THE THEORY OF THE TREATMENT OF DIABETES 89 



ter regarding the meaning of diabetic hyperglycemia. We there said that 

 hyperglycemia is the cause of most of the complications and many of the 

 dangers of diabetes mellitus, and the patient is safe only when he is excreting 

 little or no sugar. 



Therefore, there can be no question that in every case of diabetes the 

 therapeutic indication is to render the patient aglycosuric, or sugar-free. It 

 is obvious that the treatment is to be begun as soon as possible, so that little 

 time may remain in which the disease may unfold its tendency to develop 

 ad pejus. If there is any theoretical law as regards treatment which is found 

 to succeed in practice it is this. The chances for successful treatment are, 

 ceteris paribus, very much better in recent eases. It is Just as important to 

 insist that the treatment is an obvious necessity in the later course of the 

 disease, and should also be attempted from the beginning of symptoms by 

 means of dietetic treatment. For it has been determined only as regards the 

 dietetic treatment, and not as regards the aglycosuria brought about by drug 

 treatment, that it increases the tolerance of the diabetic. 



There are no theoretic contra-indications (i. e., such as might be derived 

 from our Imowledge of the diabetic disturbances of metabolism) against 

 carrying out this requirement, although the practical difficulties are fre- 

 quently great. 



The dietetic treatment of the diabetic gains its end by forbidding the use 

 of sugar and sugar-producing foods as far as possible. The sugar-producing 

 foods are the carbohydrates and albumin. Even from albumin sugar is pro- 

 duced in animal metabolism, and in no small quantity, as from 100 grams of 

 albumin (which amounts to about 400 grams of raw meat) about 50 grams of 

 sugar, or even more, may be formed. It is important to note that the organ- 

 ism also produces sugar from those varieties of albumin which contain no 

 preformed sugar, i. e., those from which it is impossible to extract sugar by 

 chemical means. An example of such an albumin containing no preformed 

 sugar is casein, and from this substance the diabetic produces sugar in large 

 amounts. 



Sugar production from fat does not play such an important role as to 

 influence diabetic glycosuria to any notable extent. For this reason, and on 

 account of its high calory value, fat is the most valuable food substance for 

 the diabetic. 



According to the very latest investigations (Bjierre) it may be looked 

 upon as settled that alcohol has nutritive value (indeed, 1 gram of alcohol 

 upon oxidation furnishes as much as 7 calories) and the diabetic does not 

 form sugar from this. But its utilization as food is limited, for if it is admin- 

 istered in large amounts it acts as a poison to protoplasm, increasing albumin 

 decomposition. It is believed that this toxic action of alcohol is to be feared 

 when more than 50 grams of alcohol are taken per day. 



That the patient must be sufficiently nourished, no matter how strict the 

 diabetic treatment, is a well-known rule, but by this we do not mean to say 

 that, temporarily, the patient may not be subjected to hyponutrition ; I have 

 already spoken of this. Under some circumstances, as we shall see, it is even 

 then permissible for the patient to abstain completely from food for twenty- 



