530 DIABETES 



total of oxidation that is going on. Proteicls and fats are 

 oxidized to a large extent, although the appearance of volatile 

 fatty acids in the urine in advanced diabetes may be taken to 

 indicate that the oxidation is not up to normal standards. O. 

 Baumgarten 1 has recently demonstrated that certain partly 

 oxidized carbohydrates can be oxidized completely in the tissues 

 of pancreatectomized dogs. The bodies examined were d-gluconic 

 acid, c?-saccharic acid, mucic acid, glycuronic acid, glycosamin 

 hydrochloride, succinic acid, c/-tartaric acid, salicylic aldehyde, 

 and vanillin. The relation of some of these bodies to glucose 

 is shown by the following formula? : 



CH 2 OH CH 2 OH COOH COOH 



(CHOH) 4 (CHOH) 4 (CHOH) 4 (CHOH), 



CHO COOH CHO COOH 



(d-glucose) (d-gluconic (d-glycuronic (d-saccharic 



acid) acid) acid) 



These experiments indicate that the diabetic organism can 

 oxidize sugars after a start has been made on the oxidation, and, 

 as it is unable to oxidize them before this first step has been 

 performed, it is a fair assumption that the difficulty lies with 

 the first attack on the sugar molecule. Baumgarten believes 

 that a "fermentative splitting of the sugar molecule must 

 precede oxidation of the carbohydrates, which splitting is more 

 or less incomplete in diabetes." On the other hand, we have 

 evidence that diabetics are not totally incapable of beginning 

 the oxidation of glucose, for if they receive such substances as 

 are eliminated in the urine combined with glycuronic acid (e. g., 

 camphor, chloral, naphthol, etc.), they eliminate this glycurouic 

 acid compound almost as abundantly as do normal individuals. 

 Indeed, glycuronic acid is frequently eliminated in diabetes, 

 even without the presence of the above-mentioned combining 

 bodies ; and sometimes it may be found in the urine even when, 

 through careful dieting, the excretion of sugar has ceased. As 

 ' glycuronic acid represents merely the result of the first step of 

 oxidation of glucose, as shown by the formulae given above, it- 

 would seem that the first step of sugar oxidation can be accom- 

 plished in diabetes, and that the fault lies rather with the 

 subsequent splitting of the molecule. This view does not 

 harmonize with Baumgarten's experiments, and the disagree- 

 ment has yet to be explained. In any case, however, experi- 

 menters are well agreed that the difficulty in diabetes lies in the 



1 Zeit. exp. Path. u. Ther., 1905 (2), 53. 



