PRACTICAL THERAPY 99 



permitted them in the form of good wheat bread. Some, however, would 

 rather have it as flour-cakes, and there is no objection to their having it in 

 the form of any simple carbohydrate that they prefer. If the patients take 

 their carbohydrates partly as wheat bread and partly in some other way, then 

 we must subtract the latter amount from the total that is permissible. Sup- 

 pose, for instance, that the patient is allowed 100 grams of wheat bread = 

 about 60 grams of starch. He prefers to take part of his starch in another 

 form, for instance, as oatmeal or rice, in soup, 10 grams being sufficient to 

 make a large dish of | of a liter ; or he takes balls of oatmeal, or 25 grams of 

 oatmeal alone. Oatmeal and rice contain about 75 per cent, of starch. We 

 can consider the 10 grams of oatmeal as equivalent to wheat bread, and there- 

 fore we must subtract 10 grams (or to be quite accurate 12 grams) from the 

 daily allowance (100 grams) of wheat bread. Twenty-five grams of grits or 

 rice are equal to about 30 grams of wheat bread. Of course, the patient may 

 have other forms of bread instead of wheat bread. Eolls are useful for this 

 purpose, the amount of starch being almost the same as in wheat bread. The 

 rolls may be cut into small slices and spread with butter. Rye bread is also 

 serviceable; it contains 15 per cent, less of starch, but is heavier and more 

 compact. Aleuronat bread contains only about half as much starch as wheat 

 bread, but there are few diabetics who like this bread, although among all the 

 varieties of so-called " diabetic bread," this has the most agreeable taste. 



Among vegetables the diabetic should eat only those in which the amount 

 of carbohydrates does not exceed 5 per cent, (compare the tables), and even 

 this slight amount of carbohydrates must not be ignored in those cases in 

 which the removal of glycosuria is difficult. With 300 grams of vegetables 

 per day, it may amount to as much as 15 grams. 



Fruits should be permitted the diabetic if possible. There are plenty of 

 fruits whose carbohydrates do not exceed 6 per cent, (sugar -\- pectin). They 

 must be well cooked and sweetened with saccharin. Almost any kind of fruit 

 may be given, even such as contain sugar in large amounts, but the amount 

 of carbohydrates they contain must be deducted from the amount of bread 

 which is permitted. Only grapes and dried fruits, on account of their high 

 sugar-contents, are to be excluded. The fact that the sugar contained in fruit 

 is levulose modifies the ease but little, for after prolonged use levulose becomes 

 almost as injurious as dextrose. Many so-called " fruits for diabetics " are to 

 be found on the market ; they contain about 2 per cent, to 4 per cent, of sugar, 

 therefore less than the fresh fruits, even those poor in sugar, but, unfortu- 

 nately, many diabetics grow tired of them after a time. 



In meat, besides the albumin, we must take into account the fat it con- 

 tains. Considering only the percentage of albumin (25 per cent.), the calory 

 value of stewed or broiled meat is only 1. When the ordinary amount of fat 

 is present (10 per cent.) the calory value becomes 2, but we must remember 

 that in the cooking of meat (broiling, stewing) part of the fat is lost ; in fact, 

 most of the fat is lost in cooking. Excluding the fat, all kinds of meat are 

 of the same calory value. Liver is strictly forbidden; of other " glands " 

 sweetbreads and brain, though not strictly meat, are of equal value on account 

 of their high percentage of fat. Naturally, fat meat is always preferable for 



