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802 URINE.
Sugar in Urine.
The occurrence of traces of glucose in the urine of perfectly healthy
persons has been, as above stated (page 749), quite positively proven. If
sugar appears in the urine in constant and especially in large quantities,
it must be considered as an abnormal constituent. In a previous chapter
several of the principal causes of glycosuria in man and animals were men-
tioned, and the reader is referred to Chapters VII and VIII for the essen-
tial facts in regard to the appearance of sugar in the urine.
In man the appearance of glucose in the urine has been observed
under various pathological conditions, such as lesions of the brain and
especially of the medulla oblongata, abnormal circulation in the abdomen,
diseases of the heart, lungs and liver, cholera, and many other diseases.
The continued presence of sugar in human urine, sometimes in very con-
siderable quantities, occurs in diabetes mellitus. In this disease there
may be elimination of 1 kilogram or even more of glucose per day.
In the beginning of the disease, when the quantity of sugar is still very
small, the urine often does not appear abnormal. In the more developed,
typical cases the quantity of urine voided increases considerably, to
3-6-10 liters per day. The percentage of the physiological constituents
is as a rule very low, while their absolute daily quantity is increased.
The urine is pale, but of a high specific gravity, 1.030-1.040 or even higher.
The high specific gravity depends upon the quantity of sugar present,
which varies in different cases, but may reach 10 per cent. The urine is
therefore characterized in typical cases of diabetes by the very large
quantity voided, by the pale color and high specific gravity, and by its
containing sugar.
That the urine after the introduction into the system of certain medici-
nal agents or poisonous bodies contains reducing substances, conjugated
glucuronic acids, which may be mistaken for sugar, has already been men-
tioned.
Glucose in urine. The properties and reactions of this sugar have been
considered in a previous chapter, and it remains but to mention the methods
for the detection and quantitative determination of glucose in the urine.
The detection of sugar in the urine is ordinarily, in the presence of not
too small quantities, a very simple task. The presence of only very small
quantities may make its detection sometimes very difficult and laborious.
A urine containing proteid must first have the proteid removed by coagu-
lation with acetic acid and heat before it can be tested for sugar.
The tests which are most frequently employed and are especially
recommended are as follows:
Trommer’s Test. In a typical diabetic urine or one rich in sugar this
test succeeds well, and it may be performed in the manner suggested on
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