RELATION OF GLYCOSURIA TO MUSCULAR EXERCISE.
As a general rule the effect of muscular exercise is to reduce the glycosuria, the dietary condition remaining unchanged (Zimmer, Kill; von Mering). Among the exercises of this nature are walking, mountain-climbing, wheel-turning, work at the ergostat, etc. This fact is readily understood, if we remember that in health the mus cles supply their needs of heat and force production by means of car bohydrates, and that muscular activity increases greatly the con sumption of this fuel. A portion of the grape sugar which would otherwise have escaped in the urine is taken up by the muscles. Finkler has observed that massage of the muscles acts iu the same way as active exercise.
A decrease in the glycosuria is not always, however, brought about by muscular exercise. Iiiilz has noted exceptions to this rule, even the opposite effect. If, in a given case, glycosuria increases in consequence of work it may be assumed that it is the result of an unusual fatigue felt by the patient during or after his exercise. In
such a case, the extra demand is evidently met by the consumption of other substances, probably albumin, and the increased destruction of albumin in turn leads to an augmented sugar excretion. Whether other influences, possibly reflex nervous irritation, also take part in paralyzing the sugar-consuming function, cannot be safely predicted.
A diminution in the glycosuria following muscular labor is usually observed in recent cases, in which the nutrition is still well sus taMed ; an increase of the process from the same cause is seen in old cases and in greatly emaciated individuals.
intellectual strain,• has been followed by a series of sleepless nights, or in which an irritation of the nervous system through bodily pain has resulted in a marked and permanent depression of the tolerance for carbohydrates. Observations of this sort may be made in every form of diabetes, whatever its cause may be and whatever its degree of mildness or severity.