98 DIABETES MELLITUS 



In the severe cases which we are now considering it is almost always neces- 

 sary to limit the entire amount of food (albumin and fat included) so that 

 its total calory value will be lowered, even below the minimum required by 

 Eubner (35 calories per kilo of body-weight). Under-nutrition need not be 

 feared ; my diabetics, at least those who are treated in the hospital, get along 

 with 30 calories, and even less, per kilo, without losing body- weight. 



When the excretion of sugar has fallen to the minimum, about 0.5 per 

 cent., and not more than 10 grams of sugar per day are excreted, aglycosuria 

 may finally be brought about by giving the patient no food for twenty-four 

 hours. He may be allowed water ad libitum, for it is unnecessary in this con- 

 dition that the patient should suffer from thirst. This procedure — a twenty- 

 four-hour fast — was introduced by Cantani. 



Both the reduction of the albuminous foods and the twenty-four-hour fast 

 seem cruel, or at least drastic, measures, but they really are not so ; at least 

 the author has never had the least difficulty in enforcing them. More diffi- 

 culty in the strict dietetic treatment of diabetes is encountered in other direc- 

 tions. We shall speak of this later on. 



After glycosuria has been abolished, if we expect to increase the tolerance, 

 we must maintain aglycosuria for at least two weeks before we can appreciably 

 add to the food. After the patient has been finally brought to the daily allow- 

 ance of food which is sufficient for him he must remain upon this diet and 

 be under observation. It is also advisable at times to institute once a week 

 a twenty-four-hour fast for carbohydrates, during which period the patient 

 receives ho bread. 



Keeping, the patient for a month or longer without bread, starchy foods 

 or milk rarely succeeds, but the author knows of several diabetics who have 

 lived for years on a strict albumin-fat diet with the addition daily of 300 

 to 400 grams of green vegetables (deficient in carbohydrates), and they have 

 been able to attend to their business without taking unusual care of them- 

 selves. One, a man about forty years of age, held the responsible position of 

 professor at a university. 



We must, then, exert all our efforts and all our art properly to regulate 

 the diet! 



In what follows, I shall only mention briefly some of the main rules, the 

 observatice of which will enable the physician judiciously to handle his dia- 

 betics. We shall see, however, that in order to prescribe a diet, he must be 

 familiar with the composition of the most common foods as regards fat and 

 carbohydrates. All recent books on diabetes contain detailed data on this 

 subject, and the most essential figures in this respect will be given at the 

 conclusion of this article. 



I shall attempt no distinction between what is absolutely (in any quan- 

 tity) allowable for a diabetic, and what is absolutely forbidden. I consider 

 such a distinction wrong and dangerous. No diabetic should be permitted 

 the unrestricted use of any food; everything must be ordered him quantita- 

 tively. 



The amount of carbohydrates permitted is best considered in terms of 

 wheat bread; and most patients prefer to take the amount of carbohydrates 



