110 



Scientific Proceedings (74). 



61 (1125) 



Diabetes of maximum severity with marked improvement. 



By H. RAWLE Geyelin (by invitation). 



[From the Medical Clinic of the Presbyterian Hospital, Columbia 

 University, New York.] 



Case on whom the following interesting observations were 

 made is a man, nineteen years of age, with history of diabetes 

 of six weeks' duration accompanied by extreme loss of weight 

 (fifty pounds) and other classical symptoms of diabetes. Ad- 

 mitted to the hospital in condition bordering on coma. 



Sugar output stationary for five fasting days. Symptoms 

 slightly worse. Alternate fast and protein feedings accompanied 

 disappearance of sugar in three weeks. During this period ex- 

 hibited excessive nitrogen loss (from 25 to 38 gm. daily). Extreme 

 acidosis and a dextrose: nitrogen ratio for three consecutive days 

 of over 3.65. 



Subsequently a tolerance of 250 gm. carbohydrate was ob- 

 tained and four months after onset patient was tolerating 100 gm. 

 carbohydrate on a mixed diet of protein, fat and carbohydrate, 

 aggregating 2,500 to 3,000 calories daily. There was no acetone 

 in the urine and the blood sugar remained normal (below 0.1 

 per cent.), the percentage when patient was first sugar-free having 

 been .195 per cent., and on admission 0.312 per cent. 



Just before discharge from hospital developed a peritonsillar 

 abscess. Tolerance for carbohydrate markedly diminished in this 

 period but rapidly returned after infection had subsided. 



Points of unusual interest: 



1. Most excessive continued nitrogen waste. 



2. Highest D:N ever seen with recovery. 



3. Acute onset of diabetes of great intensity, subsequent rapid 

 development of high food tolerance with normal blood sugar. 



