The pancreas and diabetes mellitus.

FEW theories about diabetes gain universal acceptance, and the role attributed to the pancreas varies from a major to a very minor one in the opinions of different groups of workers. Two facts that are generally accepted are that diabetes can be caused by pancreatectomy, and that its symptoms can be alleviated by insulin administration. The relative lack of insulin which is implied by these two statements is, however, not necessarily of pancreatic origin in every case of diabetes. It could be caused by a defect at any point along the pathway followed by insulin between its production by the P cell and its final effect on peripheral cell metabolism. In discussing the abnormality in insulin-carbohydrate interaction, the following points should be considered: (1) The islet cell. (2) Insulin structure. (3) Insulin transfer. (4) Insulin destruction. (5) Insulin antagonism. (6) Endorgan responsiveness. (7) 3 cell control. We should like to discuss the pathogenesis of the relative insulin lack found in diabetes mellitus under these headings, laying more stress on those factors which directly concern the pancreas.