798THE CLINICAL USE OF INSULIN
be in the first 6 to 12 or 24 hours after admission, insulin has been given to check acid production without knowing how much sugar the patient will excrete in a given period of time. In such cases large doses (40 to 80 units) have been given quickly with the view to providing for the oxidation of 40 to 80 gm. of glucose in excess of any that might burn without insulin, in order to annul acid production. To insure against over-dosages of insulin under such conditions sugar has been given by stomach prior to the administration of the insulin, and thereafter in quantity sufficient to provide all of the insulin given with enough glucose to act upon without making any allowance for the glucose that might arise from the diet and endogenous sources. Thus, if a single dose of 60 units of insulin were calculated to throw into oxidation 60 to 90 gm. of glucose in 10 hours, or on the average 6.0 to 9.0 gm. per hour, then at least that quantity of sugar has been given hourly to insure against the possibility that the glycosuria was on the decline when the insulin was given and would fade out rapidly thereafter, leaving the patient with not enough glucose to counteract the insulin given. This procedure has been used only as a temporary emergency measure. It may be superfluous to mention that diabetic patients in acid poisoning who have received no insulin not infrequently before death pass urine free of sugar and acetone bodies (provided no infection complicates the case) simply as the result of the limitation of the intake of food occasioned by the general condition. To give insulin to a patient naturally approaching this juncture and without giving sugar might lead to serious insulin poisoning. With cases in which as a result of infectious complications the overproduction of acid tends to continue in spite of diet restrictions, insulin has made it possible to stop acid production and thus avoid the continued use of alkali, besides permitting of adequate nutrition. This has proved of very great value and especially in complicated cases.
Diagnostic Use of Insulin: Certain cases of the general order of those that are called renal glycosuria have been treated with insulin. A certain case shows steadily 2 to 3 gm. of glucose in the urine on a diet with a glucose value of 100 gm. On a diet with a glucose value of 200 gm. he passes on the average 4 to 6 gm. of sugar in the urine. With the dietary G equal to 400 he passes 8 to 10 gm. He has few of the ordinary symptoms of diabetes, the sugar having been discovered during an insurance examination. The blood sugar percentage ranges between 0.1 and 0.12.