STUDIES IN DIABETES MELLITUS. II. THE OCCURRENCE OF A DIURESIS IN DIABETIC PERSONS EXPOSED TO STRESSFUL LIFE SITUATIONS, WITH EXPERIMENTAL OBSERVATIONS ON ITS RELATION TO THE CONCENTRATION OF GLUCOSE IN BLOOD AND URINE 1

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Abstract
A water diuresis occurring in non-diabetic individuals in a setting of stress associated with anxiety and apprehension was described in an earlier publication. The relevance of this phenomenon to diabetes mellitus was studied, using diabetic persons of all ages and all degrees of severity, under conditions in which such interfering variables as diet, fluid intake, insulin intake, and activity were controlled. Situations productive of anxiety and apprehension were found to be associated with a water diuresis in aglycosuric diabetics which was similar to that seen in non-diabetics. In diabetics with glycosuria, this diuresis was accompanied by an increase in glucose excretion which paralleled the increase in water excretion. It could not be attributed to changes in blood glucose concn. or in the concn. of glucose or ketone bodies in the urine. Ingestion of concd, carbohydrate solns. during stress was followed by a far greater loss of water and chlorides than was observed when the same diabetic subjects ingested the same quantity of coned, carbohydrate in the absence of significant stress. In fasting, hydropenic diabetics during stress, excretion rates as high as 4.7 cc./min. of water, 490 mg./min. of glucose, and 25 mg./min. of chloride were induced. The marked associated chloride loss which was observed, enhanced the likelihood that stress diuresis may be an important factor in the development of diabetic keto-acidosis with its attendant dehydration.