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JAMA 100 Years Ago
December 10, 2003

SUGAR METABOLISM AND DIABETES.

Author Affiliations
 

JAMA 100 Years Ago Section Editor: Jennifer Reiling, Assistant Editor.

JAMA. 2003;290(22):3010. doi:10.1001/jama.290.22.3010

When Pawlow demonstrated that pancreatic juice as secreted into the intestine in an inactive form is rendered active by another ferment, enterokinase, secreted by the intestinal mucosa, he did more than give a new light on the processes of digestion in the intestine, important as that contribution was. He also pointed the way to new researches that might show other examples of the interdependence of organs and cells. One of the fruits of this research seems to have matured in the very important discovery of O. Cohnheim1 concerning the mechanism and the agents concerned in sugar metabolism, apparently a discovery that clears up at last one of the most fundamental processes of metabolism which has evaded solution in spite of much work directed to that end. It is indeed strange that the history of sugar in the body has not been completely worked out long ago, in view of our familiarity with its chemical properties and structure, and the large quantities that the body daily utilizes. We have long been familiar with certain steps in its metabolism, knowing that in whatever form it is ingested it is absorbed as a monosaccharid; that a fairly constant amount is maintained in the blood through the ability of the liver and muscles to convert any excess into glycogen and to restore it whenever there begins to be a deficiency; and also that if the sugar in the blood greatly exceeds the normal amount it begins to escape into the urine. We also knew that sugar was the chief source of heat and energy, which it furnished by undergoing destructive oxidation; and as the chief place where heat and energy is produced is in the muscles it was probable that the oxidation took place within the muscle cells. Yet experimentally it had not been possible to demonstrate any such property in muscle tissue. It was known that glycolytic ferments exist that have the power of destroying sugar, but extracts prepared from muscles in various ways were found to have no such property, or at least not enough to begin to account for the enormous destruction of sugar that the body accomplishes every day. And so, despite the apparent certainty that the muscle tissue was the seat of an active glycolysis during life, the agents concerned could not be found within them by experimental means.

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