BLOOD DIASTASE IN HEALTH AND DIABETES*

BY MICHAEL SOMOGYI
(From the Laboratory of the Jewish Hospital of St. Louis, St. Louis)

(Received for publication, March 15, 1940)

Interest in blood diastase has greatly increased in recent years,

mainly on account of its value in clinical diagnosis. Inflamma-

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tory conditions and duct occlusions of the pancreas were long
known to increase the diastatic activity of blood to far above the
normal level. Myers and Killian claimed that blood diastase is
substantially elevated in diabetes also, and deduced a sweeping
theory from their finding (1). The inadequacy of the analytical
method of these authors, which was pointed out in a previous
communication from this laboratory (2), impelled us to reexamine
the problem.
The initial step in this work was determination of the range of
variations of the blood diastase in healthy individuals. The
attitude often taken in clinical studies of considering hospital
patients as normal in any relation except their particular known
disease was avoided. The subjects in these observations were
all people with no known disease; they were recruited from the
ranks of the medical, nursing, and laboratory staffs, and were
scrutinized for any detectable abnormalities. In all of the normal
and in many of the diabetic cases, diastase determinations were
carried out with both of our analytical methods (2).
Since the diastase values were found to be scattered over a wide
range, it was deemed necessary to use a fairly large number of
subjects in order to obtain usable information. At the time these
studies were completed some years ago, 170 subjects were exam-
ined; since then numerous additional determinations yielded
results which are in harmony with the earlier findings.
The normal diastase values are graphically shown in the left
half of Fig. 1, the horizontal bars representing the per cent dis-
tribution of diastatic activity at various levels. It may be noted
*This work was aided by a contribution from Mr. Hugo F. Urbauer.
315
316 Blood Diastase in Health and Diabetes

that although the spread is considerable, 80.5 per cent of all the
cases fall within the range of 80 to 150. The values above 150

i$!
Healthy subjcc fcr, 470 cases DjQbPfics, 382 cases
I IT0 m

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MO I

400

r-...- _...-- _----_-___. ____...

i..--.. ----. -._---------.-._ - -____.___ __-_--_ _--------.--,
80 ----....-.--------.--..---.J

70

I 10 I I I
45 - i0 5
pQr cent of no?tna/$<-. 9 L a*r cenf &ade f Id6
FIG. 1. Contrast between healthy and diabetic individuals in regard to
the distribution of blood diastase values over the normal and subnormal
range.

amount only to 2.4 per cent of the total, and none of them reaches
200. There is a greater scattering below 80, in that 13.0 per cent
of the cases range from 60 to 80, and 4.1 per cent are even lower,
 M. Somogyi 317

falling between 40 and 60. On the basis of the results of nearly

6000 diastase estimations during the past 7 years for diagnostic
purposes, we consider the values that lie between 60 and 80 as
border line values between normal and subnormal. The 4.1
per cent of our healthy subjects with blood diastase values below
60 fall then, on a statistical basis, in the subnormal range.
The wide variations of normal diastase values serve notice that
valid inferences from data relating to any disease can be drawn
only on a statistical basis, unless the deviations from normal are

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very great, as, for instance, in the case of some acute pancreatic
involvement. Accordingly we compiled the blood diastase
values obtained in 382 consecutive cases of diabetes, with no
regard to the severity of the patient’s condition. The results are
presented in the right half of Fig. 1, in the same manner as the
data on healthy subjects. As may be seen, the range of variations
in the two groups does not differ substantially; but a difference,
obvious at first glance, presents itself in the distribution of the
cases over the scale. In the diabetic subjects the great majority
of the cases piles up in the lower range of diastase values, so that
the border line cases between 60 and 80 constitute 41.3 per cent
of the diabetics, as against 13 per cent of the healthy subjects,
while 33.4 per cent of the diabetics, in contrast to 4.1 per cent
of the healthy subjects, falls into the definitely subnormal range
of diastase values. Or, summing up the low values, of the
healthy individuals 17 per cent, of the diabetics 74 per cent show
blood diastase values lower than 80.
In an earlier note we have suggested that subnormal blood
diastase levels indicate impairment of liver function (3). While
we are unable to furnish any explanation of this relationship, a
statistical study of nearly 6000 diastase determinations has fully
confirmed the validity of the observation; in addition, other
investigators, who used our analytical technique, arrived at the
same conclusion (4, 5). It is noteworthy that the finding of
subnormal blood diastase levels proved to be of early diagnostic
and prognostic value in numerous cases where other tests for
liver functions failed to disclose abnormalities.
On this basis we interpret the general trend towards lowered
blood diastase in diabetics as a sign of disturbances in liver
functions. Such disturbances may be present at early stages
318 Blood Diastase in Health and Diabetes

of the disease when the conventional, known diagnostic pro-

cedures fail to disclose any signs of abnormality. In line with
this interpretation, moderately low and border line values were
consistently found in those instances in which obesity resulting
from overeating was a significant part of the case histories.
Various degrees of fatty infiltration or degeneration of the liver
in such cases are a very likely condition that may account for the
depression of the diastatic activity of the blood and at the same
time may play a significant part in the pathogenesis of the diabetic

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condition.
Definitely subnormal diastase levels were always observed in
patients in ketosis, the severity of ketosis and the depression of
diastatic activity showing a notable parallelism. In diabetic
coma and preceding coma, diastase values as low as 20 to 30
were observed.
The results of this study tend to direct attention to the rBle of
the liver in diabetes mellitus, and bring to one’s mind pertinent
views of well known investigators, as represented by the following
remark of Krehl (6): “The behavior of the liver will always
remain of great interest with respect to the various forms of
diabetes. After having stood at one time in the center of interest,
it is now undeservedly relegated to the background.”

This work was aided by a contribution from Mr. Hugo F.

Urbauer.

BIBLIOGRAPHY

1. Myers, V. C., and Killian, J. A., J. Biol. Chem., 29, 179 (1917).
2. Somogyi, M., J. Biol. Chem., 126, 399 (1938).
3. Somogyi, M., Proc. Sot. Exp. Biol. and Med., 32, 538 (1934).
4. Rachmilewits, M., Am. J. Digest. Dis., 6, 184 (1938).
5. Cole, W. H., Am. J. Surg., 40, 245 (1938).
6. Krehl, R., Pathologische Physiologie, Leipzig, 6th edition, 482 (1910).
 BLOOD DIASTASE IN HEALTH AND
DIABETES
Michael Somogyi
J. Biol. Chem. 1940, 134:315-318.

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