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Function - Complications of Diabetes

carbohydrates, gland, obtained, results, glycosuria and withdrawal

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It was shown in the preceding section that the removal of the causes leading to diabetes can seldom be attempted with hope of suc cess. If these attempts are not successful, whether because the cause is out of the reach of our therapeutic measures, or because the dia betic changes have become independent of the cause, or finally be cause, as is usually the case, the cause is unknown, the question arises whether we possess any means of increasing the sugar-destroy ing energy of the organism. In this direction, indeed, we are not altogether powerless.

1. with Pancreas Preparations."—I begin with the con sideration of this form of treatment, in spite of the fact that its prac tical results have been very insignificant, for the theoretical interest which it has aroused is great and increasing. It is based upon the assumption that the pancreas furnishes by its internal secretion a material necessary to the function of normal sugar consumption (see p. 53). We may recall in this connection what is seen in the case of myxoedenia ; here there is a defect in a gland (the thyroid) as regards its internal secretion, with serious results to the organism; and ap parently brilliant effects are obtained by the administration of the juice or extract or of the substance itself of the thyroid gland. What then was more probable than that similar results should be obtained in diabetes? This was a question that could be determined only by experiment, for it might well be that the active material is formed only at the moment of its secretion and is not to be found in the gland itself.

The experiments thus far made have been partly with raw pan creas mixed with the food, and partly with aqueous, alcoholic, or glycerin extracts of the gland administered by the mouth or subcuta neously. The results have not been satisfactory; no actual cures have yet been obtained, but some instances of temporary improve ment have been reported by individual writers; they are not sufficient, however, to warrant a belief in the future of the method. I can only

agree with Farbringer, Leyden, and Golciseheider iu withholding judgment for the present. The method is nevertheless worth further trial, and should be employed especially iu those cases in which there is good cause for regarding the pancreas as the seat of the disease.

2. Treatment by the Trithdpalual of Carbohydrates.—We have seen. that reducing the supply of carbohydrates causes a diminution of the glycosuria. In some cases complete abstinence, in others a greater or less reduction of the amount of carbohydrates ingested is necessary in order to arrest the glycosuria; in other cases again the condition persists in a slight degree in spite of the total withdrawal of saccha rine and starchy foods. But it is, in any case, a mere concealment, as it were, of the diabetes; if carbohydrates were taken again the glycosuria would reappear in all its former intensity.

The important discovery has, however, been made that something more than this is obtained by the diminution or total withdrawal of carbohydrates. Individuals who have been for a certain time (several weeks) on a diet containing no saccharine or starchy ingredients often acquire a tolerance of carbohydrates, and excrete much less sugar after the ingestion of a certain quantity of anaylaceous food than they did before. This fact has been especially emphasized by Naunyn, who says that the sugar-consuming function of the body is spared by the temporary withdrawal of carbohydrates and is thus given an opportunity for recovery and restoration of strength. Naunyn," as well as his pupil Weintrata cmifirms this teaching by such convincing examples that all doubt is silenced. In severe cases of glycosuria the success of measures directed toward an increase of tolerance is very slight and evanescent, in those of moderate severity it is better, and in mild cases it is often excellent, most evident, and lasting. After having thus explained the principle upon which this method is based, we shall see later how we can best avail ourselves of it in practice.

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