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404 THE LIVER.
mucic acid, and others, and he found that diabetics destroyed or burned
these bodies to the same extent as healthy individuals. Besides this
it must be remarked that the two varieties of sugar, glucose and fructose,
which are oxidized with the same readiness, act differently in diabetics.
According to Rulz and other investigators fructose is, contrary to
glucose, utilized to a great extent in the organism, but this in man is,
not always the case or at least to a less extent than in certain animals.
In animals with pancreas diabetes (see below) fructose x
may cause
a deposition of glycogen in the liver while with glucose this does not
occur. The combustion of protein and fat takes place as in healthy
subjects, and the fat is completely burned into carbon dioxide and water.
In this diabetes the ability of the cells to utilize the glucose suffers diminu-
tion, and the explanation of this has been sought in the fact that the glu-
cose is not previously split before combustion.
,
c°2
The variation in the respiratory quotient, i.e., the relation ——, seems
to show an insufficiency of the glucose combustion in the tissues in
diabetes. As will be thoroughly explained in a subsequent chapter, this
quotient is greater the more carbohydrates are burned in the body, and
it is correspondingly smaller when protein and fat are chiefly burned.
The investigations of Leo, Hanriot, Weintraud and Laves,2
and
others have shown that in severe cases of diabetes, in the starving con-
dition, the low quotient is not raised after partaking of glucose, as in
healthy individuals, but that it is raised after feeding fructose, which is
also of value to diabetics.
The poverty of the organs and tissues of diabetics in glycogen indicates
that the glycogen in them is more abundantly transformed into sugar.
From what has been said above in regard to the different behavior of
fructose and glucose in the glycogen formation in diabetes, indicates that
in diabetes, also an inability of the body to transform glucose into glycogen
exists and that the lack of glycogen may come about in this way.
Indeed it has been suggested that a preliminary transformation of
glucose into glycogen is necessarybefore it can be burned in the animal body.
This assumption is without foundation, at least for the glycogen for-
mation in the liver, as the animal body as is shown with experiments
on dogs, can assimilate and burn considerable quantities of carbohy-
drates even after the liver is excluded (Wehrle, Verzar 3
) . The admitted
1
Kiilz, Beitrage zur Path. u. Therap. des Diabetes mellitus (Marburg, 1874), 1;
Weintraud and Laves, Zeitsehr. f. physiol. Chem., 19; Haycraft, ibid.; Minkowski,
Arch. f. exp. Path. u. Pharm., 31.
2
See v. Noorden, Die Zuckerkrankheit, 3. Aufl., 1901.
3
Wehrle, Bioch. Zeitsehr., 34; Verzar, ibid., 34.
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