No abstract

A remarkable reduction in insulin requirement was observed in the case of an adult woman with diabetes; after requiring 80 units of insulin daily, she later managed without insulin and had normal blood sugar tests. The dominant clinical feature in later years was renal insufficiency. At autopsy, extensive renal changes of the Kimmelstiel-Wilson type were found.Because of the apparent relation of the amelioration of the diabetes to the development of renal disease in this case, the incidence of renal changes and the severity of the diabetic state were studied in 190 cases of diabetes mellitus autopsied in recent years. These cases were divided into three groups: those with no renal disease, those with renal disease other than the Kimmelstiel-Wilson type and those with the KimmelstielWilson renal lesions.The criterion used for the Kimmelstiel lesion was solely the lumpy loop or hyaline mass in the glomerulus. There were 57 patients with the lesion-an incidence of one-third of the diabetic study group. The duration of the diabetes did not differ from that in the two other groups. In general, the patients with the lesion were obese, became hypertensive, developed refractory edema, -died in uremia. Their kidneys characteristically showed marked arteriolarsclerosis and arteriosclerosis.In 60 per cent of the diabetics with the Kimmelstiel lesion, the amount of insulin required progressively decreased as time went on. In a few cases, the diminution of the insulin requirement was so marked that diabetics previously requiring large amounts of insulin became hypoglycemic during treatment with small doses. This illustrates the need for caution. The tendency to amelioration appeared late in the course of the diabetic dis-