Pathology of Diabetes.

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Whenever sugar is absorbed into the blood from whatever source, all the body cells fix as much of it as they require in the form of glycogen, the liver perhaps having power to store whatever is in excess of immediate requirements.

In order to make use of this glycogen it must be reconverted into sugar, and this, in the case of the liver, is done by means of a ferment. Now, this ferment may be the normal sugar-forming ferment of the pancreas, which, after performing its function in the intestine, is absorbed and made use of again in the tissues, perhaps undergoing some change till such times as it is wanted.

When this ferment is not present, the glycogen in the cells cannot be made use of. But sugar may be an essential requirement of these cells, and, with the power of using the fixed glycogen gone, the small normal quantity floating in the blood may be of little use to supply this requirement.

Hence a demand on all sides for sugar, resulting in increased appetite, and the conversion of proteid and anything that can be so transformed into sugar, so that the sugar percentage of the blood is raised above normal. But as soon as this occurs two things happen:

(1) There is a demand for water, producing thirst, on account of the increased density of the blood, and

(2) The kidneys begin to filter off sugar; so that, with abundance of glycogen and sugar, the tissues are starving for it, the cells striving to establish a higher sugar percentage in the blood, the kidneys always frustrating them.

This theory would explain the good effect of pancreatic extracts in diabetes; the value of morphine may be simply that it diminishes metabolism.—Brit. Med. Jour.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.