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Scientific Proceedings (76). 



the kidneys leads to diminution or cessation of the glycosuria 

 with a "progressive" accumulation of sugar in the blood. The 

 hyperglycemia in such instances does not remain stationary, but 

 rises steadily — and often very rapidly. 



2. Surgical procedures (under anesthesia) cause a disturbance 

 in the carbohydrate metabolism, with the consequent accumu- 

 lation of sugar in the blood (hyperglycemia). A glycosuria in 

 such cases is usually absent, evidently because the function of the 

 kidneys is impaired. 



3 . Cases of diabetes which become ' 'a-glycosuric' ' spontaneously 

 or following treatment, retaining a hyperglycemia, reveal the 

 fact that disturbance of renal function has no part in the process. 

 Diminution or cessation of glycosuria through impairment of 

 renal function leads, as a rule, to a progressive increase in the 

 sugar content of the blood; but the glycosuria in these cases is 

 not "progressive." The hyperglycemia in such cases may be of 

 high degree, and remains uninfluenced by starvation. Further- 

 more, such of the cases as are relieved of their glycosuria by 

 treatment, may upon liberal administration of carbohydrate, 

 develop a glycosuria, with further increase in the hyperglycemia, 

 and show a definite relationship between the two. 



These facts are interpreted as signifying that a shifting in the 

 plane of carbohydrate metabolism may take place, in diabetes so 

 that the utilization of sugar by the tissues proceeds at a higher 

 level. Whereas there is no a priori reason to believe that the 

 utilization of sugar in the kidney differs in any way from that of 

 any other organ or tissue, it is concluded, that renal permeability 

 for sugar, is constituted of two phases: (1) a negative phase, 

 i. e., diminished permeability due to impairment of renal function; 

 and (2) a positive phase, diminished permeability due to increased 

 tolerance of the kidney for sugar. 1 



1 Tests of renal function by means of lactose, according to Schlayerand Hedinger, 

 are in progress, and the results will be reported later. 



