Diabetic Coma

Article1 March 1939DIABETIC COMA(AN INVESTIGATION OF MORTALITIES AND REPORT OF A SEVERITY INDEX FOR COMPARATIVE STUDIES)*I. M. RABINOWITCH, F.A.C.P., A. F. FOWLER, E. H. BENSLEYI. M. RABINOWITCH, F.A.C.P.Search for more papers by this author, A. F. FOWLERSearch for more papers by this author, E. H. BENSLEYSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-12-9-1403 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptRecently we1reported a method for the treatment of diabetic coma with one simultaneous injection of unmodified and protamine zinc insulin. With this method, it was shown that the blood sugar was rapidly reduced to the normal level, regardless of the degree of hyperglycemia and kept at that level for at least 40 hours, in spite of administration of many hundred (780 to 1020) grams of carbohydrate. In two cases the blood sugars were still normal at the end of 60 hours. That these large amounts of carbohydrates administered were not stored in the tissues artificially, but were utilized either...References1. RABINOWITCHFOWLERBENSLEY IMAFEH: The use of protamine zinc insulin in diabetic coma, Can. Med. Assoc. Jr., 1937, xxxvii, 105. Google Scholar2. JOSLINDUBLINMARKS EPLIHH: Mortality and longevity of diabetics, Am. Jr. Med. Sci., 1938, cxcv, 596. CrossrefGoogle Scholar3. JOSLIN EP: The treatment of diabetes mellitus, 5th Ed., 1935, Lea and Febiger, Philadelphia, p. 173. Google Scholar4. BERTRAM F: Pathogenese und Prognose des Coma diabeticum, Ergebn. d. inn. Med. u. Kinderh., 1932, xliii, 258. Google Scholar5. Quarterly Bulletin, City of New York Department of Health, Why Diabetic Coma? 1933, i, 102. Google Scholar6. BARTELSBLUM ECB: Diabetic deaths in Duluth: A statistical study, Minn. Med., 1934, xvii, 512. Google Scholar7. STAFNE WA: Diabetes in Minnesota, Minn. Med., 1934, xvii, 503. Google Scholar8. Metropolitan Life Insurance Co., Bull. No. 17, 1936. Google Scholar9. Advances in the Treatment of Diabetes, Metropolitan Life Insurance Company, 1938. Google Scholar10. JOSLIN EP: The present mortality of diabetic children, ANN. INT. MED., 1938, xi, 1348. LinkGoogle Scholar11. JOSLIN EP: The treatment of diabetes mellitus, 6th Ed., 1937, Lea and Febiger, Philadelphia. Google Scholar12. JOSLINROOTWHITE EPHFP: Diabetic coma and its treatment, Med. Clin. N. Am., 1925, viii, 1873. Google Scholar13. JOSLINROOTWHITE EPHFP: Diabetic coma and its treatment, Med. Clin. N. Am., 1927, x, 1281. Google Scholar14. JOSLINROOTWHITECURTISADAMS EPHFPWSHD: Diabetic coma, Med. Clin. N. Am., 1929, xiii, 11. Google Scholar15. JOSLINROOTWHITEJORDANHUNT EPHFPWRHM: Diabetic coma, Med. Clin. N. Am., 1932, xv, 829. Google Scholar16. JOSLINROOTWHITEMARBLEHUNT EPHFPAHM: Diabetic coma, Med. Clin. N. Am., 1933, xvi, 793. Google Scholar17. MARBLEROOTWHITE AHFP: Diabetic coma, New Eng. Jr. Med., 1935, ccxii, 288. CrossrefGoogle Scholar18. JOSLINROOTWHITEMARBLEJOSLIN EPHFPAAP: Diabetic coma, Arch. Int. Med., 1937, lix, 175. CrossrefGoogle Scholar19. DILLONDYER ESWW: Factors influencing the prognosis in diabetic coma, ANN. INT. MED., 1937, xi, 602. Google Scholar20. BAKER TW: A clinical survey of one hundred and eight consecutive cases of diabetic coma, Arch. Int. Med., 1936, lviii, 373. CrossrefGoogle Scholar21. MCCANCELAWRENCE ARD: The secretion of urine in diabetic coma, Quart. Jr. Med., 1935, xxviii, 53. Google Scholar22. FALTA W: Die Zuckerkrankheit (Urban und Schwarzenberg), p. 111, 1936. Google Scholar23. RUDYLEVIN ACM: Unusual case of diabetic acidosis without ketonuria or ketonemia, N. Y. State Med. Jr., 1927, xxvii, 1240. Google Scholar24. JOHN HJ: Diabetic coma, Jr. Am. Med. Assoc., 1929, xciii, 425. CrossrefGoogle Scholar25. STARRFITZ PR: The excretion of organic acids in the urine of patients with diabetes mellitus, Arch. Int. Med., 1924, xxxiii, 97. CrossrefGoogle Scholar26. HIMWICH HE: The metabolism of fever with special reference to diabetic hyperpyrexia, Bull. N. Y. Acad. Med., 1934, x, 16. Google Scholar27. JOSLIN EP: The treatment of diabetes mellitus, 2nd Ed., 1917, Lea and Febiger, Philadelphia. Google Scholar28. JOSLIN EP: The treatment of diabetes mellitus, 3rd Ed., 1923, Lea and Febiger, Philadelphia. Google Scholar29. LAWRENCE RD: Extreme hyperglycaemia in diabetic coma, Brit. Med. Jr., 1934, i, 377. Google Scholar30. DILLONDYER ESWD: Diabetic coma with extreme hyperglycemia, Am. Jr. Med. Sci., 1935, cxc, 683. CrossrefGoogle Scholar31. BRUGER M: Diabetes mellitus and hyperthyroidism. Report of a case with a fasting blood sugar of 1500 mg. per hundred cubic centimeters in the absence of coma, Jr. Am. Med. Assoc., 1935, civ, 2163. CrossrefGoogle Scholar32. PADDOCK BW: A fatal case of diabetic coma without ketosis, Jr. Am. Med. Assoc., 1924, lxxxii, 1855. CrossrefGoogle Scholar33. PITFIELD RL: Unusually high blood sugar content in a case of diabetes, Med. Jr. and Rec., 1924, cxx, 433. Google Scholar34. FOSTER NB: Diabetic coma, Jr. Am. Med. Assoc., 1925, lxxxiv, 719. CrossrefGoogle Scholar35. ARGY WP: An unusual case of hyperglycaemia (1.71 per cent) with coma; associated with an absence of acetone in the urine. Report of a case, Boston Med. and Surg. Jr., 1925, cxciii, 1236. CrossrefGoogle Scholar36. CURTISDIXSON WSIM: Extreme hyperglycemia in diabetic coma with recovery, Jr. Am. Med. Assoc., 1928, xc, 1115. Google Scholar37. SHEPARDSONANDERSON HCEM: Diabetic coma with marked hyperglycemia and recovery: Report of a case, Endocrinology, 1929, xiii, 188. CrossrefGoogle Scholar38. GRAYSANSUM PAWD: Diabetic coma with marked hyperglycemia and recovery. Report of a case, Jr. Am. Med. Assoc., 1931, xcvii, 230. CrossrefGoogle Scholar39. HAINESDAVIS CJR: Diabetic coma with blood sugars above one thousand milligrams: Report of three cases with recovery following treatment, Jr. Am. Med. Assoc., 1932, xcix, 24. CrossrefGoogle Scholar40. KERRKOCHER EFRA: Marked hyperglycaemia in diabetic ketosis and beginning coma with recovery, Calif. and West. Med., 1933, xxxviii, 371. Google Scholar41. OLMSTED JOSLIN EP, quoted by : See reference No. 3. Google Scholar42. ALLENWISHART FMMB: Experimental studies in diabetes. Series V. Acidosis. 5. Acidosis in phlorizinized dogs, Jr. Metab. Res., 1923, iv, 223. Google Scholar43. HARTMANN AF: Treatment of severe diabetic acidosis, Arch. Int. Med., 1935, lvi, 413. CrossrefGoogle Scholar44. RABINOWITCH IM: The kidneys in diabetic coma, Can. Med. Assoc. Jr., 1929, xxi, 274. Google Scholar45. FULLERTONLYALLDAVIDSON HWALS: The treatment of diabetic uraemia with hypertonic glucose solutions, Lancet, 1932, i, 558. CrossrefGoogle Scholar46. RABINOWITCH IM: The influence of infection upon the reaction of the diabetic to insulin treatment, Can. Med. Assoc. Jr., 1924, xiv, 481. Google Scholar47. RABINOWITCH IM: The influence of infection upon the reaction of the diabetic to insulin treatment, Can. Med. Assoc. Jr., 1932, xxvi, 551. Google Scholar48. RABINOWITCH IM: Arteriosclerosis in diabetes, ANN. INT. MED., 1935, viii, 1436. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Montreal,*Received for publication December 27, 1938.From the Department of Metabolism, The Montreal General Hospital, Montreal, Canada.†A number of others were also treated with protamine zinc insulin, but not by the method described. Nextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byDiagnosis: From classification to predictionSeverely uncontrolled diabetes in the over-fiftiesAnhangComa diabeticumCourse and prognosis of 86 episodes of diabetic comaOBSERVATIONS ON THE TREATMENT OF SEVERE DIABETIC KETOSISDie Prognose des Coma diabeticumDiabetic ÁcidosisDiabetic ComaCardiac complications of diabetes mellitusDiabetes mellitusKetosis in health and disease 1 March 1939Volume 12, Issue 9Page: 1403-1428KeywordsBlood sugarCarbohydratesComaHyperglycemiaInsulinProtaminesZinc Issue Published: 1 March 1939 Copyright & PermissionsCopyright, 1939, by The American College of PhysiciansPDF downloadLoading ...