654 METABOLISM 



diabetes. For this purpose the patient should first of all be instructed 

 to follow his usual diet, so that, by examination of the amount of sugar 

 excreted in the urine, an opinion may be formed of the severity of the 

 case. The diet should then be changed so as to consist of a part that 

 contains no carbohydrates and another composed entirely of starchy 

 food. The former is made up of eggs, fish, green vegetables, fat, etc., 

 and the latter, to start with, should consist of 100 grams of bread, dis- 

 tributed between the two main meals of the day, one of which is break- 

 fast. This diet should be continued until the glycosuria either disappears 

 or attains a constant level. If it disappears, "the case is classified as a 

 mild one of diabetes, and the daily allowance of bread may be increased, 

 by 50 grams a day, until the sugar again makes its appearance in the 

 urine, indicating that the assimilation limit has been reached. For 

 therapeutic purposes, the patient should now be instructed to take about 

 three fourths of this amount of carbohydrate in his daily rations, and 

 he should be supplied with explicit instructions in the shape of diet 

 tables as to what variety and quantities of the various carbohydrate 

 materials his food may contain. His urine should be examined at fre- 

 quent intervals once a week and he should be instructed as to the 

 nature of his disease and the importance of his remaining aglycosuric. 

 By further treatment such so-called latent cases of diabetes may be 

 kept in perfect health for many years. 



When, on the other hand, the glycosuria exists with 100 grams of 

 bread in the daily ration, this must be reduced to 50 grams, and if after 

 some days the first reduction does not suffice to render the urine free 

 from sugar, carbohydrates must be withheld entirely from the diet. 

 If the glycosuria does not now disappear, the case is to be considered 

 severe, and it may be necessary to undertake the starvation treatment, 

 which has recently been developed in this country by Allen 18 and Joslin 19 

 with apparent success. By the reduction of carbohydrate, or by the 

 starvation treatment, it is usually possible to make even the severest 

 cases of diabetes aglycosuric, and when this has been attained, then 

 gradually to increase the amount of protein or carbohydrate food until 

 the assimilation limit has been reached. 



Saturation Limits. To avoid error caused by irregular absorption from 

 the intestines, some investigators have recommended the determination 

 of the assimilation limit after intravenous or subcutaneous injections 

 of sugar. But even this refinement in technic has not, as a rule, had the 

 effect of rendering the results of any very evident value as a criterion 

 of the utilization of glucose in the animal body. The reason for this 

 unreliability of the method is mainly that the period of injection of the 

 glucose solution usually oc.cupies only a few minutes, so that it causes 



