JOUR. A. M. A.
1598 DIABETES MELLITUS-VM AJOR JURE 2, 1923
for the earlier data in his case. Figure 2 shows the Ibefore admission he had never been sugar free except by
sanie boy, Feb. 26, 1923. At this time he weighed 30 complete starvation His condition was regarded as hopeless,
pounds (13.6 kg.) and was on a diet of 55 gm. of and it was felt that this treatment offered his-only chance
carbohydra e ( am.6 kf and 1 m of fadet of ° of recovery. The patient was placed at once on a diet of
carbohydrate, 85 gm. of protein and 100 gm o fat 36 gm. of carbohydrate, 70 gm. of protein and 68 gm. of fat,
April 15, 1923, he was in excellent condition, weighed and given insulin in doses of from 30 to 40 units a day. He
32 pounds (14.5 kg.), and was on a diet of 60 gm. of became sugar free in four days, and diacetic acid and acetone
disappeared from the urine promptly. The blood sugar fell
-mn,~l~ 20i,4042i0s0~201201 01~0.~o~o 2o ~51~~_ to normal in eight days. Improvement in his general condition
Insuli_a r was striking. The soft palate healed, all symptoms of acidosis
375~~~~.. t____disappeared, and his gain in weight and strength has been rapid
75 _ _ __ and constant. Following an increase in diet the patient again
2-60 _ had an elevation of blood sugar, which, however, rapidly
x 0 2 _ ... returned to normal. He continues aglycosuric with a normal
27s _ _. _L_ _____blood sugar, and has resumed the practice of his profession.
~0 .... _ ir_ t_ _ ___ __ A man, aged 35, whose case is charted in Figure 4,
225 _ had suffered from diabetes for one year. He was placed on a
2C____1o75 diet of carbohydrate, 20 gm., protein, 35 gm., fat, 45 gm.,
175 _ with a total caloric value of 865, and was kept on this diet
15 _ \ _- _ _ - --_---____ ___ throughout. On this diet the patient had a continued hyper-
12 _ _ glycemia and glycosuria. Following the injection of 20 units
2o. _ of insulin daily, in two doses, the patient's glycosuria disap-
40. - _ . . .. _ _ _ _ peared in four days and the blood sugar became normal in
; o-all~ II0 i - ,,~ -if 1 0 1 3 - -03030302 30
_2 _* CE. o o o o o o o o o o o o o o o o o o o o o o 0I I) I0 |
22204000 O- OOO0 0g01 iiO OiO 37:
3 p70F-- -- __ _ 4O
Cal.1070 OO1. 20
Fig. 3.-Disappearance of glyosu'ria in four days and fall of blood | 25 | |\
sugar from 400 to 100 mg. per tihundred cubic centimeters in eight days. BL 250
The dosage of insulin in units is given at the top. Acetone disappeared |1
in two days, and diacetic acid in one day. 225....
carbohydrate, O8 gm. of protein and 70 gm. of fat. 175
During a period of three months his daily dosage of I I I
insulin has been reduced from 75 units to 15 units, 12o
which we feel is indication of an increasing carbohy- o. Ja
drate tolerance. o 40
|75 S'Io| |i| || ||I Di0 00ti0 O
3850 10 111 1 1 11 1 11 3101e101710193022102232202e202
| 75|8 L lCal. 740 Cl. 10 0
1 250 1 1 1 111 1 1\ 1 1 1 1 1 1 | Fig. 5.-Disapp earaee et gtycosuria and hyperglyem3ia under treat-
IBIlIoIoIdI I r | | 1l | | | | | | meneiwithiisulin,in spitef the earled iceasoe ie diii. Thi insulin
332" figores are gisen ie units.
175 I 1 i 1 1 I seven days. Tbis patient ls der observatiol at the present
1 11 time and bas not sbown aîcy return of byperglycenmia or
125l H 25 P 61 . glycosuria.
100 , r¢
| gm L Él | l;; |t | | | In Figure 5 the undoubted effecat of this preparation
r 40 IS sown in a very striking way.
5 gas _ _ A woman, aged 40, wbose illness bad a duration of two
310 30 __ II|II years, when admitted lu the bospital was placed on a diet of
107 25 gm. of carbobydrate, 61 gm. of protein and 41 gm. of fat
c "otoe ~o o o oooo joooo o witb a total calorianc lue of glycosuria and h743. Hyperglycemia and glyco-
SOootîcto s o 1~ ° I o 1 ° 1 ° e o 1 ° 1 ° 1 °1°1 suria were present on tbis diet. Af tee renmaining on the diet
Q- f 2 3 0 35 F 45 fer ten days, tbe patient was given 36 gm. of carbobydrate,
I ~~~~~~Col. 865 1 62 gm. of protein and 90 gm. of fat, the total calorie vaine
Fig. 4.-Effec ment eie e ewith insulin, in spite of Coincid the marthed increase in diet. The in sulin
acnstan diet throughout: disappearaece et hypeegtycceeiia oed glyce- given 30 units of inoulin daily in two doses. Tbe patient's
iglycosuria disappeared n two days, and in unfive days e bts.ood
\1 ~ seven days nrma. This patient is stil under observatio at the present
Figure 3 illustrates th s i blo s \ ug time a nd hacontinues not shown a noy r etma urine an of hyperglycemia orod
x~s \ I III1- ] glycosuria.
In Figure 5 the undoubted effect of thie preparationsugar.
4O. is shown in a very striking way.
Amn, age 35 A woman, aged 40, who e illness had a durat i on of Bantingwo
Ui years, whenas admitted to the Bell Memoria Hospital onw as plaed on a diet ofvalue in
xo 25 am. of carbohydrate, 61 am. of protein and 41 am. of fat
verge of diabetie coma with a vetotryal infection, the trealmentlue of 743diabetic coma. We ave used it inglyco-
whico o o o o o o o o suria were p gangrenesent on this diet.Aftpalte.r remaining onnoth the dietof coma.
P35 · ¢5 for ten days, the patient was giveni 36 am. of carbohydrate,
cal. e65 62 am. of protein and 90 am. of fat, the total caloric value
being 1,238. Coincident with the increase, the patient was
Fig. 4l.--Effect of injections of insulin on a patient maintained on given 30 units of insulin daily in two doses. The patient's
a constant diet throughout: disappearance of hyperglycemia and glyco-
suria. glycosuria disappeared in two days, and in five days the blood
sugar was normal. This patient is still under observation,
Figure 3 illustrates the specific blood sugar lowering and continues to show a normal urine and also a normal blood
effect of the preparation. sugar.
A man, aged 35, who had had diabetes for two and one-half We are also able to confirm the statement of Banting,
years, was admitted to the Bell Memorial Hospital on the Camp>bell and Fletcher that insulin is of great value in
verge of diabetic coma with a very severe nasal infection, the treatment of diabetic coma. We have used it in
which had led to gangrene of the soft palate. For six monlths three cases of coma.