Epinephrin and Insulin 



487 



Hg. In one case in which sugar had to be later administered, 

 the b.p. rose from 106/65 to 140/56. There was usually an in- 

 increase of pulse rate (8 to 12 per min.), reaching its maximum 

 35 to 40 minutes after injection. This increase was never as mark- 

 ed as when adrenalin was given to the same subject. Respiration 

 was often slightly faster after insulin. The most marked sub- 

 jective symptoms were twice noted to occur on the initial dose 

 and in a similar repeated experiment the subjective sensations 

 were minimal or absent, although the blood-sugar fell practically 

 as low as on the initial injection. The subjective symptoms were 

 of a different nature from those following the administration 

 of adrenalin: — i. e. } after insulin one noted weakness, chills or 

 sweating, dimning of sense perceptions, mental haziness and 

 wandering attention, — presumably due to the hypoglycemia. 



In the experiments with diabetics the usual dose of insulin 

 was ten units intravenously. The reaction was similar to that 

 of the controls but the effects were slower to appear and less 

 in extent, considering the dosage. The R. Q. invariably rose 

 sooner or later after insulin. The maximum rise occurred later 

 than in the case of any control at hand and it did not reach as 

 high a figure as was obtained with normal subjects. In a num- 

 ber of cases the R. Q. dropped slightly during the first half 

 hour and then went up. This usually occurred on the initial 

 dose of insulin but after a course of insulin therapy it later dis- 

 appeared. Two of those subjects reacted but little to either 

 adrenalin or insulin while two others showed marked response 

 to adrenalin and relatively little to insulin. In the case of one 

 normal subject the R. O. taken ten minutes after insulin on 

 one occasion and twenty minutes after on another showed a 

 similar early drop of quotient. That subject was very sensitive 

 to adrenalin. The extent of heat production varied. As a rule 

 it did not increase markedly and it fell to or below the basal 

 determination within two hours after insulin. The blood-sugar 

 always fell. Its lowest level was reached considerably later than 

 in the case of normal men and persisted at a low level consider- 

 ably longer. In one patient the lowest level of blood-sugar moved 

 nearer in point of time to the injection of insulin after a period 

 of clinical improvement and the sugar curve also started to rise 

 again sooner than it did on admission. 



Intravenous insulin followed from 22 to 53 minutes later by 



