Comparative Studies of Oral or Intravenous Methods of the Double Sugar Tolerance Test for Diabetic Patients

Abstract

Studies were undertaken to compare the relative merits of the double sugar tolerance test on 51 diabetic patients. This is a report of the series of tests, namely, the intravenous method which consists of 50% dextrose 40 cc. injected intravenously and the amount repeated one hour later; and the oral method which consists of 50 gm. dextrose orally administered and followed by the equal amount two hours later to be done on the same patient under the similar carbohydrate metabolic state.
1. With Staub-Effect (S-E) the both of methods agreed in most instances (70%), while the disagreement was noted in the smaller number of cases (20%). The cases of disagreement were all mild or moderately advanced cases, the majority of them showed negative with the intravenous method and positive with the oral method. There was a definite agreement of S-E pictures in either method in far advanced or advanced cases. The reason for the disagreement of S-E in both of the methods and with Kajiyama's experimental result as well as the clinical manifestation was perhaps due to the difference in time interval of the double sugar tolerance.
2. There was hardly no change to be seen between the healthy persons and the mild cases when both methods have been compared as to the quantity of urinary sugar excretion: however, with the cases of moderately or advanced, the intravenous method showed lowered urinary sugar excretion (17%-27%) in general than the oral method instituted.
3. When there occured profound difference noted between the oral and the intravenous method on the blood sugar curve, the cases will be designated as a group with specific functional derangement of sugar utilization, and a basic standard conditions necessary for the selection was prepared for these cases. It was found that the cases which met the standard basing on the respective finding numbered 14 selected cases among 51 diabetic patients.
4. The following characteristic findings were observed in these cases of the specific functional derangement of sugar utilization.
(a) 12 cases out of the above 14 patients had showed high degree of functional derangement in sugar utilization in the sugar tolerance with the oral administration method than the intravenous method.
(b) The group comprised of all degree of blood sugar tolerance curve from mild ones to advanced.
(c) Since these cases were considered to be abnormally insulin sensitive in most instances, it is reasonably assumed that these patients may have possessed with socalled extra-pancreatic factors as these patients respond little with regular insulin therapy and show less therapeutic efficacy.