XANTHOMA diabeticorum is a rare complication of diabetes mellitus which dramatically calls attention to the derangement of fat metabolism which occurs in diabetes and to the effectiveness of diabetic control in correcting this defect.Xanthoma diabeticorum was first described by Addison and Gull, in 1851.1 In the preinsulin era this condition was commoner than it is today. Related publications in recent years have been few, and xanthoma diabeticorum is considered to be a rare complication. Only 14 of Joslin's * 21,000 cases of diabetes mellitus had this complication. In Thannhauser's classification of the xanthomatoses,\s=d\ it falls into the group of secondary xanthomatoses due to hyperlipemia. In contrast to the primary essential xanthomatoses, which are constitutional disorders of the intracellular metabolism of reticuloendothelial cells, the secondary types are manifestations of hyperlipemic states. With correction of the increased blood lipids, reabsorption of the deposited lipids occurs and the eruptive lesions disappear.Characteristically, the diabetic state is as¬ sociated with a distorted fat metabolism with frequent occurrence of lipemia and hypercholesterolemia. In diabetic lipemia the neu¬ tral fat fraction is increased most, while the cholesterol and phospholipid fractions are in¬ creased less or not at all. Hirsch and coworkers * have shown that hyperglycemia is associated with a hyperlipemia, the intensity of which seems to approximate the severity of the hyperglycemia. With correction of the hyperglycemia, the esterfied fatty acids of the blood return to a high-normal range. They also have shown that the blood lipids during a fat-tolerance test are much higher when the diabetic patient has hyperglycemia than when he is normoglycemic. A clinical and laboratory study of 18 pa¬ tients admitted in diabetic acidosis was done by Tuller and co-workers.5 Although no pre¬ cise correlation could be observed between blood sugar and C02 values and either cho¬ lesterol or lipoprotein values, a general rela¬ tionship between the serum lipid deviation and the degree of acidosis was observed. Successful therapy was followed by a rising serum 2 and by a fall in serum lipoproteins and cholesterol levels. Treatment, however, did not result in a return of the lipids to a normal level for persons of the same age and sex. The authors further stated that they have seen no patient in diabetic acidosis without some increase in the serum lipoproteins. It has also been noted that serum lipids are more increased in diabetic patients with vascular changes than in those with no such complications.In xanthoma diabeticorum there is an ex¬ aggeration of the usual lipid disturbance seen in the diabetic patient. A deficiency of insulin, either absolute or relative, is responsible for a reduced carbohydrate utilization in the dia¬ betic state. Fat catabolism provides the fuel requirement of the body, and the resultant lipemia reflects the increase in transportation of lipid substances from fat depots to the liver. At the latter site...
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