STUDIES ON DIABETES MELLITUS: THE RELATION OF STRESSFUL LIFE SITUATIONS TO THE CONCENTRATION OF KETONE BODIES IN THE BLOOD OF DIABETIC AND NON-DIABETIC HUMANS 1

Abstract

15 non-diabetic persons and 22 persons with diabetes mellitus were the subjects of an integrated psychological and biochemical study. In a resting, post-absorptive state, without insulin, these persons were presented with situations and discussions which activated their important personal conflicts and aroused strong emotions. In control studies the blood ketones of non-diabetic subjects were below 1.5 mg.% (as recovered acetone), and without significant fluctuations; during stress interviews a rise of 1-2 mg.% occurred, which subsided after the stressful situation was removed. Most of the diabetic subjects without symptoms had ketone levels below 1.5 mg.%; these also did not fluctuate significantly during control studies. In such subjects the concn. rose 1-4 mg.% during stressful interviews, and subsided when the stress was removed. Diabetic subjects with blood ketones above 1.5 mg.% could also be maintained in a relatively steady state if not stimulated; but when subjected to stressful situations rises as great as 18 mg.% in 1.5 hrs. were observed. In 2 subjects with initial ketone levels of 20 mg.% and 13 mg.% associated with conflicting thoughts and feelings, falls of 18 and 6 mg.%, respectively, occurred as they were diverted from their morbid thoughts. In one subject in whom samples were obtained from the hepatic vein by catheter, increased ketone concns. were observed during discussion of significant conflicts. Evidence from other studies suggests that these changes are mediated by a pituitary-adrenal effect upon ketone production in the liver. It is concluded that stressful life situations may be associated with ketonemia in both non-diabetic and diabetic persons without the intervention of intercurrent illness or of changes in diet, activity, or insulin intake.