Some Points in the Treatment of Diabetes

ever good the treatment, cases of true coma often die. Moreover, diabetic coma is rarely of acute onset ; at least twenty-four hours (and usually several days), elapse during which gross ketosis develops before the onset of loss of consciousness and circulatory collapse. The best insurance policy therefore in the prevention of diabetic coma is the regular testing of the urine for ketone bodies. This is of much greater importance than testing for sugar. It cannot be over-emphasized that hyperglycaemia itself is not in the short term harmful : safety from diabetic coma lies in ensuring freedom from ketosis and not in ensuring normal blood-sugar. Ketosis arises whenever carbohydrate metabolism is abnormally low, either from the inadequate intake of carbohydrate or from insufficient or inefficient action of insulin or both. Ketosis is there-