95 DIABETES MELLITUS 



the urine. We must make an attempt to diminish the glycosuria, and see how 

 far we are successful. Now and then, we can accomplish more than we had 

 hoped, and a better tolerance may follow a regulation of the diet and a reduc- 

 tion of the glycosuria, so that we may succeed in maintammg the patient s 

 equilibrium of metabolism with a very slight glycosuria and with a fair con- 

 dition of health for years, even after all hope had seemed to be gone. 



This is the chief task of the physician, easy in some cases, more difficult 

 in others, and in many almost impossible. Although the treatment of the 

 different groups of cases varies, one general rule applies to all. Fe should 

 determine the exact quantitative and qualitative diet for every diabetic who 

 comes under treatment. Prout exaggerated when he stated (1820) that the 

 quantity of the food, that is, the quantitative restriction, is more important 

 for the diabetic than its quality; but his maxim that all of the diabetic's food 

 (including meat) is to be determined quantitatively, holds good, because noth- 

 ing more unfortunate can befall a diabetic than the overtaxing of his general 

 powers of metabolism. I consider the restriction of labor of the whole metab- 

 olism to be an important advance in the therapy of diabetes. There are no 

 foods which the diabetic can be allowed to eat in unrestricted amount; the 

 quantity of each must be measured. We must see that he does not get too 

 much carbohydrate food, or too much animal food, and that he has just enough 

 fat, neither too much nor too little. 



I am proceeding on the supposition that the patient is to be treated not 

 in a hospital but in his own home. First of all, we must determine quantita- 

 tively for several days the amount of each food ingested. For this purpose it 

 is only necessary to know the amount of each carbohydrate (flour, bread, 

 sugar and milk) used in the preparation of his meals. If this plan is carried 

 out, there is no difficulty later. Each variety of food should be served on a 

 separate plate, and the amount weighed. Sauces are not considered, and bread 

 is weighed separately. If the patient cannot afford this, or if he is unwilling 

 to do it, he should either go to a hospital where others will look after his food, 

 or we must relinquish the attempt to regulate the whole diet quantitatively. 

 We may be able to get along without weighing the food in very mild cases in 

 which a moderate reduction of the carbohydrates is sufficient to control the 

 disease. 



Still, most patients, even those in limited circumstances, can arrange to 

 weigh their food. Usually a simple quantitative regulation of the diet, with 

 liberal allowance for the wishes and inclination of the patient, and without 

 too strict limitation, may be followed by good, even remarkably good results ; 

 at any rate, we may thus ascertain the maximum of the glycosuria on a given 

 diet and thus establish the necessary basis for further dietary regulations. 

 An example will best serve to make this intelligible. 



A woman, forty years of age, no hereditary history obtainable, has suffered for four 

 months from extreme hunger and thirst ; there is copious diuresis ; loss of weight 20 

 kilograms. Present weight 58 kilograms; no organic disturbances or complications; no 

 acidosis ; reflexes normal. The patient asserts that she has been on a diet, that is, that 

 she has eaten but little bread, etc. During the first three days of treatment, she ate as 

 before and was found to be excreting 2J to 3 liters of urine with 6 per cent, to 7 per cent. 

 (=: 150 to 200 grams) of sugar per day. Then the diet was regulated quantitatively, 



