Francis D W Lukens

The proper use of laboratory tests in the diagnosis and management of diabetes.

A well-balanced index of suspicion of diabetes is essential to the physician in internal medicine or general practice. As one sees the kaleidoscopic range of disease, the possibility of diabetes should be rapidly, routinely and reflexly considered in dealing with persons in the following categories: all those who have diabetic relatives, the obese, and those with conditions which place a burden on the function of insulin. A suspicion should lead to investigation by laboratory tests.

Present state of knowledge concerning effects of the sulfonylurea compounds in diabetes mellitus; report of the Committee on Summarization of the Conference.

1. Peripheral Tissues. No convincing evidence has been adduced that the sulfonylurea compounds increase utilization of glucose by peripheral tissues: They do not lower the blood sugar of eviscerated dogs (Levine), rabbits (Wick) or rats (Ingle) with or without supplementary insulin; they do not increase glucose uptake or glycogen deposition by isolated rat diaphragm, or glucose uptake by rat adipose tissue, in a medium of physiologic salt solution (Krebs-Ringer) where insulin has a pronounced effect (Krahl, Cahill, Clarke: Canad. M.A.J., 1956, and Field); and they do not increase the arteriovenous blood sugar difference after glucose loading (Goldner, Volk and co-workers). 2. Liver. Studies of the effects of these substances on liver glycogen levels have given conflicting results, possibly because of differences in experimental conditions such as lack of uniformity in species, nutritional state, timing of samples, and duration and intensity of treatment. There is evidence that the sulfonylurea compounds inhibit the output of glucose from the intact liver (Anderson, Bondy), especially that derived from fructose and galactose (Renold, Craig) and possibly that resulting from stimulation by glucagon and epinephrine (Izzo; not confirmed by Fajans, Anderson, Goldner). On the other hand, in in vitro experiments with liver slices from normal fasted and fed rats, addition of these compounds to the medium did not affect glycogenolysis or glucose output (Cahill, Sutherland). The ordinarily glycogenolytic effect of glucagon and epinephrine in such slices appears to be inhibited by the drugs (Vaughan). Chronic medication of normal rats was followed by a reduction in glucose-6-phosphatase of the liver (Cahill, Haist, Kuether), but this effect was in no instance correlated temporally with the hypoglycemia. It was not observed in the livers of alloxan diabetic rats. Destruction of insulin in either the whole animal or isolated liver preparations was not significantly reduced by concentrations of the drugs sufficient to cause hypoglycemia (Vaughan, Williams).

Fluids and Electrolytes in the Therapy of Diabetic Acidosis: Panel Discussion

MODERATOR HOWARD: Dr. Osier used to say that anyone who knew syphilis knew medicine because the wide variations in the late complications required the physician to know something about nearly every field of medicine. Since late complications of syphilis are now relatively rare, I think diabetes has taken its place and the physician who tries to take care of diabetics must know something about all the medical specialties. The most serious disturbances of water and electrolyte metabolism occur in association with diabetic acidosis, and result directly from the metabolic defect of insulin deficiency. Many patients in acidosis present coincident abnormalities in other areas, such as renal disease, heart failure, septicemia and the like, which must be given due consideration in planning the course of therapy. In order to highlight the water and electrolyte problems, we have felt it wise to eliminate such complications, at least

William C, Stadie, 1886-1959.

William Christopher Stadie died on Sept. n , 1959, at the age of seventy-three. In the course of a life marked by the affection of family and friends, he was a great man, an outstanding scientist and a beloved guide to his companions in research. Because he will receive many tributes, it seems fitting that this memorial should emphasize the part he played in the growth of our knowledge of diabetes and in the combined service and leadership which he contributed as editor of this Journal and as an active participant in many activities of the American Diabetes Association.

The Natural History and Identification of Diabetes: Panel Discussion

MODERATOR MULHOLLAND: Dr. Colwell, I believe you have made the statement in a published article that diabetes is a syndrome and not a disease. Will you explain what you mean by that term? DR. COLWELL: From my viewpoint, Dr. Mulholland, diabetes mellitus is not a disease. It is a syndrome, characterized by relatively persistent hyperglycemia and glycosuria when untreated. In the majority of cases the cause cannot be determined or removed, but, like fever, hypertension, and tachycardia, for example, the syndrome can be due to a variety of causes, some of which can be determined and a few removed. Our habit of thinking of diabetes as a disease entity stems from the fact that in the ordinary case a cause cannot be assigned.