated cases have been, studied all 

 of which ran normal urinary nitrogens. The rates so far observed have 

 varied between -f- 2 and 18 per cent. From the Allen, Du Bois anal- 

 ysis, it would appear that acidosis is not incompatible with subnormal 

 rates nor constantly present in cases that show increased rates. 



Sources of Glucose Supply 



Carbohydrates. Carbohydrates, other than glucose, that are capable of 

 complete utilization on the larger scale in the normal body appear to be 

 completely convertible into glucose by the processes of digestion, inter- 

 mediate metabolism, or both. At least this has been found to hold virtually 

 true in the case of all carbohydrates that have been tested with sufficient 

 care. Thus in cases of severe diabetes mellitus the feeding of starch and 

 dextrin, the disaccharides fructose, maltose and lactose, the hexoses man- 

 nose, levulose and galactose, the trioses glyceric aldehyde and dihydroxy 

 acetone and probably even the 2 carbon sugar glycollic aldehyde all lead to 

 increased excretions of glucose in completely phlorhizin ized dogs when 

 the experiments have been beyond criticism. All of these form glycogen 



