EDITORIAL EXACERBATION OF DIABETES BY EXCESS INSULIN ACTION

Insulin therapy of diabetes, almost four decades after its introduction, is still beset with grave difficulties. Two particularly disturbing problems are presented by insulin reactions and the unstable ("brittle") form of the disease, which seriously interfere with the pursuit of a normal life. No one can disagree with Marble,1 who as recently as 1959 succinctly stated that "episodes of hypoglycemia due to insulin constitute one of the major problems in the treatment of diabetes." No less of a problem is the management of unstable diabetes, a condition characterized by abrupt fluctua-tions of the glycemic level, which entail wide day-to-day as well as diurnal variations in the degree of glycosuria and are accompanied, as a rule, by intermittent ketosis. In 1955 Colwell2 estimated that about 10 per cent o