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October 29, 1955, Vol 159, No. 9 >
ARTICLE | October 29, 1955

MANAGEMENT OF DIABETES MELLITUS DURING KETOACIDOSIS, ACUTE INFECTION, AND SURGERY

Joseph I. Goodman, M.D.
JAMA. 1955;159(9):831-835. doi:10.1001/jama.1955.02960260001001.
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The three commonest acute complications in diabetic patients are ketogenic acidosis, acute infection, and surgical or traumatic events. It will be shown in this paper that the underlying pathological physiology is the same regardless of which condition prevails. With this concept in mind, the management of these diabetic complications is greatly simplified. A regimen is presented that is based on the physiological mechanism of ketogenesis and applicable to any of these complications.

CAUSES OF DIABETIC ACIDOSIS AND COMA 

Mechanism of Ketogenesis.—  Results of experimental studies during the past decade have altered the concept of ketone formation, and ketones are no longer considered abnormal metabolites. The evidence favors the theory that ketones are normal end-products of fat catabolism and are made in significant quantities solely in the liver whence they are distributed to the blood. A liver rich in glycogen will supply no more ketones than the body can use. Under

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