Letters to the Editors

Diabetes mellitus: Its differentiation into insulin‐sensitive and insulin‐insensitive types*

“…It may here be noted that the curve in healthy subjects approximates to that of the insulin‐sensitive diabetics 2 . The curve obtained in this type of patient (II.…”

“…I have shown that capillary blood taken from the warm ear has approximately the same sugar content as arterial blood, and also that venous blood specimens taken under identical conditions from the same half inch of vein in all tests on the same subject give a reliable if only relative indication of the sugar content of the blood leaving the limb 2 . By performing simultaneous curves on capillary and venous blood (A.V.…”

“…In these cases absorption from the stomach is delayed and a fallacious result obtained. Secondly, if it is desired to compare a series of curves, the patients must all be receiving diets containing approximately the same amount of carbohydrate, as I have previously shown that the insulin sensitivity of a normal subject is determined by the amount of carbohydrate utilised 5 . In the case of diabetics care should be taken that sugar is not being excreted in the urine in such amounts as to reduce materially the carbohydrate supply of the body.…”

“…In previous publications 1–5 it has been shown that the efficiency with which insulin acts in the body is governed by an unknown factor or condition which renders the body sensitive both to injected and pancreatic insulin. When this sensitising factor is limited the efficiency with which each unit of insulin depresses the blood‐sugar is decreased, and when it is abundant the efficiency of each unit is correspondingly increased.…”

“…It can easily be seen that if this sensitising factor is limited below a certain degree, then the insulin in the body will be relatively powerless and the symptoms and signs of hypoinsulinism, clinically recognisable as diabetes mellitus, will appear. This consideration led me to suggest 4,5 that a type of diabetes mellitus might exist which was due, not to lack of insulin, but rather to lack of this sensitising factor. An investigation of cases of diabetic patients from this point of view was therefore commenced.…”