Glycosuria

“ But, in view of our ignorance of the intimate nature of even regular gout, I should myself deprecate affixing the prefix “gouty” to any glycosuria other than one that has supervened in sequence to, or alternates with, gouty arthritic seizures. Moreover, the glycosuria of gout is usually the alimentary glycosuria of fat elderly people, in whom the sugar excreted represents the unconsumed surplus of carbohydrate food. But fat elderly people are not necessarily “gouty,” neither is every so-called benign glycosuria inevitably linked on to a gouty diathesis. ”

“ Levulose, lactose, and some others are occasionally met with.
(1) Glucose (Dextrose) .—It is probable that traces of glucose, too small to respond to the ordinary tests, are present in the urine in health. Its presence in appreciable amount constitutes "glycosuria."
Transitory glycosuria is unimportant, and may occur in many conditions, as after general anesthesia and [p. 77] administration of certain drugs, in pregnancy, and following shock and head injuries. ”

“ What is the cause of the glycosuria? First: possibly it has no relation with the syphilis; secondly: it may possibly be due to a syphilitic involvement of the pancreas; thirdly: it is barely possible that it is due to syphilitic disease of the fourth ventricle or of the base of the brain, involving the pituitary region. Perhaps our case is too complex for analysis. At all events, the case brings up the possibility of a syphilitic glycosuria. ”

“ It is certainly unnecessary in gouty glycosurics to wholly banish the carbohydrates. By such a plan we are more likely to do material injury than by exceeding by a little their limits of tolerance. Our remarks of course apply strictly to alimentary glycosuria. But we should also remember that exceptionally a case of gouty glycosuria may emerge into one of true diabetes.
Albuminuria.—In the so-called “gouty” contracted kidney, if the amount of albumen in the urine be very large, or when there are symptoms of nephritis, a milk diet for a few days or a week at a time may be given. ”

“ In these cases the earthy or calcareous waters enjoy a considerable reputation, notably Contrexéville, and not a few with uric acid gravel and slight albuminuria resort to Wildungen.
I have before alluded to the beneficial effects in glycosuria of Bath waters, which, like Contrexéville and Wildungen, have an earthy or calcareous content. For the less robust and lean type of glycosuric Sir Hermann Weber recommends “simple thermal baths, such as can be obtained at many resorts of moderate elevation (Gastein, Wildbad, Buxton, Schlangenbad, and Ragatz) .” ”

“ No one surely would deny the diagnostic value of glycosuria for diabetes, because in conditions of inanition, for instance, the sugar of a diabetic may completely vanish, although the disease continues. ”

“ Does the adrenal secretion discharged in pain and strong emotional excitement play a rôle in producing glycosuria under such conditions?
In clinical literature scattered suggestions are to be found that conditions giving rise to emotional states may be the occasion also of more or less permanent glycosuria. Great grief and prolonged anxiety during a momentous crisis have been regarded as causes of individual instances of diabetes, and anger or fright has been followed by an increase in the sugar excreted by persons who already have the disease. ”

“ The pricking and irritation of this center leads to congestion of the liver and the excessive production of sugar. Irritation carried to this point through the pneumogastric nerve causes saccharine urine, and, in keeping with this, disease of the pancreas has been found in this malady. The complete removal of the pancreas, however, determines glycosuria, the organ having in health an inhibitive action on sugar production by the liver. ”

“ It may be necessary to add more albumin than the patient can actually take before glycosuria indication is reacted.... Once a medium amount of albumin is exceeded, say 70 to 80 grams, the glycosuria increases, no matter what the type of albumin is.”
My analysis also shows that the carbohydrates are not excluded from this food as claimed above.
40 PER CENT. GLUTEN BISCUIT
No analysis is supplied by the company, but this may be called properly a “40 per cent. Gluten Biscuit.” The company claims, however, that this is “Best for Diabetics,” which is not true. ”

“ Diabetes, as distinguished from transitory glycosuria, is produced by a diminution in the power of the tissues to use sugar, which thus accumulates in the blood and escapes in the urine. One great source of energy being unavailable, the tissues have to use more fats and more proteids to procure the necessary energy, and hence, unless these are supplied in very large quantities, there is a tendency to emaciation. ”

“ This fact must be considered a physiological axiom as regards the constituents of normal urine. The quantity of sugar contained can be [139] increased by a condition of alimentary glycosuria. But, when there is no such artificial cause, and yet the sugar is recognizable, without the ordinary régime of life being altered, still its presence is no symptom of a pathological process going on. Even the continuation of the insignificant excretion of sugar, when it continues for many years, appears to exercise no influence over the health. ”

“ Pavy has recently put forward some chemical theories which explain the action of the hyperæmia in producing glycosuria, but they do not account for the hyperæmia itself. In healthy digestion the carbohydrates (starch and sugar) are converted, not into glucose, but into maltose, C12H22O11, dextrin being intermediate in composition. Maltose is absorbed and assimilated, converted into glycogen. So, too, when glucose is ingested as such, it is converted by the glucose ferment into maltose in the stomach and intestines. ”

“ Obesity and Glycosuria.—Gouty individuals often become obese and show evidences of glycosuria. Consequently it is important to regulate the carbohydrates as well as the purin-bearing foods in the diet. Only the simplest foods are permissible. In acute attacks it has been found that milk and alcohol cause less disturbance than meat and alcohol. While the acute symptoms exist all meat should be avoided and the daily allowance of alcohol cut down. ”

“ Both Naunyn [8] and Hirschfeld, although mentioning instances of diabetes apparently due to an emotional experience, urge a skeptical attitude toward such statements. It is desirable, therefore, that the question of an emotional glycosuria be tested under simpler and more controllable conditions. “Emotional glycosuria” in experimental animals has indeed been referred to by Waterman and Smit [9] and more recently by Henderson and Underhill. [10] Both these references, however, are based on the work of Böhm and Hoffmann, [11] reported in 1878. ”

“ In this way the quantity of fluid injected could be accurately measured and controlled. The salt solution after passing through the long tube reached the ear at approximately body temperature. It is of the greatest importance to protect the intestinal loops in every way possible from loss of heat or from drying.
In the above experiment the intestinal glycosuria, if such a term may be applied to this phenomenon, appears under circumstances which are exactly the same as those necessary for the production of sugar in the urine by saline infusions. ”

“ We are sure that in diabetes the over-eating of starchy and sugary substances produces what is, at the beginning, an alimentary or so-called physiological glycosuria, though it is doubtful whether any glycosuria is ever absolutely physiological. ”

“ The power of storing and using sugar in the tissues is strictly limited, and varies considerably in healthy individuals. Normally, when about 200 grms. of glucose are taken at one time, some of it appears in the urine within one hour. In some individuals the taking of even 100 grms. leads to a transient glycosuria, while others can take 250 grms. or more and use it all. But even in the same healthy individual the power of using sugar varies at different times and in different conditions, muscular exercise markedly increasing the combustion. ”

“ There is no doubt that some patients have been passing sugar for a long time before any sure symptom can be noted in their general health, or, indeed, before there is anything to call attention to the possibility of glycosuria. In many of these cases, however, there is a feeling of muscular tiredness and a sense of inadequacy for occupations which were before easy, that may be attributed to neurasthenia. ”

“ The diet should be raised very gradually, and it is not well to raise the protein and carbohydrate at the same time, for it is important to know which of the two is causing the more trouble. The protein intake may perhaps be raised more rapidly than the carbohydrate, but an excess of protein is very important in causing glycosuria, and for this reason the protein intake must be watched as carefully as the carbohydrate. With adults, it is advisable to give about 1 gram of protein per kilogram of body weight, if possible; with children 1.5 to 2 grams. ”

“ In intense transverse sclerosis of the upper dorsal region I observed gastric crises, and in a second, whose lesion is of slight intensity, but probably diffused over a considerable length of the cerebro-spinal axis, there is at present pathological glycosuria. The bladder commonly shows slight impairment of expulsive as well as retaining power, the patients micturating frequently and passing the last drops of urine with difficulty. Constipation is the rule. The sexual powers are usually diminished, though rarely abolished. ”

“ I can cite a case of glycosuria in a man supervening on a severe blow on the head from a falling ledger. Brain injuries which suspend animal functions, but not the nutritive ones, such as apoplexy, concussion of the brain or curare poisoning are liable to induce diabetes. ”

“ GLYCOSURIA IN THE DOG. More common than in horses and cattle. Causes: pampered in diet, sweets, liver, disease of pituitary body, or mostly of the liver. Removal of pancreas. Brain and nervous lesions and reflex action. Symptoms: pampered asthmatic subject, with dysuria and lameness, dense, saccharine urine, bulimia, loss of weight, corneal ulcers, cataracts, palsy, coma. Duration: 4 to 8 months, sugar may disappear with complete liver degeneration. Diagnosis: by pampered condition, asthma, thirst, diuresis, later by loss of weight, troubles of vision, saccharine urine. ”

“ Furthermore, it is known that lesions of different ductless glands will produce isolated identical effects, which overlap each other in a group of symptoms, making the causal relation dubious when there is a "pluriglandular syndrome." Glycosuria (lowered tolerance for carbohydrates) may be produced by goiter, by injection of thyroid extract in acromegaly or by injection of pituitary extract, by excision of the parathyroid body, by injection of adrenalin, by excision of the pancreas or by a lesion of the islands of Langerhans in that organ. ”

“ Bain and Edgecombe, discussing gouty albuminuria, state that the magnesia water of Harrogate, in combination with the old sulphur, has a marked effect in reducing the absolute amount of albumen in the urine, e.g., from one-fourth by volume to a mere trace. They add, that if the specific gravity of the urine be low chalybeate water is indicated with, if necessary, a morning aperient draught. If glycosuria and albuminuria co-exist, the “sulphur waters may be tried tentatively” as the specific gravity does not help us in these cases. ”

“ None of these last three is found in the portal vein nor bile ducts, but all four are found in the liver cells, and in the hepatic veins.
In health a physiological balance is maintained by the oxidation of the glucose, mainly in the lungs, so that in the blood of the pulmonary veins no sugar is found. There is an exception to this observable after a full meal, rich in starch and sugar, which produces such an excess of glycogen that a portion is carried to the kidneys and expelled by them causing temporary glycosuria. ”

“ In normal pregnancy the functions of the liver in the secretion of bile and the excretion of cholesterin are not materially modified. The case is different with the glycogenic function. Blot in 1856 detected the presence of glycogen in the urine of nearly half the pregnant women examined. He concluded that this glycosuria was physiological. Tarnier in 1857 called attention to certain structural changes in the liver occurring during normal gestation. The liver is enlarged in volume, and a peculiar fatty infiltration within the lobule is perceptible. ”

“ Restricted diet is of great importance. During the siege of Paris the short rations led to the disappearance of glycosuria from many human patients.
Among medicinal agents, cholagogues come first, sulphate of soda with chloride of sodium, bicarbonate of soda, salicylate of soda, salol, nitro-muriatic acid, may be named. For the febrile condition, antipyrine, acetanilid, or phenacetin may be employed, and iodoform, ergot or codeine may be tried when other measures fail. Bitter tonics and mineral acids may be beneficial, and lastly blisters to the region of the liver may prove of service. ”

“ Dextrin, as has already been stated, is an intermediate product of the hydrolysis of starch by acid or enzymes.
Glycogen is the form in which the carbohydrates are stored in the body, just as starch is the form in which they are stored in plants. It is found in all parts of the body, but is especially abundant in the liver. Here it is stored in the cell substance rather than in the nucleus. The storage of glycogen in the human body depends largely upon the mode of life and upon the diet. Active muscular work, especially out of doors, uses up the store of glycogen with great rapidity ”