BRmSHM WICAL. JOURNAL (glycosuria 1%); I hour, 157 mg. (1%); 1-hours, 273 mg. (2%); 21 hours, 220 mg. (5%). Insulin was then reduced to 5 units once daily, and the patient Was discharged 44 days after admission.Since then, good progress has been maintained and he has been supervised for more than three years. Soluble insulin therapy was changed to globin insuliTr(8 units once daily), with appropriate diet for a child aged 11 years, height 48 in. (122 cm.), and weight 56 lb. (25.4 kg.). There have been no relapses. COMMENT Joslin et al. (1946) reported a blood glucose concentration of 1,680 mg. per 100 ml. in a patient who recovered. The maximum recorded value in a patient who recovered appears to be 1,850 mg. per 100 ml. (Dillon and Dyer, 1935). A value of 2,060 mg. per 100 ml. was found by Lawrence (1934) in a patient two hours after 40 units of insulin had been given; this patient died.Our patient, after receiving 660 units insulin and 320 g. glucose in 16 hours, attained a blood glucose concentration of 2,100 mg. per 100 ml.; this was at 2 a.m. Assuming that the " active volume of tissue fluid" was initially 0.5 that of the body weight, and allowing for the administration of nearly 3 litres of intravenous saline, calculations show that more than half the glucose administered had already been disposed of up to this time. In the next few hours, continued treatment rapidly restored the blood (and tissue fluid) glucose concentration to normal.We wish to thank Miss E. Radovitch, formerly house-physician, for her co-operation, and Dr. H. L. Milles, under whose care the patient was admitted, for his help and encouragement in preparing this memorandum.
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