Abstract
To the Editor.— The article Prevention of Diabetic Ketoacidosis by Schade and Eaton (242:2455, 1979) in the TRENDS IN THERAPY section emphasizes the importance of stress in the pathogenesis of diabetic ketoacidosis. In describing the triggering of the anterior pituitary secretions responsible for the phenomenon, the only stresses the authors identify are infection, fever, and dehydration. They thereby ignore the role of emotional stress, which was carefully documented 30 years ago in a series of articles by Hinkle and associates. 1-5 In fact, Hinkle and his co-workers were able to observe the appearance of ketosis in a hospitalized patient during a serious emotional conflict, while insulin dosage, diet, and exercise were held constant. 1 Therefore, the preventive advice of Schade and Eaton should have included awareness of psychosocial stresses as well as the early signs of infection.
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