PRACTICAL THERAPY 97 



taking the ■wishes .of the patient into consideration. She received daily 500 grams of 

 milk, 100 grams of bread, 200 grams of meat, 4 eggs, 200 grams of vegetables with ten 

 per cent, of fat, 50 grams of butter, and 75 grams of fatty cheese or sausage, etc., with 

 tea, coffee, and water ad libitum, and a half liter of wine. This diet was abundant, and 

 gave the patient 35 calories per kilo of body-weight. She remarked that she had not 

 eaten much more before treatment, not even of bread. During the following days she 

 excreted IJ to 2 liters of urine, and 3.5 per cent. (^50-70 grams) of sugar daily. At 

 the same time she felt stronger and improved each day. No acidosis. 



This is, in itself, a truly remarkable result of quantitative regulation of 

 the diet. Of course, there was some restriction, but the patient hardly 

 noticed it. 



In this case, the milk and the bread must be still further reduced until 

 the sugar has disappeared entirely. 



Our patient preferred not to have the milk in her diet reduced. The bread was there- 

 fore reduced to 40 grams, but after four days upon a diet containing 60 grams of bread 

 she still excreted sugar, but when the milk was reduced to 300 grams and the bread to 

 40 grams there was no glycosuria. On this diet she remained aglycosuric, so that after 

 fourteen days it was deemed possible to increase her food. For the sake of precaution, 

 100 grams of milk were withdrawn, but 10 grams of bread were added. She remained 

 free from sugar. After three days 100 grams of milk were added, and the patient 

 continued free from sugar; again after three days 10 grams of bread were added, and 

 100 grams of milk withdrawn. Thus she continued upon a diet of 500 grams of milk 

 and 100 grams of bread for six weeks, when she was aglycosuric and in apparent full 

 health, having attained a weight of 62 kilograms. 



She remained under observation. Occasionally, as the result of an indiscretion in 

 diet, a slight, transitory glycosuria occurred, and then the patient would live on 50 

 grams of bread for a few days, or would desist altogether from eating bread for a whole 

 day, then return to 50 grams of bread for a few days, until finally she became perfectly 

 aglycosuric on a diet of 100 grams of bread. 



The removal of glycosuria is by no means always so easy and simple. 

 "Very often more stringent methods must be employed; carbohydrates, flour 

 foods, and even milk, must be wholly excluded before the patient becomes 

 entirely free from sugar, and frequently even this is insufficient and nothing 

 remains but the reduction of albuminous food. The albumin nutrition may 

 then be restricted to 200 grams, even to 150 grams of cooked meat (reckoning 

 albumin as meat), so that the patient does not receive more than 40 to SO 

 grams of albumin. In the severe cases this limitation of the albumin nour- 

 ishment is one of the most important points. Its effect is often much greater 

 than can be explained by the withdrawal of the sugar formed from the albu- 

 min. For example: With 100 grams of albumin (besides the necessary fat.) 

 40 grams of sugar are excreted; after a reduction to 60 grams of albumin, 

 sugar disappears in a few days. That 40 grams of sugar are formed from 40 

 grams of albumin is hardly possible ; therefore, the aglycosuria cannot be due 

 to the limitation of sugar intake (in albumin). I have long been. convinced 

 that it is the limitation of food and the resulting disencumbrance of the 

 entire metabolism which brings about this favorable result. The metabolism 

 of the diabetic is not deficient in only one respect, namely, that with which 

 we are concerned, the working up of the sugar molecule and its preparation 

 for oxidation. His metabolism is deficient as a whole — witness the weakness 

 of the powers of oxidation as expressed unmistakably in the acidosis. 

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