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Relation of Glycosuria to Intercurrent Diseases

diabetes, sugar, patient and fever


I have already had occasion to note the fact that in many cases of diabetes the urine becomes less saccharine or entirely sugar-free during the intercurrence of an acute pyretic infectious disease. This is an old experience. Typhoid fever and relapsing fever are most commonly known as glycosuria-lessening; I have observed the same result in fibrinous pneumonia and influenza. Chronic diseases ac companied by fever, pulmonary tuberculosis in particular, have less influence in causing a diminution of the glycosuria.

We cannot always count with certainty upon the occurrence of this phenomenon, individual cases reacting in various ways. The symp tom is of evil prognostic import, and as a general rule it may be said that the more marked it is the lower has the patient's strength been reduced by the intercurrent disease. Doubtless the loss of appetite and diminished ingestion of food, accompanying the acute disease, have something to do with this; but they do not explain all, for it may be observed that a diabetic, during an attack of pneumonia, will bear large quantities of farinaceous food which would inevitably in duce marked glycosuria if eaten at any other times. It is possible that the ferments produced by the specific bacteria and circulating in the blood may give a fillip to the cells, enabling them to dispose more effectually of the sugar molecule for the time being. There is a field here for further investigation, and it is possible that it may lead to discoveries of therapeutic value.

A reduced excretion of sugar accompanies the final stages of dia betes more often than it does the acute infectious diseases. It some times happens that a patient with diabetes is brought to the hospital in a state of coma; the urine contains no sugar; the patient dies, and the diagnosis of diabetes mellitus is made on pure conjecture; after ward it is learned from the statements of the relatives that the man had suffered from diabetes. Without doubt the condition of com plete inanition in which a patient with diabetic coma exists for sev eral days is the cause of the disappearance of the glycosuria. The abstinence from food brings with it a marked diminution in the decomposition of albumin and thus actively lessens the formation of sugar in the organism.

It is interesting and noteworthy that the glycosuria very often disappears in patients iu whom—whether as a consequence or not of the diabetes—grand/Lzr atrophy of the kidney has developed (Frerichs, Stocvis, Filrbringer "). The diabetes is cured, but we do not know the connection. The fact is, however, important, because the tran sition from diabetes to nephritis must be regarded as rather favora ble than otherwise.

Finally it may be recalled that sufferers from diabetes, who are at the same time subjects of the gouty diathesis, as a rule pass urine that contains no sugar during an attack of the gout—diabetes alter nails.