One of the most common complications of diabetes mellitus is an albuminuria, doubtles?.: in most instances secondary to the action of a urine rendered irritant by the presence of -sugar upon the renal structures. In 1300 diabetics in whose urine the eondition was sought for, S24 were also subjects of an albuminuria.
- In a large number of these eases the cause of thc albuminuria is probably the excessive amount of eggs consumed in the diabetic diet, while in others the albuminuria is symptomatic of some complication, as tuberculosis, cardiac disease, renal inflammation, or a cystitis or pyelitis, depending upon the irritating nature of the sugary urine. Schmitz (Berliner klin. INroch., Apr. 13, '91).
ln pancreatic diabetes albutninuria is quite exceptional; in traumatic diabetes it is a little more frequent; albuminuria is by far most frequently met with in diabetes with obesity. In grave form of albuminuria of diabetes well-marked nephritis is always found at autopsy; in the benign form but slight nephritic changes are sometimes found; more rarely no changes are detected in the kidneys. Replacement of.sugar by albu min is always an extremely grave sign, but the case may not immediately termi nate fatally. Jacobson (Gaz. des Hop., Aug. 25, '94).
The frequency of albuminuria in dia betes is variable and may- occur in two forms: functional and that due to grave nephritic disease. In the first form it may be extremely slight, or else may constitute a very marked feature in the ease. Goudart (Jour. de Med., Aug. 25, '97).
Owing to the polyuria, urea is nat urally only present in the urine in a very small proportion, but the daily quantity of this substance is increased. Its relation to the total of nitrogen is not noticeably altered, except in grave cases of diabetes, in which the propor tion of ammoniacal salts is, as is well known, greatly increased, in order to overcome the acid dyscrasia.
In serious cases the excretion of lime is also increased. Thirst is usually, but not always, predominant. Hunger is much less frequent, and a great many diabetic patients do not eat any more than a healthy person. Constipation is the rule, being either due solely to the impoverishment of the system with re gard to water, or to an exaggerated tonus of the splanchnic nerve. It may be stated, in support of the latter hy pothesis, that this symptom frequently precedes the appearance of the diabetes.
The saliva is more abundant. Ex ceptionally it has been found to con taiu sugar and sometimes lactic acid.
The skin is dry and perspiration is rarely modified from the normal. The blood contains a variable proportion of glucose, usually more than 3 grammes per litre, and quite frequently from 4 to 5 grammes. In exceptional cases, when the kidneys have undergone altera tion, the proportion may be greater.
[I have recently seen a case in which there were more than 10 grammes of sugar per litre. R. LI,:PINE.
There is no close relation between the percentage of sugar in the blood and urine. That more sugar is excreted by the urine on certain days than on others does not depend on the fact that the amount in the blood has reached a cer tain quantity, but on other complex conditions. The administration of a diuretic diminishes byperglycmnia and retards the decrease of glycosuria. Le pine (Lyon Med., July 21, '95).
When treated by certain aniline colors, the red globules (as found by Bremer) take on a different color in diabetic pa tients from that assumed in other pa tients or in healthy subjects.
The pulse is full, but of normal fre quency, except in the case of complica tions, when it may be rapid.
The majority of diabetics excrete more nitrogen than healthy persons of the same weight. This results from the fact that the sugar not being completely utilized, they must necessarily consume more albuminoid matter (and fatty stances), as has been proved by com parative experiments made upon a dia betic patient and a healthy subject.
[Pettenkofcr and Voit formerly be lieved that diabetics absorbed less oxy gen and excreted less carbonic acid than healthy subjects. Later on Voit formu lated certain reservations upon this sub ject, and T.eo, in an important article, affirmed that. with an equal weight in the diabetic and the healthy person, the respiratory exchanges are the same. This opinion has again been contradicted. R. LtPINE.] Twenty experiments upon 5 diabetics, two having a grave form of the disease, which prove that the absoiption of oxy gen and the exhalation of carbonic acid are not diminished in diabetics, if tbeir weight is considered. The following are the figures obtained by causing the pa tients to breathe for several minutes into the apparatus of Zuntz and Gep pert, the volume of gas being calculated by minutes and the kilogrammes by weight Hanriot, Weintraub and Laver, Eb stein, and others positively assert that, when subjected to the same regime dia betics exhale less carbonic acid than healthy persons.