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Diabetes Mellitus

sugar, glycosuria, definition, carbohydrates and urine


Definition.—By the term Diabetes Mellitus is understood a dis ease characterized by an excretion of grape sugar in the urine, con tinued through weeks, months, or years, following the ingestion of moderate amounts of carbohydrates, or even, in certain cases, when no carbohydrates have been taken into the system.

This definition calls for certain amplifications: a. The excretion of grape sugar (glycosuria) must have continued for a certain length of time to justify the nosological term " diabetes mellitus," for a temporary glycosuria of a few hours' or days' dura tion may follow any one of a number of insults to the organism, such, for example, as that from nervous irritants or from the introduction of certain poisons ; and such an evanescent excretion of sugar in the urine affords no justification for the diagnosis of diabetes mellitus. It is often difficult to draw the dividing line between this symptom atic glycosuria and true diabetes mellitus, and in such cases the dura tion of the glycosuria is of weighty diagnostic significance.

b. In order to justify the designation diabetes mellitus, the excre tion of sugar in the urine must take place after the ingestion of mod erate amounts of carbohydrates, for a glycosuria appearing after the taking of excessive quantities of carbohydrates is not a pathological symptom (see below).

c. It is better to restrict the term diabetes mellitus to those cases in which the sugar excreted is grape sugar. Isolated cases, indeed, are on record in which other forms of sugar, especially fruit sugar (levulose), have been found in the urine, but these instances are so rare and as yet so unexplained that we are obliged in practice to ignore them.

d. The definition which I have given is, strictly speaking, a very superficial one. It seizes upon only oue feature of the morbid com plex and ignores the other clinical symptoms, the polyuria, the poly dipsia, the polyphagia, the emaciation. But the definition cannot be justly criticised on this account, for all these and other clinical symptoms are of secondary importance, they are in a measure de pendent upon the glycosuria, and are often absent. A more objection would be that a definition should not rest upon the symp toms at all but should refer rather to the nature of the disease. But iu the case of diabetes mellitus we are in the difficult position that we are ignorant of the nature of the disease, and any attempt at a more exact definition would at once involve a contradiction at one point or another.

For example, I am strongly inclined to define the disease in the following formula : By the term diabetes mellitus is understood a disease in which the capacity of the organism for burning tep grape sugar is morbidly depressed. We shall, indeed, see that all the phenomena of diabetes may, without compulsion, be explained by this formula, yet I hesitate to place the definition at the head of this treatise for the reason that we have as yet no certain evidence that it exhaustively ex plains the condition actually present.