ELLIOTT P. JOSLIN, HORACE GRAY AND HOWARD F. ROOT 661
Case No. 2979, 3 years old, came out of threatening coma with diet and
insulin with unusual readiness, and Mrs. H., Case No. 2972, 68 years of
age with 524 units of insulin used in 54 days, gained from 69.5 pounds to
79 pounds. At both extremes of life unusual conditions may prevent such
favorable results; thus, Olive O., Case No. 2815, who developed diabetes
in September, 1922, at the age of 2 years, 10 months, but was kept sugar-
free only intermittently until entrance to hospital on January 5, 1923, was
not rendered sugar-free with 238 units of insulin. At present she has
developed an acute respiratory infection and though the diet is carbo-
hydrate 36 grams, protein 40 grams, fat 58 grams, she does not keep sugar-
free with 16 units daily. The little girl has been much disturbed with the
injections and the nervous element may be a part. The present infection
is a most unfortunate complication. Likewise, at the other end of life,
Mr. S., Case No. 2626, who developed diabetes at the age of 61 years,
came for treatment with a septic foot on May 2, 1922, but eventually
recovered under the surgical care of Dr. R. C. Cochrane. He began
insulin January 3, 1923, and at present has 20 units daily. With the addi-
; tion of 12 grams of carbohydrate to his diet, the quantity of sugar in the
urine has not increased, but it did not decrease, (though today, January 31,
we learn that the glycosuria which had been 0.2 per cent. has disappeared
for the first time in nine years). This recently favorable course leads us
to be cautious before being doubtful of the good effect of insulin on this
patient or at his age. A somewhat similar case is that of Mrs. M., Case No.
2980, whose leg was amputated for gangrene. Insulin appeared to help
in the emergency, but the 30 units daily were omitted 8 days after the
operation and during the 10 days following she gradually became sugar-
free without it and has been able to increase her carbohydrate since. Still
another patient, Mrs. L., Case No. 2908, seen in consultation was found
to be taking 30 units of insulin daily. With this patient the insulin did
not appear to have any advantageous effect because the sugar in the urine
did not markedly increase when the insulin was omitted. The glycosuria
yielded to diet though she did not become actually sugar-free until the
carbohydrate was reduced to 35 grams.
Insulin, therefore, can act favorably with both extremes of life,
but does not necessarily act favorably, and whether heroic doses
will bring about favorable results must be left in abeyance so far
as this clinic is able to report.
The age of the cases treated with insulin is recorded by decades
In Table 2. Since many of these cases have been under observa-
tion for a short period or have been treated simply for emer-
gencies in a temporary fashion the numnber of cases available for
statistics is reduced. The table shows both the gain in weight
and gain in per cent. body weight per patient and the average
number of days required to secure with these patients a gain of
one pound. It will be observed that the gross gains in weight are
quite evenly distributed between the different decades, but that
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