Moxness, Karen E.

Eighteen diabetic patients representing a spectrum from hyperlabile to stable forms of this disease were investigated under metabolic ward conditions. Hyperlabile patients had the greatest daily and hourly variation in glycosuria and the most marked ketonuria. In our hyperlabile patients, multiple daily injections of short-acting insulin proved to be the only therapeutic measure that provided significant improvement in diabetic regulation when dietary and general health measures were already optimal. In more stable patients, longer acting insulin injected less frequently was found to be satisfactory therapy if careful adjustments to individual needs were made. Blood glucose and serum ketone-body and free fatty acid concentrations as well as qualitative estimates of glucose and ketone bodies in small samples of freshly voided urine were found to be suitable indicators of the immediate state of metabolic regulation. These parameters correlated with one another to a satisfactory degree, but they proved to be poorly correlated with measurements of urinary glucose and ketone bodies during periods of five to twenty-four hours. Quantitative analysis of individual blood samples or qualitative estimates of glucose or ketone bodies in freshly voided urine specimens proved to be unreliable indices of the patients' long-term metabolic compensation except in the most stable patients. Quantitations of urinary glucose and ketone bodiesin five, nine, and twenty-four-hour collections of urine, on the other hand, give satisfactory data to assess diabetic regulation, both as to accuracy of compensation and stability.

Exercise studies were performed on six intact and seven pancreatectomized, unanesthetized dogs to examine the conditions under which exercise decreases the concentration of glucose in blood. No major change in blood glucose concentration was demonstrated during exercise experiments on normoglycemic intact dogs. In the pancreatectomized dogs, the blood glucose concentration curves during exercise followed either one of two patterns: Some rose with exercise and some fell. In dogs with baseline blood glucose concentrations less than 400 mg. per 100 ml., a sustained decline in blood glucose occurred with exercise, while in those dogs with an initial level greater than 400, a rise occurred. No effect of exercise was evident in a pancreatectomized dog with blood glucose concentration near the normal range during continuous infusion of insulin. Exercise produced a decrease in blood glucose concentration in an intact dog with hyperglycemia induced by glucose infusion, but this dog's blood glucose level increased during rest periods following exercise.