86 DIABETES MELLITUS 



helps but little; digitalis, however, soon brings relief. We must not be too 

 certain that, in these complications of diabetes, glycosuria does not play a 

 part, and we should never fail to attempt to remove the glycosuria, for there 

 are cases, like the one just described, in which no result can be obtained with- 

 out this method of treatment. It should remain a rule that wherever there 

 is even a possibility that the symptom present is of a diabetic nature, the 

 attempt must be made to reduce the glycosuria. 



We are compelled, then, seriously to consider glycosuria as the cause of 

 these symptoms. Glycosuria may produce symptoms in two ways: First, by 

 the loss of sugar; of this we have already spoken and shall have to refer to 

 it again frequently; in mild diabetes the loss of sugar is not important, and 

 glycosuria as such is only to be considered as the cause of urinary fermenta- 

 tion and its consequences, such as pneumaturia, cystitis, pyelonephritis, 

 pruritus pudendorum, balanitis, vaginitis, etc. In mild diabetes it is the 

 hyperglycemia that we hold responsible for symptoms. 



As long as the diabetic excretes sugar, the sugar contents of his blood is 

 increased above the normal and there is hyperglycemia. In marked glycosuria 

 (above 1 per cent.) the hyperglycemia amounts to over 0.3 per cent, and in 

 the severe grades of glycosuria it may amount to 0.7 per cent.; if the gly- 

 cosuria is slight (i per cent, to 1 per cent.), or if the urine of the patient 

 is free from sugar, the hyperglycemia is very slight, scarcely amounting to 

 more than 0.1 per cent, (which is almost normal), and then the condition is 

 not serious. 



Diabetic hyperglycemia may certainly be held responsible for the loss of 

 resistance of the diabetic — even of the mild cases — toward infections ; at least 

 it has been experimentally proven that many of the pathogenic microbes flour- 

 ish better in the tissues which contain sugar. I shall include, besides this, 

 the cutaneous affections and the neuralgias as among the complications de- 

 pendent upon the hyperglycemia, basing my opinion upon the results of the 

 therapeutic removal of glycosuria. Removal, perhaps, implies too much; it 

 would be more correct to say reduction, for to render the hyperglycemia 

 innocuous, it is almost always sufficient to reduce the glycosuria to the limit 

 mentioned above. 



Eegarding the symptomatology and complications of diabetes, I must limit 

 myself to what has been previously mentioned. The other important symp- 

 toms not yet enumerated, for instance, coma, will be spoken of elsewhere; 

 only in regard to albuminuria I should like to add a few words. 



Alhuminuria has one significance in mild and another in severe cases; 

 in mild cases, the albuminuria is the expression of a renal affection inde- 

 pendent of the diabetes, although in some cases arteriosclerosis or hepatic 

 cirrhosis may represent a connection between these diseases and the diabetes. 

 In severe diabetes, the albuminuria may be referred directly to the diabetes; 

 it IS the consequence of the excessive functional irritation from which the 

 kidney suffers owing to the continued polyuria. 



Perhaps the abnormal constitutents of diabetic urine, possibly the sugar 

 itself, may irritate the renal elements. But this diabetic albuminuria is not 

 nephritic m origin, i.e., it does not denote nephritis; and we should err 



