Permeability vs. tolerance of the kidneys for sugar in diabetes mellitus

Abstract

In the study of the relation of hyperglycemia to glycosuria in diabetic and non-diabetic conditions, the following facts have been elicited:

1. In diabetic individuals possessing healthy kidneys the glycosuria bears a definite relationship to the hyperglycemia. 1

2. Cases of diabetes with definite renal disease, frequently show no relationship between the hyperglycemia and the glycosuria. 2 The hyperglycemia in such individuals is usually greater in proportion to the glycosuria than it is in those with normal kidneys. Means which promote renal secretion, increase the urinary output of sugar, with a consequent reduction of the hyperglycemia.

3. Acute impairment of renal function in clinical and experimental diabetes leads to a diminution or cessation of the glycosuria with a progressive rise in the sugar content of the blood. The removal of both kidneys in animals, previously made diabetic by pancreatectomy, causes a progressive increase in the hyperglycemia. 1

4. Operative procedures in non-diabetic individuals, involving the use of anesthetics (nitrous oxid and ether) lead to the development of a hyperglycemia, and rarely a glycosuria.

5. Cases of diabetes are frequently encountered showing no evidence of renal disease, in which the glycosuria disappears spontaneously or as the result of treatment, but in which a hyperglycemia persists. The hyperglycemia may be of high degree, and show slight or no variation.

When tests to ascertain the functional activity of the kidneys are instituted on the different types of cases represented above, the following phenomena are observed:

1. In diabetic individuals in whom the glycosuria is proportionate to the hyperglycemia the response of the kidneys to the phenolsulfonephthalein test is normal.

2. That when the hyperglycemia and the glycosuria in diabetic individuals do not show any relationship (the hyperglycemia being greater than one would expect to find with a limited glycosuria) there is a delayed excretion of phenolsulfonephthalein.