Glycosuria may be combined with obesity in such a way that the patient's organism has lost only some of its power to burn up sugar, while the synthesis of the carbohydrates into fat is still effected. Under such circumstances, with the plentiful nutrition to which these patients are particularly inclined, obesity is sure to develop. Such patients are diabetic, but they do not always excrete the sugar by way of the urine, or do so only in a minor degree, the carbohydrates being transformed into fat and the obesity masks the diabetes—dia betogeuous obesity. But in most cases of diabetes associated with corpulence, lipogenous diabetes, not only is the combustion of carbo hydrates greatly restricted, but also their transformation into fat, which in ordinary cases of diabetes is nearly as much impaired, has suffered some diminution.
Glycosuria may occur spontaneously or may be hereditary like obesity. A special predisposition to either of these diseases seems to be also peculiar to some nations and races, e.y., the Jews.
Seegen first called attention to the frequent occurrence of diabetes mellitus iu obesity. Among his 140 cases were 52 in which the gly cosuria was preceded by obesity. Pfeiffer places the percentage of obesity as high as 33, while Kisch states that in cases of extensive hereditary obesity more than half become affected with diabetes mel litus, as opposed to about fifteen per cent. in the acquired forms. In cases of hereditary tendency the diabetes may occur without obesity or supervene after the development of the latter, while other cases be come phthisical, or, after the patients have in earlier life presented symptoms of beginning phthisis, they become later on rapidly and extremely obese and finally succumb to diabetes.
The age at which diabetes develops is between thirty and forty years, though the disease is also frequent beyond the fortieth year.
The first symptoms by which the development of diabetes is manifested are apparently favorable to the patient, since he gradu ally becomes thinner, his inconveniences diminish without loss of appetite, while the thirst and the excretion of urine increase notice ably. The emaciation progresses steadily, independently of any thing done by the patient. The ingestion of food is still plentiful and the muscular activity the same as that under which the corpu lence developed. Therefore, when a corpulent person loses weight steadily though slowly, and this fact is not explained by a change in the diet directed toward the reduction of the obesity or by increased muscular labor, the indication is urgent to examine the urine, in which sugar in greater or less amount can nearly always be demonstrated.
The appetite then gradually lessens, the nutrition suffers, losses of albumin and fat ensue, thirst increases, more and more fluids are consumed, chiefly water, and large quantities of clear, light-colored urine of high specific gravity are passed. The diabetes has become fully developed_ and can no longer be mistaken.
The course and termination of the disease vary greatly. When the presence of sugar in the urine is chiefly due to the excessive in gestion of carbohydrates (the milder form) the glycosuria may dis appear if a strict antidiabetic diet is maintained. Thus I had under treatment a female corpulent patient in whom glycosuria occurred every February, when she consumed large quantities of honey, per sisted several months, and again disappeared in July or August under strict diet. Cantani ascribes the frequent occurrence of diabetes in Italy to the preference of the inhabitants for farinaceous and sweet dishes. In other cases the diabetes induced by unsuitable nutrition persists for a longer time, increases in intensity, and while it finally improves more or less under strict dietetic treatment it never disap pears completely.
Hereditary diabetes is less influenced by treatment and runs a more rapid and serious course.
The termination of the diabetes of the corpulent is the same as that of the form occurring under other circumstances : simple maras mus, pulmonary phthisis, general furunculosis and the formation of carbuncles, nephritis, more rarely diabetic coma. The ordinary termination of obesity by cerebral hemorrhage, paralysis of the heart, and dropsy may also end the disease.
mention must be made of a complication observed in obesity which is frequently recorded in the older literature, namely, carcinosis.
The symptoms, course, and termination depend upon the impor tance of the organ attacked by the carcinomatous process, upon the variety of the malignant new formation, and the prevailing resistant power of the organism by which the occurrence of cachexia is kept in abeyance for a longer or shorter time.