VOLUME 80 DIABETES MELLITUS-MAJOR 1599
The first of these patients died after admission to the hos- persistent marked lipemia and disturbed carbohydrate
pital, but was moribund when the first injection was given, metabolism.
anid was pulseless when first seen. Our studies to date indicate that 1 unit of insulin
The second patient was a boy, aged 3, who had been in takes care of approximately 2 gm. of carbohydrate in
coma twenty hours, when the first injection was given, and the diet. The study of the urinary output has shown
who died five hours later. His blood sugar on admission to
the hospital was 344 mg. per hundred cubic centimeters, and that a polyuria of from 3,500 to 5,500 c.c. in twenty-
his carbon dioxid tension 10 per cent. by volume (Van
Slyke). Just before death, following the injection of 35 uînits - 1
of insulin in two doses, the patient's blood sugar had fallen ,O.îon ,slOs
from 344 mg. to 244 mg. per hundred cubic centimeters, and .ît.eoSr _
the carbon dioxid tension had risen slightly to 11.5 per cent. co2r
by volume. so a- 6_
The third patient was a man, aged 26, who went into coma ?7 _
at 7 a. m., Feb. 21, 1923. He had shown symptoms of diabetes 6 . 0cF _
for only two weeks, and the positive diagnosis was made two 2 - .
days before the onset of coma. He was seen on the afternoon _ _ \/
of the same day at 4 o'clock, and had been unconscious. His 56o ss 050
pulse was 140; the blood pressure, 75 systolic and 55 diastolic. 3
His blood sugar was 667 mg. per hundred cubic centimeters. z,5
He was given 25 units of insulin at 4 p. m., at 8 p. m., at __ * ,\
midnight and the following morning at 4 o'clock. At 8 a. m., 2zi [
February 22, he seemed partially conscious, and his blood sugar soo z0 zoo i
had dropped from 667 to 294 mg. per hundred cubic centime- 17 _ _ ·
ters. He was given 10 units at 8 a. m., 11 a. m. and 1 p. m., 50 15 _ _
twenty-four hours after the first dose, the patient, having 5 _ _ o c, ·_
received 130 units, was conscious and rational, talked with his 7.
family, and his blood sugar had fallen from 667 to 170 mg. 20
per hundred cubic centimeters. Improvement has been con- ,
stant since that time, and he has been free from sugar. This 2o0 ___
patient had a small area of gangrene on the right toe which r _
cleared up completely in ten days, and a larger area on the i0
sole of the left foot which healed in three weeks. This patient 5 * _ P 6) F M6
received no alkali, and in addition to receiving 130 units of Cal
insulin, was given 3,000 c.c. of physiologic sodium chlorid Fig. 7.-Fall in blood cholesterol in a patient showing a marked
solution by hyperdermoclysis. lipemia: rapid rise in carbon dioxid tension, patient semiconscious when
admitted, and kept on a constant diet.
Two patients presenting a high degree of lipemia
were studied. Figure 7, illustrates the marked fall of four hours is commonly present with an absence of
glycosuria. Such large amounts of urine, however,
Ins,lin 100 3o 5a 50- 70 3o o were coincident with high values for blood sugar,
BLOOD Fb · ; although the ratio between the two was not constant.
co0 8upr 11111. In only one patient in this series was sodium bicarbonate
| · 7o | | | , used. It had no apparent effect on the acidosis.
... /0k In two patients we have seen symptoms of collapse,
| o600 1o /\ 1 1 III V 1 II accompanied by profuse sweating and a sense of great
| o 5S \| J |^|||/ - | oppression and fear, three hours after the injection of
SO j\ /\ / 15 units of insulin. One of these patients was given
| ,50o \ \ / I III III1 20 gm. of glucose by mouth, and recovered promptly.
o20 400oo The second patient recovered quite suddenly from his
1 15 3oo I / | 1I collapse, without treatment. This attack occurred
| 250 ¢ , \ N I 1 I I1during the night, and the blood sugar the following
Io k, 200 ..m | 1 morning at 8 o'clock wvas 50 mg. per hundred cubic
1o \ 00 centimeters. Both of these patients had a hypoglycemia
s Cao when studied soon after these syimptoms, and it is
so . probable that the blood sugar was .markedly depressed
during the attacks. Our experience with these two
20 patients emphasizes that caution must be exercised in
n - -X the use of this preparation. This danger has been
1 10 1 1 I I I I l I I I I emphasized by Banting and his co-workers.
I 6~~~.. I The blood sugar determinations referred to in this
paper were carried out according to the method of
Folin and Wu, the carbon dioxid tension in the blood by
Fig. 6.-Reduction in blood sugar, with 'ncrease in carbon dioxid
tension and disappearance of glycosuria in a patient suffering from the method of Van Slyke, and the blood cholesterol by
diabetic coma. Recovery. the method of Myers and Wardell.
the blood cholesterol in a patient following treatment. SUMMARY
In the two patients with marked lipemia, the milky 1. Insulin has a specific effect in abolishing glyco-
appearance of the serum disappeared in four days, and suria, hyperglycemia and ketonuria, and in relieving the
in five patients, a cloudy serum became clear in the same cardinal symptoms of diabetes mellitus.
length of time. These observations are of especial 2. Patients treated with insulin have shown a prompt
interest as emphasizing the close relationship between rise in carbon dioxid tension.