George M. Guest

The Course of Juvenile Diabetes Treated with Unmeasured Diet

Prospective observations over a ten-year period of 108 juvenile diabetics treated with unmeasured diet are reported. Description is given of the patient material, circumstances at diagnosis, and course of management. Hyperglycemia and glycosuria were common, and ketoacidosis occurred often. Total plasma lipidswere elevated. Chemical control was unsatisfactory according to current popular standards. Growth was less in those with onset before puberty, and the men were underweight. Infections may have been excessive. Adolescent emotional difficulties were exaggerated. Educational, athletic, and vocational achievements probably equaled the normal expectation. Pregnancies were only 55 per cent successful when fetuses were viable. The prevalence of degenerative complication was similar to that reported from restricted diet studies. No factors were found to account for vascular disease. It is surmised that the general course of the patients compared favorably to those reported to be following diets. It is also suggested that if diet control does have favorable effects, then those reported to follow diets are not following them, or factors other than control are more influential on the progression of juvenile diabetic vascular disease.

A note on the pathogenesis of renal rickets

Summary In types of nephritis characterized by relative inability of the kidneys to excrete phosphates, there exists a considerable amount of evidence that the waste endogenous phosphates of the body which are ordinarily found in the urine may be excreted through the bowel, and that the phosphates thereby increased in the intestinal contents can interfere with the absorption of calcium by the formation of insoluble calcium phosphates which, unabsorbed, leave the body in the feces. It is suggested that long-continued partial starvation of calcium resulting from this metabolic fault is principally responsible for the condition known as renal rickets; that is, the low calcium type of rickets seen accompanying marked renal insufficiency in growing children.