A new system of treatment of diabetes mellitus

H Chabanier, WSC Copeman - British Medical Journal, 1926 - ncbi.nlm.nih.gov
H Chabanier, WSC Copeman
British Medical Journal, 1926ncbi.nlm.nih.gov
THE following is an outline account of a method of treatment which, although not claimed as
a cure for diabetes, has been employed in over 160 cases of varying degrees of severity
with considerable success since 1923.1 If insulin be administered in large doses before the
two principal meals of the day, over unbroken periods, it has been observed that a certain
summation of effect can be obtained. That the actual basal trouble is diminished in intensity
is shown by the progressive lowering of the" ketonic threshold value" 2-the point at which …
THE following is an outline account of a method of treatment which, although not claimed as a cure for diabetes, has been employed in over 160 cases of varying degrees of severity with considerable success since 1923.1 If insulin be administered in large doses before the two principal meals of the day, over unbroken periods, it has been observed that a certain summation of effect can be obtained. That the actual basal trouble is diminished in intensity is shown by the progressive lowering of the" ketonic threshold value" 2-the point at which ketonuria appears when a patient is placed on a diet containing a known quantity of protein and fat and no carbohydrate. This value is expressed as the patient's blood sugar content at this moment, and isa direct method of expressing the initenisity of the basalfactor. at any given period. This action of insulin can be pushed to such an extent that the patient may be transformed, metabolically speak-ing, inito a normal person whilst under its influence; this condition being capable, in favourable cases, of persisting for variable periods after the cessation of injections. This experience led to the idea that treatmiient might be attempted in the form of" series" of injections, somewhat in the same way that syphilitic courses are arranged. The results which have been obtained appear to justify the adoption of this method of treatment, at any rate in a majority of cases. Advantage is, further, taken of the fact that the patient is temporarily transformed into a normal individual to in6Xrease considerably the ingestion of carbohydrate which can, under the influence of the large doses of insulin administered (80 uniits per twenty-four hours), be easily toleriated and utilized to improve the general condition and resistance of the patient. Itis found that in spite of the fact that, in certain instances, theregime is increased to almo'st normal proportions, the urine becomes sugar-free, anld the blood sugar falls to the region of the normal ina short time.
It is considered that every case of diabetes mellitus presents two essential elements:(a) a basal, or metabolic, element;(b) a renalelement. 3 The former consists in the defective power of the tissues to consume glucose in normal ratio to their blood sugar content---for quantitatively this consumption is often found to be equal to thenormal. The renal element is a phenomenon similar to tlhat observed in cases of" renal glycosuria," but with the basal element
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