THE THEORY OF THE TREATMENT OF DIABETES 87 



greatly if we were to diagnosticate nephritis on this account. What is found 

 at the autopsy is the large, slightly hyperemia " diabetic kidney " which shows 

 none of the changes that we expect to find in nephritis. 



The transition of diabetes into nephritis, which is frequently mentioned, 

 is, therefore, very questionable; the true diabetic albuminuria of severe cases 

 is not nephritic, and the albuminuria of the mild cases is not diabetic, but 

 frequently due to an independent nephritis. It is true that a genuine nephritic 

 albuminuria not infrequently takes the place of glycosuria; for when the 

 arterio-sclerotic or other form of chronic nephritis which may appear becomes 

 really severe, the albuminuria becomes more pronounced, whereas the sugar 

 disappears from the urine. 



IV. THE THEORY OF THE TREATMENT OF DIABETES 



Diabetic glycosuria has a tendency to increase during a decrease in the patient's 

 tolerance, whereas during sugar-free periods the tolerance usually increases. Hyper- 

 compensatory hyperglycemia. Dietetic aglyoosuria as a theoretic postulate. The rela- 

 tive importance of carbohydrates, albumin, fat, and alcohol for the diabetic. Difficulties 

 in supplying sufficient nutrition ; temporary under-nutrition not always avoidable. 

 Acidosis diabetica with acetonuria and diaceturia. The secondary increase of albumin 

 waste and the secondary decrease of the powers of oxidation in diabetics. Acidosis an 

 expression of the disproportion between over-abundant tissue-destruction and the less- 

 ened powers of oxidation. Acidosis as a cause of the diabetic (dyspneic) coma. 



The only method of treatment of real value in diabetes is the dietetic. 

 (We shall refer later to the medical treatment.) 



The foundation for the dietetic treatment in diabetes was laid one hundred 

 years ago by an English physician, Rollo, but it is only of late years that this 

 method of treatment has become general. Eollo discovered the correct method 

 empirically, but, as is frequently the case, the theoretic foundation had to be 

 worked out before his treatment obtained general recognition, and it required 

 great labor to establish this theoretic foundation. But it is not for this reason 

 that I intend to enter somewhat more minutely into these theoretic considera- 

 tions of the treatment of diabetes, but because we cannot otherwise obtain 

 such clear ideas of diabetes as are required for the practice of medicine. 



The first fundamental principle in the treatment of diabetes to which 

 I refer is this : 



Diabetic glycosuria usually increases with time, while the tolerance of the 

 patient decreases. 



The tolerance of the diabetic depends upon the relation between the 

 amount of sugar excreted and the quantity of sugar and sugar producers (par- 

 ticularly the carbohydrates) ingested. 



In the following example, for the sake of simplicity, I shall estimate the 

 entire amount of the carbohydrates in the food as bread. 



A patient receives 500 grams of meat, 3 eggs, 400 grams of vegetables deficient in 

 carbohydrates (salad, spinach, etc.), 100 grams of fat (cheese, sausage), in which there 

 is some albumin which need not be taken into account, butter and fat in the food, 100 

 grams of wheat bread, 100 grams of cream and the necessary wine, coffee and water. He 

 excretes two and a half liters of urine, with 3.5 per cent, sugar, that is, on the average, 



