The presence of an internal secretion in the pancreas and its controlling influence on carbohydrate metabolism have long been surmised. The discovery of insulin fully confirmed this supposition, but the exact mechanism by which diabetes is produced is still problematic. It is now believed that the disease is due to a deficient production of insulin, resulting from a structural or functional change in the islands of Langerhans. In the light of recently acquired knowledge, this explanation seems inadequate. While this disease is undoubtedly due to a lack of insulin, the shortage cannot be ascribed to a simple quantitative reduction in the secretion of this hormone by the pancreas, on either a morphologic or a functional basis.
Gross pathologic affections of the pancreas, in the majority of cases, do not produce diabetes. The degenerative changes in the islands of Langerhans noted in some cases of diabetes are absent in others. The
EPSTEIN AA. THE CAUSAL MECHANISM OF DIABETES MELLITUS. JAMA. 1925;85(1):29–31. doi:10.1001/jama.1925.02670010033010
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