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December 1, 1923


Author Affiliations

From the Diabetic Clinic, New England Deaconess Hospital.

JAMA. 1923;81(22):1847-1848. doi:10.1001/jama.1923.02650220017004

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Unconsciousness in a patient who has sugar in the urine demands prompt use of the physician's utmost diagnostic skill, (1) to avoid hasty and harmful injection of insulin in unsuitable cases; (2) to adjust treatment to both diabetes and probable complications; (3) to protect the rights of the patient's family, and (4) to improve our knowledge of diabetes by more accurate tabulation of statistics.

The term "diabetic coma" should be reserved for unconsciousness (not mere drowsiness) due to diabetic acidosis. It is characterized clinically by "air hunger" (Kussmaul respiration), and chemically by an excess in blood and urine of sugar and of the end-products of faulty fat metabolism (the acetone bodies). Absence of any of these symptoms implies that the unconsciousness is not due solely to true diabetic acidosis, and that therefore it cannot be safely treated with large doses of insulin.

A gradual, not a sudden, onset characterizes uncomplicated

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