PATHOLOGICAL METABOLISM OF DIABETES 281 



"milk cure," a von Dueririg "rice cure," a Mosse "potato cure," a von 

 Norden "oatmeal cure," or any one of several analogous procedures can 

 not be denied and have never been fully explained to the extent that one 

 may predict with certainty just when one of these empirical procedures 

 will, and when it will not, produce a result better than that attainable by a 

 more systematic method. 



Discrepancies in the clinical literature .of diabetes arise from three 

 main sources : 



(1) Confusion in the minds of writers as to the exact nature of the 

 anomaly of the metabolism which characterizes diabetes with a resulting 

 lack of understanding of the rationale of dietetic management. 



(2) A general tendency to think of the food supply of the body too 

 exclusively in terms of the diet to the neglect of endogenous factors, and 



(3) The custom of thinking of the food supply simply as so much 

 carbohydrate, protein and fat, and as so many calories without further 

 analysis. 



1. Rationale of Dietetic Management. It would follow from the 

 preceding discussion that the rationale of dietetic management in dia- 

 betes is to bring the quantity of glucose entering the metabolism from all 

 sources below the quantity that can be utilized without abnormal waste; 

 and to adjust the supply of ketogenic acids in relationship to the quantity 

 of glucose so that in the mixture of foodstuffs oxidizing in the body, the 

 ratio of the ketogenic acids to glucose shall not exceed limits com- 

 patible with freedom from ketonuria. When as, and if, under these con- 

 ditions of relative rest for the pancreas, the glucose-using function im- 

 proves, then the food supply may be increased gradually in so far as 

 this can be done without disturbing the above relations. 



2. Endogenous Factors of Food Supply. Normal men during a fast 

 on light exertion have been observed to produce 29 to 30 calories per kg. 

 of body weight daily. For a 50 kg. man, this implies 1500 calories 

 per day. During the first 4 days of a fast Cetti produced on the average 

 29 calories per kg. for a total of 1618 calories per day, and catabolized 

 85.88 gm. of protein for 329.8 calories and 136.72 gm. of fat for the 

 remaining 1288 calories. 3 In a case studied by F. G. Benedict, 4 on 

 the second day of fasting there were produced 1768 calories, or 29.9 

 calories per kg., and the individual was estimated to have catabolized 7.47 

 grams of protein, 147.6 grams of fat and 23.1 grams of glycogen. Thus 

 a well nourished normal man weighing 50 kg., who during a fast produces 

 1500 calories per day may actually catabolize in the neighborhood of 75 

 gm. of protein, 125 grams of fat, and a little carbohydrate from glycogen. 

 These are well known facts repeated simply to emphasize the magnitude 

 of the food supply from the tissues in fasting and to point out in particular 



3 Citation from Lusk, Elements of the Science of Nutrition, 3rd, pp. 86-89 (1917). 



4 The Influence of Inanition on Metabolism, p. 184, Table 128 (1907). 



