I n previous experiments (G6th, Lengyel, SBvely, 1955) we demonstrated eosinopenia and increased urinary adrenocortical steroid excretion in cases of diabetes mellitus with excessive fluctuations in the blood sugar levels. I n well controlled cases with compensated metabolism the number of circulating eosinophils and the steroid excretion was found to be normal. Later we obtained similar results with plasma steroid determinations (G6th & co-workers, 1957). I n expcriments with rats we showed that insulin or glucose alone induced eosinopenia; but the combination of insulin with glucose so as to produce no change of blood sugar level, produced no eosinopenia. More recently Abelin and Pfister found adrenal ascorbic acid depletion due to glucose. Proesch found increased urinary steroid excretion in insulin hypoglycemia. These findings and others indicate that the adrenal cortex is stimulated by fluctuations of the blood sugar level. When the toxic effect of cortisone and similar substances on blood vessels is considered (Friedenwald; BretLn, Oblatt, R6na and KerBnyi; Bloodworth and Hamwi) one wonders whether the angiopathy (nephropathy and retinal changes) of poorly controlled diabetic patients is not due to the mobilisation of cortisone-type hormones caused by blood sugar fluctuations. It is a known fact that the poorer control and longer duration of diabetes, the more angiopathy. Out of 451 diabetic patients of Marble 11 were excellently controlled: none of them had nephropathy. Of 50 well controlled cases only one showed nephropathy. These 61 cases were diabetics for more than 20 years. I n contradistinction 17 per cent of 92 moderately controlled and 28 per cent of 298 uncontrolled cases had severe nephropathy.In order to elucidate the question, we investigated the effect of blood sugar fluctuations on the kidneys of normal rats. Blood sugar fluctuations were induced by insulin and glucose and the kidneys were examined histologically. We also investigated, whether pathological changes could be prevented by hypophysectomy, adrenalectomy or methylandrostenediol (Neosteron, Organon OSS) treatment.
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