CASES WITH ACUTE ONSET - COMPLICATIONS OF DIABETES.
The patients assert positively that the quantity of urine became suddenly greater at a definite period, that they were obliged to rise in the night to pass water, that they suffered from great thirst and hunger, and that, despite the large quantities of food taken, they lost flesh rapidly and failed in strength; to these symptoms were added insomnia, nervous irritability, and generalized pruritus. ally in these cases it can be ascertained that the patient had suffered from some great psychic disturbance or a bodily injury. Almost always the patients are young and the family history presents many cases of diabetes or some other constitutional disease.
The intensity of the glycosuria at the beginning in these cases furnishes no data upon which we can base a prognosis or judge of the subsequent course of the disease, but after a short time (a few weeks or months) matters usually shape themselves in such a way that we can form a pretty accurate estimate of the gravity of the case.
I. If during this interval the sugar-consuming function becomes essentially better, the case will almost always result in recovery ; at first the urine becomes sugar-free after the withdrawal of carbohy drates from the food, and later the carbohydrates are tolerated in increasing amounts until a permanent cure is effected. Schmitz de
scribes several cases of this kind, and F. A. Hoffmann had this form of the disease in mind in his characterization of neurogenous diabetes (see p. 71). The sooner the carbohydrates are withheld the better will he the prognosis. Cases of this kind are unquestionably rare.
2. If the tolerance of carbohydrates does not become materially greater after the patient has been on a suitable diet for some weeks or months, these cases progress almost without exception to a rapidly fatal termination (within one or two years), even when the glycosuria yields to a strict abstinence from carbohydrates and the nutrition is satisfactorily maintained by a plentiful supply of albumin and fat. A complicating tuberculosis or diabetic coma puts an end to the patient's existence. The other complications are of subordinate importance.