AND DIABETES 169 



^^^th pancreatic extract was able to break down 

 sugar, but that neither was able to do so without 

 the other. It has since been abundantly proved 

 that muscle extract can break down sugar just as well 

 by itself. Von Noorden considers that the pancreatic 

 secretion is necessary to enable the tissues to build 

 up sugar (QHijOg) into the more complex glycogen 

 {CgHjoOJn, where the n may stand for a very high 

 figure ; glycogen he takes to be a necessary stage in 

 the absorption of sugar into the molecule of proto- 

 plasm. Certain it is that both in experimental and 

 human diabetes, glycogen is absent from the liver 

 and muscles in all but mild cases. 



Returning to the question of acidosis in diabetes, 

 we are now able to understand why it is so marked 

 and so fatal an occurrence. We saw that the cause of 

 acidosis was the failure of the tissues to obtain sugar. 

 Obviously severe diabetes will be a far more potent 

 factor in leading up to this condition than even 

 starvation. And indeed, of severe cases of diabetes, 

 that is, cases in which complete deprivation of 

 carbohydrate food will not abolish the glycosuria, 

 about four-fifths die in coma. Most of us have known 

 instances. It may have been a young man or woman, 

 the victim of diabetes certainly, but otherwise 

 apparently in good health, with only the fatal red 

 fringe on touching the urine with ferric chloride to 

 hold out any warning. There was a long walk, a 

 feverish cold, an anaesthetic ; or some physician too 

 suddenly instituted a severe deprivation of carbo- 

 hydrate food, and within a few hours coma had set 

 in, and death was inevitable. 



