94 DIABETES MELLITUS 



We have already learned to differentiate between mild and severe eases, 

 but in gauging the case from a therapeutic standpoint we need to recognize 

 also a group of moderately severe cases. The mild cases are so benign that 

 they offer a splendid prospect for therapy and usually require but little treat- 

 ment. The severe and very severe cases, on the other hand, are so malignant 

 that even after the most energetic therapy the results obtained are slight and 

 unsatisfactory because incomplete or transitory. In the group of moderately 

 severe cases are included a great many which occupy a middle position, being 

 by no means so benign that they do not require continued observation ■ and 

 proper treatment, but by no means so malignant that they should be left to 

 their fate; by a more or less strict plan of treatment, they may be preserved 

 in fair health and moderate activity for many years. Among the cases which 

 at the beginning of treatment must be included in this intermediate group, 

 there are not a few which prove to belong to the mild form, but which, on 

 account of unfavorable influences, have passed temporarily into the moder- 

 ately severe form. In this group we also find some which belong to the severe 

 or very severe forms, but have not yet reached the full development of the 

 disease. 



Let us illustrate : 



A man aged fifty, with an inherited predisposition to diabetes. Ten days previously, 

 he undertook a lengthy and fatiguing excursion in the Black Forest, ate and drank more 

 than usual, and was thoroughly drenched by a heavy rain. Since that time, he has had 

 a voracious appetite, extreme thirst, marked diuresis, and has lost much weight. His 

 urine contained 8 per cent, of sugar ( ! ) . His daily dietary was restricted quantitatively 

 to about one pound of meat, several eggs, coffee with rich cream but no sugar, green 

 vegetables (no potatoes or beets), no cereals, 80 grams only of wheat bread, his meals 

 to be prepared without flour ; one bottle of wine was allowed. Within a few days his 

 glycosuria had disappeared. The case has continued to run a mild course up to the 

 present time ( twelve years subsequently ) . Since the acute attack, the patient's diet, 

 for the most part, has been restricted as above, although at times it has been relaxed 

 to the extent of allowing sweet champagne ; the sugar in the urine has never risen above 

 0.5 per cent. 



At the beginning of treatment this case appeared very desperate, but it 

 soon became a clear example of the mild form of diabetes. 

 To illustrate again : 



A peasant, thirty-three years of age and of a diabetic family. For five weeks following 

 an accident he complained of hunger, thirst, loss of flesh, lassitude, and cramps in the 

 calves of his legs. Patellar reflexes present; no complications; weight 48 kilograms; 

 internal organs sound. After eight days on regulated diet including fat meat, with 150 

 grams of milk, and 20 grams of wheat bread, the sugar in his urine was still 4 per cent. 

 - 5 per cent. (75 to 100 grams of sugar a day). Only after the complete withdrawal of 

 bread and increase of milk to 200 grams did the urine gradually become free from sugar. 

 After this on a diet with 200 grams of milk and 50 grams of bread he remained aglyco- 

 suric for several months, but even then he had to rigidly conform to rules in order to 

 prevent the reappearance of glycosuria. In this fashion he has now lived for years. His 

 weight is 56 kilograms. 



This is a typical case of the medium severe form ; severe at its onset but 

 under continuous, moderately strict dietetic treatment taking a rather favor- 

 able course. 



