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Theory of an over - Production of Sugar

diabetes, grams, urine, nitrogen, albumin and over-production

THEORY OF AN OVER - PRODUCTION OF SUGAR.

Taking the term " over-production" in a rather comprehensive sense, it is unquestionable that it enters into consideration in all acute forms of glycosuria following upon an over-ingestion of carbo hydrates. This follows immediately from the description of alimen tary glycosuria and its origin which I have given above.

We can also speak of " over-production" in those forms of glyco suria occurring in man and animals which result from the irritations and injuries of the nervous system, of which piqi2re is the type; also probably in those forms occasioned by any of the intoxications of which carbonic oxide pOisoning is the type. But in all these cases we have to do merely with an over-production of grape sugar from already existing glycogen, apparently never, however, with an abnor mally increased new formation of carbohydrates from other sub stances. We had, indeed, seen in what close relation all these forms of glycosuria stand to a repletion of the glycogen reservoirs, and how constantly they fail to be produced when there is no formed store of glycogen to draw upon.

We have undoubtedly to do with "under-consumption" and " over production" in phloridzin diabetes. In this case the sugar is not consumed but is drained away from the blood through the kidneys. In order to compensate for this loss of nutritive material by the blood, there follows an increased production from the glycogen at hand, and, when this supply is exhausted, from the albuminates.a The under-consumption is therefore the primary condition, over-pro duction being secondary. We must leave it a mooted question whether similar conditions ever play a part in human pathology.

There remains for consideration pancreatic diabetes and diabetes mellitus in the human subject. The question here is a more com plicated one and we must arrive at its solution in a roundabout way. And first we must get a clear conception of normal sugar production.

The blood draws its sugar: 1. Certainly from the carbohydrates of the food.

2. Certainly from the albumin split up in the body, in the pro portion of at least 4:i grams of sugar to every 100 grains of al bumin. In 100 grains of albumin there are 16 grains of nitro gen, and as all the nitrogen of the decomposed albumin appears in the urine, so we have 45 grams of newly formed sugar for every 16 grains of nitrogen excreted in the urine—or 2.S grams of sugar for each grain of nitrogen.

3. Possibly for every gram of nitrogen in the urine (representing 6.25 grams of albumin) more than 2.8 grams of sugar are formed.

4. Possibly also sugar is normally formed from fat (see page 41).

We have, therefore, t vvo certain and two hypothetical sources of sugar production in the body. Let us consider only the first two. It is evident that an ab»ormal, (bat is, increased, productiou of suyar is to be assumed as most certain when the olycosuPia auswePs to the fol lowiny formula : Sugar in the urine > sugar of the food (nitrogen in the urine X 2.8).

As a matter of fact the quantity of sugar in the urine in pancreatic diabetes never rises above the value expressed by the second half of this formula (Minkowski). The same is true in still greater degree in diabetes in man when the diet is poor iu carbohydrates—even in the severest forms of the disease. When, however, an individual with profuse glycosuria ingests a large amount of carbohydrates the quan tity of sugar excreted may temporarily reach the height given in the formula, but that occurs only on single days and never continues for long periods. And as only cases of long duration could serve as a basis upon which to found conclusions, we are unable to gather any thing from the metabolism of the diabetic in support of the theory of over-production.