■ GLYCOSURIA AND DIABETES 79 



this reason that sugar is excreted by the kidneys. But the organs whose 

 function it is to burn sugar cannot take up from the blood and consume an 

 unlimited amount of sugar, even if they and all the other organs are per- 

 fectly sound and function normally. It is true that a flooding of the blood 

 with sugar can hardly occur in health through the ingestion of starches, even 

 in the largest amounts, as these are absorbed too slowly, but it may readily 

 occur after ingestion of large quantities of readily absorbable sugar solu- 

 tions. That alimentary glycosuria (e saccharo) may be explained in this 

 manner is evident from the fact that in most of these cases the sugar 

 (for example, milk-sugar or levulose) is excreted in the Sams' form in which 

 it is introduced. This explanation is also favored by the circumstance that 

 alimentary glycosuria occurs more readily when the stomach is empty, for, as 

 is well known, absorption is then more rapid. This pathologic but non- 

 diabetic alimentary glycosuria (e saccharo) is 'probably due, therefore, to an 

 abnormally hastened absorption of the sugar solution. 



Finally, non-diabetic glycosuria, i. e., glycosuria despite a normal condi- 

 tion of the sugar-consuming organs, may occur when the renal secretion has 

 become so increased that sugar and other solids are drawn out of the 

 blood in abnormally large quantities and excreted with the urine. Perhaps 

 it may be possible to explain in this way the fact that, after the ingestion of 

 much beer or champagne, sugar (even several per cent.) is occasionally found 

 in the urine. 



It is possible, however, that in these " beer glycosurias " the damaging 

 influence of the alcoholic beverage upon the liver is also a factor; the possi- 

 bility is obvious enough, since, in cirrhosis of the liver, alimentary glycosuria 

 is frequent. In these cases we are then concerned with diabetic glycosuria, 

 i. e., with the complication of cirrhosis of the liver and diabetes mellitus. 



This example shows how difficult it is to separate alimentary glycosuria 

 from the diabetic form, and there are many other illustrations of this diffi- 

 culty. Thus, in traumatic neuroses true diabetes may occur. On the other 

 hand, alimentary glycosuria (e saccharo) is a particularly frequent symptom 

 in traumatic neuroses. And one cannot look upon this sign, in all cases, 

 as indicating diabetes — at any rate in the overwhelming majority of cases 

 such a condition does not arise. In exophthalmic goiter the same state of 

 affairs exists. Taken all in all, in every alimentary glycosuria, including the 

 "e saccharo" variety, it is necessary to observe great caution in deciding 

 whether this is a sign of diabetes or not. Alimentary glycosuria following 

 the ingestion of starch must always be looked upon as a sign of true diabetes. 



"Experimental" glycosuria in the human being does not play a great 

 role, although it occasionally occurs — for example, glycosuria after poison- 

 ing with coal gas, or with phloridzin for purposes of malingering. These 

 conditions must be understood in order to recognize that they are not cases 

 of diabetes. 



In all cases of spontaneous glycosuria (non-alimentary) the greatest care 

 is necessary before deciding whether they are to be looked upon as signs of 

 diabetes or not. We must be sure that pentose or glycuronic acid in the urine 

 is not mistaken for glycosuria; when lactosuria occurs in pregnancy or in 



