GLYCOSURIA

GLYCOSURIA, the excretion of grape sugar with urine, the main symptom of diabetes mellitus, but it is also observed outside of this disease. By G. in the narrower sense is meant precisely non-diabetic G. The percentage content of sugar in urine in this type of G. usually does not reach high figures, varying from traces to (approximately) 2-3%. The daily amount of sugar is expressed at a maximum of 20-25 g with a normal amount of urine and does not depend on the amount of carbohydrates and proteins in food. Non-diabetic G. do not have a constant character, disappearing and reappearing for more or less long periods, although cases of such G. that do not leave a person throughout life but have an absolutely benign course are observed. This group of G. in relation to pathogenesis does not always appear quite clear. According to the expression of Umber, here we have to deal with "extra-insular" causes, i.e., in these G. the islet apparatus of the pancreas is both functionally and organically completely normal. The cause of G. in such cases should be considered the enhanced mobilization and diastatic breakdown of liver glycogen with the onset of temporary hyperglycemia. In this case, the increased glycogenolysis may depend on irritation of both the central and peripheral parts of the corresponding nervous apparatus. Claude Bernard's sugar injection and its various experimental variations act on liver cells in two ways: partially directly from the center in the area of medulla oblongata through nn. splanchnici, irritating the liver cells, and partially through the adrenal glands, causing adrenalinemia and thereby irritating the endings of the same nerves peripherically. Apart from this schematic division stands the so-called experimental mering's floridzin G., which is apparently caused mainly by the loss by the kidneys of the ability to prevent sugar from passing into the urine even with its normal content in the blood. Floridzin G. differs from other G. by a decrease in sugar content in the blood. G., caused by influence through nerve centers, includes a number of experimental G., having mainly theoretical significance. G., caused by narcotics (chloroform, morphine), the caffeine group (theobromine, diuretin), asphyxia, etc., can be explained by irritation of the central nervous system. Heavy metals (especially uranium), on the contrary, act peripherically, possibly directly on liver cells. To non-diabetic G. can also be attributed a number of G. in humans, having great practical significance. Here, first of all, G. in diseases of the endocrine glands - in Basedow's disease, in hyperfunction of the pituitary gland (see Acromegaly), in tumors of the adrenal glands; here also belongs the glycosuria of pregnancy (see Pregnancy). The method of occurrence of G. in diseases of the endocrine glands is still not sufficiently clear. G. in Basedow's disease can be explained by the effect on liver cells, and on the pancreas, and on the chromaffin system, and in view of the known connection of the thyroid gland with the sympathetic system, the effect through the sympathetic system and adrenal glands is most probable. The pathogenesis of pituitary G. is also still unclear. Here, in addition to the effect on the autonomic nervous system due to disruption of the correlation of glands with internal secretion, one cannot exclude the dependence of G. on the close proximity of the pituitary to the autonomic nerve centers. Disorders of the function of the base of the brain, fluctuations in blood filling, stagnation phenomena can cause G. Pituitary hyperglycemia and G. are labile. However, according to Nordau, there are not sufficient grounds for isolating a special form of pituitary diabetes. For the practical physician, the so-called benign, harmless G. (glycosuria innocens, Umber) are especially important. Their pathogenesis has not yet been clarified, but in any case they have an "extra-insular" character, although in exceptional cases a transition of such G. into true diabetes mellitus has been observed. In diagnostic terms, the recognition of benign G., i.e., its differentiation from diabetes mellitus, is of interest. Certain indications can be given by the following tests: 1) loading with grape sugar per os or intravenously in non-diabetic G. gives a blood sugar curve similar to that of a healthy person; 2) expansion or restriction of diet little affects the daily excretion of sugar in urine; 3) the use of insulin almost does not change the daily glycosuria. It remains to mention G. in some diseases of the nervous system: in cerebral hemorrhages, in brain tumors, after injuries, in progressive paralysis, dementia praecox; their basis is the effect on the central nervous system. The influence of higher nervous activity on blood sugar content is manifested in the appearance of hyperglycemia and G. during affects (see). This includes Bem's and Hoffmann's "tying-up G.", developing in cats and rabbits under the influence of only tying them to a certain stall, glycosuria after examinations in students, etc. The pathogenesis of all these G. is completely analogous to the pathogenesis of G. developing under the influence of Claude Bernard's injection. Alimentary G. is characterized by the appearance of sugar in urine due to excessive introduction per os. The boundary of tolerance to glucose in different people and in different conditions is variable. According to the data of Naunyn, a healthy person when given 100 g of grape sugar 2 hours after a light breakfast (100 g of bread and a cup of coffee with milk) should not excrete sugar in urine. In neurasthenics, hysterics and in febrile diseases, the boundary of tolerance to grape sugar is lowered. In all the mentioned G. except G. in pregnancy and floridzin G., there is an increase in blood sugar. Benign G. almost always occur with normal blood sugar content, although in them sometimes blood sugar can be elevated. The treatment of G. should be etiological,-this especially applies to G. in diseases of the endocrine glands. There are indications of the disappearance of G. after active or conservative treatment of Basedow's disease. G. of pregnancy requires observation and not strict restriction of carbohydrates in food. Benign G., in view of the possibility of transition into diabetes mellitus, requires repeated research and observation and in some cases prophylactically a certain restriction of carbohydrates in food.

G. British.