ON DIABETIC ACIDOSIS

Abstract

The effects of the withdrawal and reestablishment of insulin therapy in 2 diabetic subjects were studied intensively by means of relatively complete electrolyte balances; it has been possible to segregate the disturbances due to extensive alteration of carbohydrate metabolism alone from those dependent upon ketogenic acidosis. The effects of insulin withdrawal on the 2 subjects, one of whom developed a ketogenic acidosis, and the other a glycosuria with minimal ketosis, were: (1) During the first 48 hrs., accompanying the initial glycosuria, and before the de-velopment of acidosis, both patients showed essentially the same response (loss of both intra- and extracellular body water, together with the constituent electrolytes) . (2) In the patient with simple glycosuria, during the days succeeding withdrawal of insulin, the water and electrolyte excretion continued at a level above that of the foreperiod, though less than during the first 48 hrs. Glucose, water and electrolyte excretion proceeded at an approximately constant rate, at this new level. (3) The other patient (T.M.) also began on his 2nd day of insulin withdrawal to decrease his water and electrolyte output. Then, however, with the progressive development of ketogenic acidosis, there occurred a 2nd rise in water and electrolyte excretion. This was qualitatively similar to that of the first 2 days. It continued progressively until terminated by restoration of insulin therapy. (4) During recovery, following readministration of insulin, the responses of both patients were the same: there was retention of intracellular and extracellular water and their constituent electrolytes; glycosuria and ketonuria subsided promptly. (5) In both patients the level of ammonia excretion remained above that of the foreperiod for 3-4 days after the termination of ketosis. (6) In both patients there appeared to be a decrease in water loss through the skin during the "acidosis" and recovery periods as compared with the foreperiod.