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DIABETES MELLITUS—1967* F. D. W. LUKENS, Af.D.f Since the outline of Dr. Kober's career and of his contributions to Georgetown University are part ofthe printed program I shall only note, for those who do not already know about it, that in the seventy-five-year history ofthe Association ofAmerican Physicians [i] there is a separate chapter on "The Benefactions ofDr. Kober." Later in this volume there is an excerpt from the remarks ofDr. Rufus Cole on receiving the Kober Medal. Referring to the earlier meetings ofthe association, he said: "On the front row sat Dr. Osier, Dr. Welch, Dr. Weir Mitchell, Dr. Delafield, Dr. Meltzer, Dr. Kober, and others who had reached their prime or were even then old men. . . . Dr. Kober frequently took part in the discussions and his courtly manner and deliberate speech accompanied by his slightly foreign accent always added a gracious touch which fitted perfectly into the atmosphere ofthe occasion. To those ofus on the rear seats, the men I have mentioned and others ofthe same generation represented all that was admirable and splendid in medicine." Later than Dr. Cole, I too was one ofthe young men on the rear seats in time to remember Dr. Kober in this way. This recollection makes it an especial pleasure to be asked to talk in his memory. Many people, among whom congressmen andjournalists are conspicuous , complain about the delay between discovery and application ofnew knowledge. Theirimpatienceis understandable, and thereareundoubtedly instances of unwarranted delay. However, there are probably far more occasions when new ideas andprocedures are tried rashly andprematurely. I only want to note in this connection that the extension andrevision ofold concepts ofdisease are often far more slowly recognized than new procedures . This is particularly true when new viewpoints are unaccompanied * Delivered at the George M. Kober Memorial Lecture at Georgetown University School of Medicine, April, 1967. Reprinted with permission ofthe Georgetown Medical Bulletin. t ChiefofStaff, Veterans Administration Hospital, Pittsburgh, Pennsylvania. I36 F. D. W. Lukens · Diabetes Mellitus—1967 Perspectives in Biology and Medicine · Autumn 1967 by dramatic new tools for diagnosis and treatment. It is such an approach to diabetes mellitus that I wish to discuss. First, I must set down the almost unanimous definition of diabetes. In the words ofBondy [2], "Diabetes mellitus is a disorder ofcarbohydrate metabolism characterized by hyperglycemia and glycosuria, and associated with a disturbance of the normal insulin mechanism." Conn and Fajans [3] have called it, "An abnormal metabolic state induced by deficient insulin activity." Davidson [4], in an English textbook, states: "The cause ofthis disorder is deficiency or diminished effectiveness ofinsulin." Many other authors agree, and I shall take as a premise, that the multiple TABLE 1 Effects of Insulin on the Metabolism of Glucose U-14C in Rat Adipose Tissue adapted from goodman. h.m. endocrinology 80:45, 1967_________ GLUCOSE IN MEDIUM 1. 0 mg/ml CONTROL INSULIN· 0. 1 mg/ml CONTRa INSULIN* ^g glucose TAKEN UP carbon / g fresh tissue /hr. 87.2 + 32 686. +36 19.8 + 1.4 85.6 + 6.8 CONVERTEDTO FATTYACID 29.8+ 5.7 310. +16.0 4.5+ 1.0 32.8+ 3.3 OXIDIZED TOCO2 35.4+ 4.3 248. +11.3 11.8+ 1.2 39.8+ 3.3 •0.5mu/nil in medium in these experiments. For all differences between control and Insulin series P; ) OENSA ° A MESANOIAL CHANGE NORMAL DIABETIC (c) L.O. J. V. 12 14-16 13-23 2/12-10 10 Yes 1106 (3256-5822) 4723 (2315-8250) 5023 (3877-5988) 4723 (3109-8250) +++ Adaptad fro« Fisher, Perez-Stable, Aaidl, Server and Danowski (in presa) (a)Hyalinosis of renal arterioles. (b)Mean and range. diabetic children. Again the question arises: What made the regulation of L.O. better than that ofJ.V. with respect to the development of renal lesions? Investigators have long observed that the most popular tissues for the study ofinsulin have been rat diaphragm or heart (muscle), adipose tissue, andliver, althoughthesetissues allsuffernopathologicallesions inlife-long diabetes ifone excepts the current and, at times, contradictory work on their capillaries. Most people seem to think that the acceleration ofatherosclerosis oflarger vessels in diabetes is best related to the secondary aberrations...

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