DIABETES MELLITUS
~Definition.~--Diabetes is a disease which is characterized by an
inability on the part of the body to utilize the carbohydrates, in
consequence of which there is abnormal excretion of glucose in the
urine.
~Sugar in the Urine.~--The appearance of sugar in the urine may not
necessarily signify diabetes, it may be merely a temporary glycosuria
due to certain pathological conditions, such as infectious diseases,
diseases or trauma which affect the pancreas, and which disappear upon
the recovery from the disease. But any appearance of sugar in the
urine should be looked upon with suspicion, since the future welfare
of the patient depends largely upon an early diagnosis in any form of
diabetes.
~True Diabetes.~--Allen claims that true diabetes may always be
distinguished from nervous glycosuria by the application of the laws
governing these conditions (Allen's Paradoxical Law[137]), which is
"whereas in normal individuals the more sugar given the more is
utilized, the reverse is true in diabetes."
~Manufacture of Sugar from Other Foods.~--If the carbohydrate foods
alone caused all the trouble in diabetes, the disease might be more
easily controlled. This, we found, however, not to be true, since in
certain conditions the body utilizes the protein foods for the
manufacture of glucose also. Consequently in diabetes if the absolute
sugar output of the body is to be controlled, the intake of
nitrogenous foods must be likewise adjusted.
~Functions of Carbohydrates.~--In the chapter describing the
functions of the carbohydrates in the human body it was demonstrated
that their energy-producing properties did not cover the extent of
their usefulness. It has been proved that this food constituent
normally acts as neutralizing agent for the toxic acids produced
within the organism as a result of the breaking down of the _fats_.
Hence, when this function of the carbohydrates becomes impaired, these
acids, Oxybutyric acid, Diacetic acid and Acetone, fail to be
neutralized and are consequently absorbed into the blood stream,
giving rise to a form of intoxication known as acidosis. When acidosis
becomes extreme, the diabetic patient is apt at any time to succumb to
the dreaded diabetic coma.
~Keeping Urine Sugar Free.~--Thus it is seen that the treatment of
diabetes mellitus consists not alone of freeing the urine from sugar
and keeping it free, but of controlling the acidosis which may at any
time develop.
~Diabetic Cures.~--Numberless so-called diabetic cures have been
brought forward and more or less tested for years, but whether they
have really accomplished cures has not been satisfactorily proved. Not
until Dr. Allen instituted what is known as the Allen's Starvation
Treatment has the disease been so universally treated, at least by one
method or modification of one method. Dr. Joslin, who has used this
treatment most successfully, does not claim to have accomplished a
cure, but states that he is watching the results of the treatment in
his patients with interest.
~Starvation Treatment.~--The Allen Starvation Treatment consists of
first a period of about forty-eight hours in which the patient is
given an ordinary diet, during which time the daily weight is taken
and the urine examined and recorded.
~Acidosis.~--It has been found in some cases, such as with elderly
patients or those in whom there is an evident acidosis, advisable to
precede the period of starvation by a preliminary treatment.
~Method of Treatment.~--Joslin[138] suggests the following method of
procedure:
"Without otherwise changing the diet omit fat. After two days, omit
protein, then halve the carbohydrates daily until the patient is
taking only ten grams, then fast."
In the Michael Reese Hospital, the following series of test diets are
given to determine the severity of the diabetes:
DIABETIC TEST DIETS[139]
BREAKFAST
Grapefruit 1/2
Eggs 2
Bacon 20 grams
Bread 25 grams
Butter 10 grams
Cream 15 c.c.
Coffee 1 cup
DINNER
Cream soup 3 oz.
Roast beef 75 grams
Spinach 100 grams
Kohl-rabi 100 grams
Lettuce salad 50 grams
Ripe olives 15 grams
Bread 25 grams
Butter 20 grams
Wine gelatin 4 oz.
Coffee
Cream 15 c.c.
SUPPER
Lamb chop 1
Asparagus tips 50 grams
Eggplant 50 grams
Tomato salad 50 grams
Custard (diabetic)
Coffee
Cream 15 c.c.
Butter 20 grams
Bread 25 grams
~Diet in Mild Cases.~--This diet contains approximately 70 grams of
protein, 100 grams of fat, and 70 grams of carbohydrates, and the
patient is kept on it for at least two days; then the carbohydrates
are cut down by taking away 25 grams of bread every day.
DIABETIC DIETS[140]
KEY
A Carbohydrate
B Protein
C Fat
D Calories
E 5% Vegetable
F Orange
G Oatmeal
H Shredded Wheat
I Uneeda
J Potato
K Bread
L Egg
M Cream 20% Fat
N Bacon
O Butter
P Meat
Q Fish
R Skimmed Milk
S _Name of Diet_
T _Maintenance Diets_
========+==============+===============================================+==
Diets | _Diet in_ | |
with | _Grams_ | _Test Diets_ |
which to+---+--+--+----+---+---+--+---+-+---+--+-+---+--+--+---+---+---+
become | | | | | | | | | | | | | | | | | | |
Sugar | | | | | | | | | | | | | | | | | | |
free | A |B |C | D | E | F |G | H |I| J |K |L| M |N |O | P | Q | R |S
--------+---+--+--+----+---+---+--+---+-+---+--+-+---+--+--+---+---+---+--
T. D.1 |189|89|15|1247|300|300| | 1 | |240|90| | | | | 90|120|480| 1
T. D.2 |102|58| 0| 640|300|300| | 1 | |120| | | | | | |180|300| 2
T. D.3 | 64|33| 0| 388|300|300| | | | 60| | | | | | | 90|240| 3
T. D.4 | 36|27| 0| 252|300|200| | | | | | | | | | | 90|120| 4
T. D.5 | 15| 5| 0| 80|300| 50| | | | | | | | | | | | | 5
--------+---+--+--+----+---+---+--+---+-+---+--+-+---+--+--+---+---+---+--
| | _Carbohydrate_ | _Protein and Fat_ |
T | | (_C_) | (_PF_) |
--------+---+--+--+----+---+---+--+---+-+---+--+-+---+--+--+---+---+---+--
C1 +PF1 | 10|11| 6| 138|300| | | | | | |1| | | | | | | 1
C2 +PF2 | 22|13|18| 302|300|100| | | | | |1| 60| | | | | | 2
C3 +PF3 | 32|24|24| 440|600|100| | | | | |2| 60| | | | | | 3
C4 +PF4 | 42|29|39| 635|600|200| | | | | |2| 60|30| | | | | 4
C5 +PF5 | 52|32|53| 813|600|200|15| | | | |2| 60|30|15| | | | 5
C6 +PF6 | 63|43|65|1009|600|200|30| | | | |2| 90|30|15| 30| | | 6
C7 +PF7 | 73|51|70|1126|600|300|30| | | | |2| 90|30|15| 60| | | 7
C8 +PF8 | 83|59|87|1351|600|300|30| |2| | |2| 90|30|30| 90| | | 8
C9 +PF9 | 96|62|93|1469|600|300|30|1/2|2| | |2|120|30|30| 90| | | 9
C10+PF10|107|63|93|1517|600|300|30| 1 |2| | |2|120|30|30| 90| | |10
C11+PF11|131|75|98|1706|600|300|30| 1 |2|120| |2|120|30|30|120| | |11
C12+PF12|155|79|98|1818|600|300|30| 1 |2|240| |2|120|30|30|120| | |12
========+===+==+==+====+===+===+==+===+=+===+==+=+===+==+==+===+===+===+==
_Weight in_ _Approximate_
_Food_ _grams_ _equivalent_
Orange 300 One and one-half (large size)
5 per cent vegetables 300 Three moderate portions
Skimmed milk 480 One pint (16 ounces)
Fish 120 Two small portions
Potato 240 Two medium sized potatoes
Meat 90 One moderate portion
Bread 90 Three small slices
Oatmeal (dry wgt.) 30 One large saucerful
Cream 60 Four tablespoonfuls
Bacon 30 Four crisp strips
Butter 30 Three medium portions
The Test Diets are designed for the period during which
the patient becomes gradually sugar free. On successive
days advances can be made from Test Diet 1 to Test Diet
5, and if on the fifth day the patient is not sugar
free, fasting can be employed for one or more days.
The Maintenance Diets are for use so soon as the urine
of the patient is free from sugar. If this occurs as a
result of Test Diet 5 the patient begins with
Maintenance Diet C1PF1. The actual articles of food
representing the carbohydrate in the diet for the first
day are given under the heading of carbohydrate, for
convenience described C1, 2, 3, etc. The articles
referred to under protein and fat are under that
heading, which for the same reason is described as PF1,
2, 3, etc. Certain cases of diabetes can proceed
steadily day by day from C1PF1 to C12PF12, without
showing sugar. If sugar does appear in the urine, drop
back two days in the carbohydrate group, wait till sugar
free, then advance in the protein and fat group until
sufficient calories are obtained. Thus, if sugar shows
on C7PF7 the diet prescribed would be that included in
C5PF7 and thereafter progression could be made in the PF
group until twenty-five to thirty calories per kilogram
body weight were furnished the patient.
Occasionally the patient becomes sugar free on Test Diet
2, 3, or 4. It is then unnecessary to begin with
Maintenance Diet C1PF1, but instead with a maintenance
diet which contains a value for carbohydrate similar to
that of the test diet upon which the patient became
sugar free.
If the protein and fat are too high for the individual
on a given day it is easy to advance the carbohydrate
and decrease to an earlier day on protein and fat.
The plan is arbitrary and the majority of cases will
demand some modification. It is arranged to enable
patient or nurse to see in advance the general plan of
treatment.
(Courtesy of Dr. Joslin and Thomas Groom & Co., Boston.)
If the case is a mild one, this may be sufficient to free the urine
from sugar, but the diet is given primarily to enable the physician to
find out by means of urinalysis just how great is the functional
impairment.
In some cases, which are mild in character, the urine is made free of
both sugar and acetone without further dietetic measures. However,
when a severe diabetes is manifested and a high percentage of glucose
and in some cases acetone bodies are found in the urine a more rigid
treatment will be found necessary.
~Preliminary Diet.~--Many physicians find it advisable, as has already
been stated, to cut down the food allowance before stopping it
entirely. In the Michael Reese Hospital this is done by first giving a
practically fat-free diet, followed by one or two days in which three
or four eggs, 250 to 300 grams (8 or 10 ounces) of 5% vegetables are
given, after which it is found safe to institute the starvation
treatment.
~Sample Menus.~--The following menus are given to illustrate the
dietetic treatment which it is deemed advisable to institute in cases
where the starvation treatment cannot be given at once:
After the test diet of forty-eight hours, the following regime is
instituted:
THIRD DAY
=============================+=========+=======+==============+==========
|_Protein_| _Fat_ |_Carbohydrate_|
| _Gm._ | _Gm._ | _Gm._ |_Calories_
-----------------------------+---------+-------+--------------+----------
Breakfast: | | | |
1/2 grapefruit | | | 5 | 20
1 egg | 5.3 | 4.1 | | 59
1 slice bread 30 gm. | 2.6 | .3 | 15 | 73
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 7.9 | 4.4 | 20 | 152
Dinner: | | | |
Broth 180 c.c. | 3.7 | .17 | .34 | 18
Chicken (breast) 90 gm. | 18.2 | 2.1 | | 92
Spinach 100 gm. | 2.0 | | 3.0 | 20
Potato (1 medium) 90 gm. | 1.8 | .09 | 15.6 | 70
Lemon jelly 90 gm. | 4.2 | | 2.7 | 27
+---------+-------+--------------+----------
Total for meal | 29.9 | 2.3 | 21.6 | 227
Supper: | | | |
Lamb chop 50 gm. | 9.3 | 14.1 | | 126
Asparagus 100 gm. | 1.5 | | 3 | 18
Bread 20 gm. | 1.6 | .2 | 10 | 48
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 12.4 | 14.3 | 13 | 192
Total for day | 40.2 | 21 | 54.6 | 571
=============================+=========+=======+==============+==========
FOURTH DAY
=============================+=========+=======+==============+==========
|_Protein_| _Fat_ |_Carbohydrate_|
| _Gm._ | _Gm._ | _Gm._ |_Calories_
-----------------------------+---------+-------+--------------+----------
Breakfast: | | | |
1/2 grapefruit | | | 5 | 20
1 egg | 5.3 | 4.1 | | 59
1 slice bread 20 gm. | 1.6 | .2 | 10 | 48
Coffee or tea | | | |
+---------+-------+--------------+----------
Total for meal | 6.9 | 4.3 | 15 | 107
Dinner: | | | |
Tomato bouillon 180 gm. | 2.2 | .23 | 2.5 | 15
Whitefish 90 gm. | 2 | | 5 | 28
Boiled onions 100 gm. | 1.5 | .3 | 7.5 | 40
Bran muffin (1) | 5 | 7 | 4.5 | 101
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 25.7 | 16.2 | 20.5 | 322
Supper: | | | |
1 egg | 5.2 | 4.1 | | 59
Tomato (baked) 100 gm. | .6 | | 2 | 10
Bran muffin (1) | 1 | 5 | 7 | 101
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 6.8 | 9.1 | 9 | 170
Total for day | 38.4 | 29.6 | 44 | 513
=============================+=========+=======+==============+==========
FIFTH DAY
=============================+=========+=======+==============+==========
|_Protein_| _Fat_ |_Carbohydrate_|
| _Gm._ | _Gm._ | _Gm._ |_Calories_
-----------------------------+---------+-------+--------------+----------
Breakfast: | | | |
1/2 grapefruit | | | 5 | 20
Broiled tomato 100 gm. | 1.5 | | 3 | 18
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 1.5 | | 8 | 38
Dinner: | | | |
Broth 120 c.c. | 3 | | | 12
Lettuce 50 gm. | .5 | | 1.5 | 8
Cauliflower 90 gm. | 1.5 | .4 | 3.9 | 25
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 5 | .4 | 5.4 | 45
Supper: | | | |
1 egg | 5.35 | 4.16 | | 59
String beans 100 gm. | 2 | | 5 | 28
Celery 50 gm. | .5 | | 1.5 | 8
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 7.85 | 4.16 | 6.5 | 85
Total for day | 14.3 | 12.5 | 19.9 | 168
=============================+=========+=======+==============+==========
SIXTH DAY
=============================+=========+=======+==============+==========
|_Protein_| _Fat_ |_Carbohydrate_|
| _Gm._ | _Gm._ | _Gm._ |_Calories_
-----------------------------+---------+-------+--------------+----------
Breakfast: | | | |
Asparagus tips 60 gm. | 1.5 | | 3 | 18
Spinach 60 gm. | 1.1 | 1.8 | 1.8 | 32
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 2.68 | 1.8 | 5.8 | 50
Dinner: | | | |
Stewed celery 100 gm. | 1 | .10 | 2.1 | 15
String beans 50 gm. | 1.5 | | 2.5 | 16
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 2.5 | .1 | 5.6 | 31
Supper: | | | |
Beet tops 75 gm. | 1.5 | | 2.5 | 16
Onions (boiled) 75 gm. | 1.5 | .3 | 7.5 | 44
Tea or coffee | | | |
+---------+-------+--------------+----------
Total for meal | 3 | .3 | 10 | 60
Total for day | 11.2 | 2.2 | 21.4 | 141
=============================+=========+=======+==============+==========
FAST
~Method of Administering Treatment.~--In many cases the patient is
first put to bed during the starvation treatment, but recently Dr.
Allen has emphasized the value of exercise, claiming that it assists
in utilizing the sugar. In any case, the starvation regime remains the
same. The patient is given only coffee or clear broth with or without
whisky (one ounce every two hours) and the treatment continued from
one to four days, or until the urine becomes sugar free.[141]
It has rarely been found necessary to continue the fast longer than
four days, since in most cases the sugar decreases rapidly upon the
discontinuance of food.
~Loss of Weight.~--The slight loss of weight, which may be noticeable
as the result of starvation, is not undesirable, especially in those
cases where obesity is a prominent feature. In fact care must be
exercised in the follow-up treatment to prevent the taking on of
weight by the diabetic individual, since, according to Allen, it is
often found that even moderately obese patients (180 lb.) continue to
excrete a small amount of sugar so long as they hold this weight, even
upon a low carbohydrate diet, whereas those same patients show no
difficulty in becoming sugar free if the weight is reduced by ten or
fifteen pounds.
SCHEDULE FOR TREATMENT AND METHODS OF DETERMINING FOOD TOLERANCES
A number of schedules have been devised to enable the nurse
successfully to carry out the Allen Treatment. In following out this
treatment and reeducating the organs afterward to tolerate foods which
they have been unable to handle on account of the impairment of the
sugar-making organs, it is necessary to make a series of tests
whereby the diet is gradually increased in its various constituents
until the diabetic patient is able to handle a reasonable amount of
carbohydrates as well as other foods which have given more or less
trouble in the past.
The following schedule, after Joslin,[142] is included, and a careful
study of it is advised in order that the nurse may intelligently carry
out the Allen Treatment.
~Schedule.~--Fasting in many cases begins at once and the patient
experiences no ill effects from it. However, in severe, long-standing
cases many patients do better if the fats are omitted at once and the
rest of the diet left unchanged for two days. Then the proteins in the
diet are omitted and the carbohydrates cut in half. This halving of
the carbohydrates is continued daily until only 10 grams remain, after
which they too are omitted. The fast is thus made complete and remains
so until the urine is entirely free from sugar.
~Carbohydrate Tolerance~ is determined by giving, as soon as the urine
has been sugar-free for twenty-four hours, 150 grams of 5% vegetables.
This is equivalent to from 8 to 10 grams of carbohydrates. After this
5 grams of carbohydrates, or 75 grams of 5% vegetables, are added
daily to the diet until the patient is taking 20 grams. Then the
addition of 5 grams of carbohydrates is made every other day, using
the fruits and vegetables belonging to the 10% and 15% carbohydrate
group, until potatoes and oatmeal and finally bread can be tolerated
unless sugar appears in the urine before this or the tolerance reaches
3 grams to each kilogram of body weight or, in other words, until a
man weighing 150 pounds is consuming 225 grams of carbohydrates per
day.
~Protein Tolerance.~--In making the test for the protein tolerance it
is necessary to wait until the urine has been sugar free for
forty-eight hours; 20 grams of protein is then given. This is
equivalent to 3 eggs, and daily additions of 5 grams protein are made,
usually in the form of meat, until the patient is receiving 1 gram of
protein to every kilogram of his body weight per day unless his
carbohydrate tolerance is zero, in which case it is wise to add only
three-fourths of a gram of protein per day.
~Fat Tolerance.~--A determination of the fat tolerance is made
coincidently with that of the protein. No additional fat is allowed
until the protein tolerance reaches 1 gram per kilogram of body
weight, unless the patient's tolerance for protein is less than that.
After which 25 grams of fat per day are added until there is no
further loss of weight, taking care never to allow more than 40
calories per kilogram of body weight.
~Reappearance of Sugar.~--Should the urine again show the presence of
sugar, another period of fasting lasting for twenty-four hours, or
until the urine is again sugar free, must be instituted. After the
second fast the increase in the diet may be twice as rapid as used
after the first fast. However, it is not advisable to increase the
amount of carbohydrates to more than half of that determined by the
former tolerance for a period of two weeks, during which time the
urine has been entirely sugar free, then the increase is made more
slowly and the amount given should not exceed 5 grams a week.
~Weekly Fast Days.~--One day in seven should be set aside by the
diabetic patient for fasting, when the carbohydrate tolerance is less
than 20 grams. When, however, the tolerance is between 20 and 50 grams
of carbohydrates, the patient may take one-half of his daily allowance
of protein and fat and a certain amount of 5% vegetables as well upon
the weekly fast day. When the tolerance reaches between 50 and 100
grams per day, vegetables of a higher carbohydrate content may also be
included. If the carbohydrate tolerance should exceed 100 grams per
day, the carbohydrates upon the fast day may be simply half of the
amount allowed upon other days.
~The Giving of Alkalies.~--If acidosis is evident, as may be indicated
by an excretion of diacetic acid, oxybutyric acid, or acetone in the
urine, alkalies may be given. Bicarbonate of soda may be given in
doses of 2 grams every 3 hours, as suggested by Hill and Eckman,[143]
but this is not as a rule necessary, for, as Jacobi aptly remarks:
"Prevention is the treatment of acidosis in children, and those
susceptible to acidosis should not have fat." What he has said for
children holds good for adults. However, it is likewise true that fat
must constitute a large part of a diabetic diet and the only way to
prevent it poisoning, is to raise the fat in the diet gradually until
the tolerance is determined.
~Determining the Extent of Acidosis.~--It will be remembered that in
an earlier chapter it was found that the excretion of ammonia in the
urine to a certain extent indicated the extent of the acidosis in the
body, that is, if the ammonia output exceeds three or four grams a day
(twenty-four hours), the extent of the acidosis is considerable, while
if it falls below that amount it is not alarming. More exact methods,
however, for the determining of the severity of the acidosis will be
found in another part of this text, where the test for sugar and the
acetone bodies will be explained in detail.
~Dietetic Treatment.~--The patient is placed upon a vegetable diet
consisting of vegetables containing not more than five per cent.
carbohydrate.[144] These vegetables have their carbohydrate content
still further reduced by changing the water in which they are cooked
three times. In many cases this will reduce their content as much as
one-half.
A small amount of fat usually in the form of butter is allowed with
these vegetables. The amount of 5% vegetables given must be carefully
adjusted since the patient might readily take too much if allowed to
follow the dictates of his appetite.
The carbohydrate intake during the first one or two days must be
limited to 15 grams. This allows about 10 grams of protein, 7 grams of
fat, and 15 grams of carbohydrates. Tea or coffee, without sugar or
cream, may be given at each of the three meals.
The following table is included, showing the various foods arranged
according to their carbohydrate content:
TABLE[145]
STRICT DIET
Meats, fish, broths, gelatin, eggs, butter, olive oil, coffee, tea,
and cracked cocoa.
Foods arranged approximately according to per cent of carbohydrates
======================+==============+================+===============
5% | 10% | 15% | 20%
----+-----------------+--------------+----------------+---------------
|Lettuce |Pumpkin |Greens |Potatoes
|Cucumbers |Turnip |Peas |Shell beans
|Spinach |Kohl-rabi |Artichokes |Baked beans
|Asparagus |Squash |Parsnips |Green corn
|Rhubarb |Beets |Lima beans |Boiled rice
F |Endive |Carrots | (canned) |Boiled macaroni
r |Marrow |Onions | |Prunes
V e |Sorrel |Mushrooms | |
e s |Sauerkraut | | |
g h |Beet greens | | |
e |Dandelion | | |
t o |Swiss chard | | |
a r |Celery | | |
b |Brussels sprouts | | |
l C |Water cress | | |
e a |Sea kale | | |
s n |Okra | | |
, n |Cauliflower | | |
e |Eggplant | | |
d |Cabbage | | |
|Radishes | | |
|Leeks | | |
|String beans | | |
|Broccoli | | |
|Tomatoes | | |
----+-----------------+--------------+----------------+---------------
|Ripe olives |Lemons |Apples |Plums
F | (20% fat) |Oranges |Pears |Bananas
r |Grapefruit |Cranberries |Apricots |
u | |Blackberries |Blueberries |
i | |Gooseberries |Cherries |
t | |Peaches |Currants |
s | |Pineapple |Raspberries |
| |Watermelon |Huckleberries |
----+-----------------+--------------+----------------+---------------
|Butternuts |Brazil nuts |Almonds |Peanuts 40%
N |Pignolias |Black walnuts |English walnuts |Chestnuts
u | |Hickory |Beechnuts |
t | |Pecans |Pistachios |
s | |Filberts |Pine nuts |
====+=================+==============+================+===============
M | Unsweetened and unspiced Reckon available carbohydrates
i | pickle, clams, oysters, in vegetables of 5% group as 3%,
s | scallops, liver, fish of 10% group as 6%.
c | roe.
. |
====+=================================================================
30 grams (1 oz.) contains approximately:
==============================+=========+=====+==============+==========
|_Protein_|_Fat_|_Carbohydrate_|
| _Gm._ |_Gm._| _Gm._ |_Calories_
------------------------------+---------+-----+--------------+----------
Oatmeal, dry weight | 5 | 2 | 20 | 110
Meat (uncooked ham) | 6 | 3 | 0 | 50
Meat (cooked ham) | 8 | 5 | 0 | 75
Broth | 0.7 | 0 | 0 | 3
Potato | 1 | 0 | 6 | 25
Bacon | 5 | 15 | 0 | 155
Cream, 40% | 1 | 12 | 1 | 120
Cream, 20% | 1 | 6 | 1 | 60
Milk | 1 | 1 | 1.5 | 20
Bread | 3 | 0 | 18 | 90
Butter | 0 | 25 | 0 | 240
Egg (one) | 6 | 6 | 0 | 75
Brazil nuts | 5 | 20 | 2 | 210
Orange or grapefruit (one) | 0 | 0 | 10 | 40
Vegetables, 5% and 10% groups | 0.5 | 0 | 1 or 2 | 6 or 10
Oysters | 6 | 1 | 4 | 50
------------------------------+---------+-----+--------------+----------
TABLE[146]
Carbohydrate equivalent of 1 slice of white bread (1 oz. or 30 gm.)
containing approximately 15 gm. of starch
==============+==============+=====+===============+==============+======
_Uncooked_ |_Household_ | | _Cooked_ | _Household_ |
_Flours, etc._|_Measure_[147]|_Gm._| _Vegetables_ | _Measure_ | _Gm._
--------------+--------------+-----+---------------+--------------+------
Barley | 1 h. tbs. | 21 |Artichokes | 1 medium | 320
Buckwheat | 1 h. tbs. | 19 |Beans (baked | |
Corn meal | 1 h. tbs. | 20 | canned) | 2 h. tbs. | 75
Farina | 1 h. tbs. | 20 |Beans, lima | 1-1/4 tbs. | 50
Hominy | 1 h. tbs. | 18 |Beets | 6 tbs. | 200
Macaroni | 1 h. tbs. | 20 |Carrots | 13 tbs. | 446
Noodles |1-1/2 h. tbs. | 20 |Okra | 4 tbs. | 200
Oatmeal | 1 h. tbs. | 22 |Onions | 3 tbs. | 300
Rice | 1 h. tbs. | 18 |Parsnips | 4 slices | 120
Rye flour | 1 h. tbs. | 18 |Peas, green | 3 h. tbs. | 100
Spaghetti |1-1/2 tbs. | 20 |Potatoes | |
Vermicelli |1-1/2 tbs. | 21 | (baked) | 1/2 medium | 60
Wheat flour | 1 tbs. | 20 |Potatoes | |
| | | (boiled) | 1/2 medium | 70
| | |Potatoes | |
| | | (mashed) | 1-1/2 h. tbs.| 80
| | |Potatoes, sweet| |
| | | (boiled) | 1/3 medium | 35
| | |Squash | 2 h. tbs. | 100
| | |Turnips | 3 | 210
| | | | |
_Bread and_ | | |_Cooked Cereal_| |
_Crackers_ | | |Force | 5 h. tbs. | 18
Bread | 1 slice | 30 |Farina | 2-1/2 h. tbs.| 125
Breakfast | | |Grape-Nuts | 1-1/2 h. tbs.| 20
biscuit, | | |Hominy | 1-1/2 h. tbs.| 90
Huntley | | |Macaroni | 2 h. tbs. | 100
and Palmer | 3 | 18 |Oatmeal | 2-1/2 h. tbs.| 130
Corn bread | 1 slice | 32 |Rice | 1/2 h. tbs. | 60
Roll, Vienna | 3 | 18 |Shredded wheat | |
Zwieback | 1-1/3 | 20 | biscuit | 3/4 | 22
| | | | |
_Fruits_ | | | | |
Apple | 1 medium | 120 | | |
Apricots | 2 large | 120 |_Dried Fruit_ | |
Banana | | |Apples | 3 small | 22
(without skin)|1/2 medium | 75 |Apricots | 3 large | 24
Cherries | | 90 |Currants | 1-1/2 h. tbs.| 20
Currants | 5 h. tbs. | 120 |Dates | 3 | 19
Grapefruit | 1/2 small | 150 |Figs | 1 large | 12
Huckleberries | 3-1/2 tbs. | 90 |Prunes | 2 large | 24
Lemons | 2 medium | 210 |Raisins |10 large | 23
Muskmelon | 1/3 | 300 | | |
Nectarine | 1 | 100 |_Milk and_ | _Household_ |
Olives (green)| 20 | 180 | _Cream_ | _Measure_ |_C.C._
Orange | 1/2 large | 150 |Buttermilk |1-1/2 tumbler | 300
Peaches | 1-1/2 medium | 150 |Cream, 16% |1-1/2 tumbler | 300
Pear | 1 small | 100 |Cream, 40% |1-1/2 tumbler | 300
Pineapple | 3 slices | 150 |Koumiss |1-1/2 tumbler | 300
Plums | 3 medium | 75 |Whole milk |1-1/2 tumbler | 300
Raspberries | 4-1/2 h. tbs.| 120 | | |
Strawberries | 8 h. tbs. | 200 | _Nuts_ | | _Gm._
Watermelon | large slice | 300 |Almonds | 60 | 90
| | |Brazil | 30 | 180
| | |Chestnuts | |
| | | (roasted) | 15 | 40
| | |Cocoanut | 1 slice |
| | | | (3 x 2 in.) | 50
| | |Filberts | 100 | 110
| | |Peanuts | 40 | 80
| | |Pecans | 35 | 110
| | |Pistachios | 190 | 95
| | |Walnuts | 30 | 125
==============+==============+=====+===============+==============+======
TABLE[148]
Caloric equivalent of 10 gm. steak in carbohydrate-free meat or fish
=================+============+============+============+===========
_Food_ | _Gm._ | _Fat_ | _Protein_ | _Calories_
| | _Gm._ | _Gm._ |
-----------------+------------+------------+------------+-----------
Steak | 10 | 1.0 | 2.4 | 19
Roast beef | 5 | 1.4 | 1.1 | 18
Tongue | 7 | 1.4 | 1.6 | 20
Lamb chop | 5 | 1.5 | 1.1 | 18
Roast lamb | 8 | 1.3 | 1.6 | 20
Sweetbreads | 11 | 0.1 | 4.4 | 19
Boiled ham | 7 | 1.4 | 1.5 | 19
Fried ham | 5 | 1.7 | 1.1 | 20
Roast pork | 9 | 0.9 | 2.6 | 19
Bacon | 9 | 1.7 | 0.9 | 20
Chicken | 10 | 1.0 | 2.4 | 19
Duck | 9 | 1.3 | 1.8 | 19
Guinea hen | 12 | 0.8 | 2.8 | 19
Squab | 9 | 1.1 | 2.1 | 19
Turkey | 7 | 1.3 | 2.0 | 20
Bluefish | 13 | 0.6 | 3.5 | 20
Halibut | 16 | 0.7 | 3.3 | 20
Mackerel | 15 | 1.0 | 2.5 | 20
Sardines in oil | 7 | 1.4 | 1.6 | 20
=================+============+============+============+===========
Approximate equivalent in 30 c.c. (1 oz.) of whisky in liquors
containing 2 per cent or less of carbohydrates
==============================+==============+===============
| | _Household_
| _C.C._ | _Measure_
------------------------------+--------------+---------------
Gin, rum, brandy | 30 | 2 tbs.
Claret, Burgundy Hock, Rhine | |
and Moselle wines | 130-160 | 3/4 tumbler
==============================+==============+===============
CARBOHYDRATE-FREE MENUS
The following menus are suggested as meeting the carbohydrate-free
diet requirements with a nutrient value of from 200 to 500 calories:
Breakfast--Black coffee (cream, 20 c.c.) }
Bacon, 2 slices (1 oz.) } 30 grams
Egg--1
Dinner--Broth, 6 ounces 180 grams
Steak, 1 small piece, 1-1/3 oz. 40 grams
Stewed tomatoes, 3-1/3 oz. 100 grams
Lettuce (lemon juice and olive oil) 25 grams
Supper--Broth 180 grams
Whitefish 40 grams
Spinach 100 grams
Cabbage salad 100 grams
Coffee
Breakfast--1/2 grapefruit
1 egg
Bacon 40 grams
Coffee 50 grams
Cream 20 c.c.
Dinner--Broth 180 c.c.
Kohl-rabi 100 grams
Lettuce 25 grams
Cheese salad 50 grams
Roast beef 40 grams
Coffee
Butter 5 grams
Supper--Cold chicken 25 grams
Baked tomatoes 100 grams
Water cress 50 grams
Coffee
Cream 20 c.c.
Butter 5 grams
TABLE
KEY:
A _Protein Gm._
B _Fat Gm._
C _Carbohydrate Gm._
D _Calories_
===================+========================+=====+======+=====+========
| | | | |
_Material_ | _Measure_ | A | B | C | D
-------------------+------------------------+-----+------+-----+--------
Apple | 1 medium (150 gm.) | .5| .5 | 16 | 70
Almonds[149] | 10 small (10 gm.) | 2 | 5 | 2 | 63
Apricots (dried) | 1 oz. (30 gm.) | 1.5| .28| 17.5| 78
Asparagus | 6 large stalks | 1.3| .14| 2.5| 16
| (74 gm.) | | | |
Bacon (raw)[149] | 4 slices, 6 in. long, | 10 | 64 | | 636
| 2 in. wide | | | |
Bacon (cooked)[149]| 4 slices, 6 in. long, | 10 | 32 to| | 388 to
| 2 in. wide | | 46 | | 468
Beef juice[150] | 100 gm. | 4.9| .6 | | 25
Beef roast[149] | 1-1/2 in. x 1/8 in. | 6 | 7 | | 89
Cheese[149] | | | | |
(Neufchatel) | 1 cheese 2-1/4 in. x | 16 | 23 | 1 | 284
| 1-1/2 in. x 1-1/4 in. | | | |
Cream, gravity 16% | 1 glass (7 oz.) | 5 | 32 | 10 | 359
Cream, 40% | 30 c.c. (2 tbs.) | .6| 12 | 1 | 114
Cracker (Uneeda | 1 biscuit | 1 | .5 | 1 | 16
biscuit) | | | | |
Dry peptonoids[150]| 1 tbs. | 6 | | 8 | 57
Egg | 1 medium (45 to | 54 | 4.2 | | 60
| 50 gm.) | | | |
Fowl | 3-1/2 oz. (100 gm.) | 19.3| 16.3 | | 224
Grapefruit | 1/2 | | | 5 | 20
Ham (lean) | 50 gm. | 12.4| 7.1 | | 113
Lemon juice[151] | 3 tbs. (43 gm.) | | | 4.2| 19
Lemon Jelly[152] | 3 oz. (90 gm.) | 2.6 | | 1.4| 16
Milk (whole) | 1 glass (8 oz.) | 7.9 | 9.6 | 10 | 158
| 240 c.c. | | | |
Oatmeal[153] | 1 tbs. (50 gm.) | 1 | | 6 | 33
Oatmeal | 1/2 cup (3.6 oz.) | 2.1| .1 | 8.2| 50
Potato[153] (size | | | | |
large egg) | 1 (100 gm.) | 2 | | .8| 83
5% vegetable[153] | | | | |
uncooked | 1 tbs. | | | 2.5| 10
5% vegetable | | | | |
(boiled once) | 1 tbs. | | | 1.7| 7
5% vegetable | | | | |
(boiled thrice) | 1 tbs. | | | 1 | 4
Orange | 1 large | 1.7| .2 | 22.7| 100
Orange[153] | 1 medium | 1 | | 13 | 57
-------------------+------------------------+-----+------+-----+--------
~Increasing the Diet.~--The following menus show the manner in which
the diet is increased after the starvation treatment:
~First Day~
Approximately 150 grams of vegetables with tea or coffee; value:
protein 2, fat trace, carbohydrate 4.
Breakfast--String beans 20 grams
Celery hearts 20 grams
Lunch--Spinach 25 grams
Lettuce 25 grams
Supper--Tomatoes 25 grams
Cucumbers 25 grams
~Second Day~
Three eggs, 150 grams of 5% vegetables, tea or coffee; value
approximately: protein 18, fat 12, carbohydrate, 4, calories 198.
Breakfast--1 poached egg
Spinach or beet tops 50 grams
Coffee or tea
Dinner--1 hard-cooked egg
String beans 25 grams
Lettuce 25 grams
Tea
Supper--1 soft-cooked egg
Asparagus tips 25 grams
Tomatoes 25 grams
~Third Day~
Approximately 19 grams protein, 15 grams fat, 5 grams carbohydrate,
230 calories.
Breakfast--1 egg
String beans 50 grams
Tomatoes 25 grams
Coffee
Dinner--Cauliflower 50 grams
Celery 50 grams
Tea
Supper--Asparagus 75 grams
Lettuce 50 grams
~Fourth Day~
Approximately 26 grams protein, 15 grams fat, 10 grams carbohydrate,
279 calories.
Breakfast--1 egg
String beans 75 grams
Coffee with cream 15 c.c.
Dinner--Tomato bouillon 6 oz. (180 c.c.)
1 egg
Asparagus 75 grams
Lettuce 25 grams
Tea
Supper--1 egg
Celery 50 grams
Cauliflower 100 grams
~Fifth Day~
Approximately 20 grams protein, 46 grams fat, 15 grams carbohydrate.
Breakfast--Egg omelet (1 egg)
Butter 10 grams
Vegetable hash 100 grams
Coffee or tea
Cream 15 grams
Dinner--Chicken broth 180 c.c.
1 poached egg
Tomatoes 100 grams
Tea
Supper--1 soft-cooked egg
Spinach 100 grams
Cucumbers 50 grams
Tea or Coffee
Cream 15 grams
~Sixth Day~
Approximately 33 grams protein, 35 grams fat, 12 grams carbohydrate,
495 calories.
Breakfast--1/2 grapefruit
1 egg
Butter 5 grams
Spinach 50 grams
Coffee
Cream 15 grams
Dinner--Broth 180 grams
Fish 50 grams
String beans 100 grams
Lettuce 50 grams
Asparagus 50 grams
Supper--2 eggs
Tomato, baked (1 medium) 75 grams
Cabbage salad 75 grams
Tea
Cream 15 grams
~Seventh Day~
Approximately 38 grams protein, 45 grams fat, 17 grams carbohydrate,
625 calories.
Breakfast--1/2 grapefruit
2 eggs
Butter 10 grams
Coffee
Cream 15 grams
Dinner--Beef broth 180 grams
1 lamb chop 50 grams
Cauliflower 100 grams
Tomato 150 grams
Lettuce 50 grams
Butter 10 grams
Supper--1 egg
Tuna salad 50 grams
String beans 100 grams
Butter 5 grams
Tea
~Eighth Day~
Approximately 32 grams protein, 16 grams fat, 20 grams carbohydrate,
625 calories.
Breakfast--1 egg
String beans 100 grams
Raw tomatoes 100 grams
Coffee
Cream 15 grams
Dinner--Chicken 50 grams
Cabbage 100 grams
Asparagus 100 grams
Water-cress salad 50 grams
Tea
Supper--1 egg
Greens 100 grams
Celery salad 50 grams
Tea
Cream 15 grams
The following menus are used after the diet has been more or less
increased:
~First Day~
Breakfast--1 soft-cooked egg
2 slices of bacon
1 bran muffin, 5 gm. butter
Coffee with 15 c.c. of 40% cream
Lunch--6 oz. tomato bouillon
2 oz. (60 gm.) roast lamb
60 gm. string beans
50 gm. lettuce and celery salad
25 gm. lemon jelly with 15 gm. cream
Dinner--60 gm. chicken
75 gm. asparagus
4 olives
50 gm. cauliflower
30 gm. ice cream
1 Lister roll, 5 gm. butter
Black coffee
~Second Day~
Breakfast--1/2 grapefruit
1 scrambled egg
1 Lister roll, 8 gm. butter
Coffee with 15 gm. cream
Lunch--60 gm. baked halibut with 10 gm. parsley butter
70 gm. cauliflower
50 gm. lettuce
1 Lister roll, 8 gm. butter
Tea
Dinner--6 oz. chicken broth
60 gm. roast beef
75 gm. cabbage
75 gm. string beans
30 gm. coffee jelly with 15 gm. cream
Black coffee
~Third Day~
Breakfast--1 soft-cooked egg
2 slices bacon
1 Casoid flour and bran muffin with 5 gm. butter
Coffee with 15 gm. cream
Lunch--100 gm. cabbage
40 gm. corned beef
50 gm. tomato salad
1 soya meal muffin, 8 gm. butter
Tea
Dinner--60 gm. beefsteak
75 gm. asparagus
75 gm. spinach
30 gm. tomato aspic
30 gm. soft (diabetic) custard
Black coffee
~Fourth Day~
Breakfast--1 scrambled egg with 20 gm. chipped beef
1 Casoid flour muffin with 8 gm. butter
Coffee with 30 gm. or less cream
Lunch--6 oz. tomato bisque
60 gm. tuna fish salad
75 gm. vegetable hash
1 Lister roll, 8 gm butter
Tea
Dinner--60 gm. broiled chicken
75 gm. string beans
75 gm. cauliflower
30 gm. tomato and celery salad
30 gm. wine jelly, with 15 gm. whipped cream
Black coffee
~Fifth Day~
Breakfast--1/2 grapefruit
1 soft-cooked egg
1 bran muffin with 8 gm. butter
Coffee, 15 gm. cream
Lunch--40 gm. broiled beefsteak
75 gm. spinach
75 gm. boiled onion
1 soya meal muffin with 8 gm. butter
Tea
Dinner--6 oz. tomato bouillon
80 gm. baked fish with parsley sauce
75 gm. Brussels sprouts with 5 gm. butter
1 Lister roll with 5 gm. butter
Coffee jelly, 30 gm., with 15 gm. whipped cream
~Sixth Day~
Breakfast--1 poached egg
2 slices bacon
1 bran and Casoid muffin with 5 gm. butter
Coffee with 15 gm. cream
Lunch--Ham omelet (1 egg, 1 tbs. cream, 15 gm. minced ham)
75 gm. spinach
1 soya meal muffin with 8 gm. butter
Tea
A departure from the now almost universally used "Allen-Joslin
Starvation Diet," is seen in the "Newburg-Marsh High Fat Diet."
The use of a high fat diet in the treatment of diabetes is based
primarily on one fact--namely, that if the food eaten is not
sufficient for the needs of metabolism, the body itself supplies the
deficiency. Fat is used as long as it lasts, body protein being drawn
upon for fuel when this is exhausted. It is of distinct advantage to
the patient to have a diet of sufficient fuel value to run his body
machine and permit him a moderate degree of exercise. For by this
means he is not obliged to use his own body substance to carry on
metabolic processes. We thereby avoid the condition of extreme
emaciation (though it is to be emphasized that gain in weight is to be
carefully guarded against) with its constant lowering of the general
health.
The system of feeding consists of a series of four diets, examples and
standards of which are given below. The diet is made up of protein on
the basis of approximately 2/3 of a gram per kilogram of body weight
at the time the patient leaves the hospital, a quantity of
carbohydrate known to be well tolerated and the balance of the
calories in fat.[154]
DIABETIC DIET NO. 1
=======================================================================
18-22 Proteins
12-15 Carbohydrates
800-1000 calories
-------------------------+--------+---------+-----+---------+----------
|_Weight_|_Protein_|_Fat_|_Carbo-_ |
_Food_ | _Gm._ | _Gm._ |_Gm._|_hydrate_|_Calories_
| | | | _Gm._ |
-------------------------+--------+---------+-----+---------+----------
Dinner: | | | | |
Fish | 50 | 8.9 | 5.1| | 82
with Butter | 10 | .1 | 8.5| | 77
Cabbage | 50 | .8 | .1| 2.8 | 16
with mayonnaise | | .7 | 38.2| | 353
Tomatoes | 100 | 1.2 | .2| 4.0 | 23
Broth--Tea | | | | |
| | | | |
Supper: | | | | |
String beans | 80 | 1.8 | .2| 5.9 | 33
with bacon | 10 | 1.0 | 6.5| | 62
Spinach soup-- | | | | |
Spinach | 10 | .2 | | .3 | 2
Cream | 10 | .2 | 4.0| .3 | 38
Broth to fill bowl | | | | |
Celery | 20 | .2 | | .7 | 4
Broth--Tea | | | | |
| | | | |
Breakfast: | | | | |
Omelet-- | | | | |
1 egg | | 6.7 | 5.2| | 74
with butter | 10 | .1 | 8.5| | 77
Coffee | | | | |
-------------------------+--------+---------+-----+---------+----------
| | 21.9 | 76.5| 14.0 | 842
=========================+========+=========+=====+=========+==========
DIABETIC DIET NO. 2
=======================================================================
25-30 Proteins
18-22 Carbohydrates
1200-1600 calories
-------------------------+--------+---------+-----+---------+----------
|_Weight_|_Protein_|_Fat_|_Carbo-_ |
_Food_ | _Gm._ | _Gm._ |_Gm._|_hydrate_|_Calories_
| | | | _Gm._ |
-------------------------+--------+---------+-----+---------+----------
Dinner: | | | | |
Pork chops | 60 | 10.0 | 18.0| | 202
Cabbage | 100 | .2 | .3| 5.6 | 32
(Use pork drippings) | | | | |
Spinach | 100 | 2.1 | .3| 3.2 | 24
with butter | 20 | .2 | 17.0| | 154
Broth--Tea | | | | |
| | | | |
Supper: | | | | |
Asparagus salad-- | | | | |
Lettuce | 10 | .1 | | .3 | 2
Asparagus | 80 | 1.2 | .1| 2.1 | 13
Mayonnaise | 50 | .7 | 38.8| | 338
Tomatoes | 100 | 1.2 | .2| 4.0 | 23
with butter | 10 | .1 | 8.5| | 77
Nut charlotte-- | | | | |
Walnuts, chopped | 10 | 1.8 | 6.4| 1.3 | 70
Cream | 50 | 1.1 | 20.0| 1.5 | 190
Broth--Tea | | | | |
| | | | |
Breakfast: | | | | |
Bacon | 20 | 2.1 | 13.0| | 125
with 1 egg | | 6.7 | 5.2| | 74
Coffee with cream | 30 | .7 | 12.0| .9 | 114
-------------------------+--------+---------+-----+---------+----------
| | 28.2 |139.8| 18.9 | 1438
=========================+========+=========+=====+=========+==========
DIABETIC DIET NO. 3
=======================================================================
30-35 Proteins
25-30 Carbohydrates
1600-2000 calories
-------------------------+--------+---------+-----+---------+----------
|_Weight_|_Protein_|_Fat_|_Carbo-_ |
_Food_ | _Gm._ | _Gm._ |_Gm._|_hydrate_|_Calories_
| | | | _Gm._ |
-------------------------+--------+---------+-----+---------+----------
Dinner: | | | | |
Beef tenderloins | 80 | 13.0 | 19.5| | 227
with butter | 10 | .1 | 8.5| | 77
Asparagus | 100 | 1.5 | .1| 2.8 | 18
with butter | 10 | .1 | 8.5| | 77
Squash | 100 | 1.4 | .5| 9.0 | 46
with butter | 10 | .1 | 8.5| | 77
Broth--Tea | | | | |
| | | | |
Supper: | | | | |
String bean salad-- | | | | |
Lettuce | 10 | .1 | | .3 | 2
String beans | 50 | 1.1 | .1| 3.7 | 26
Pimento | 10 | .2 | | .4 | 2
Onion | 10 | .2 | | 1.0 | 5
Mayonnaise | 30 | .5 | 23.3| | 228
Tomatoes | 120 | 1.4 | .2| 4.8 | 28
with butter | 20 | .2 | 17.0| | 154
Chocolate pudding-- | | | | |
Cream | 100 | 2.2 | 40.0| 3.0 | 381
Cocoa, 1/2 tsp | 1 | .2 | .3| .4 | 5
Broth--Tea | | | | |
| | | | |
Breakfast: | | | | |
Bacon | 30 | 3.2 | 19.4| | 187
with 1 egg | | 6.7 | 5.3| | 74
Coffee with cream | 30 | .7 | 12.0| .9 | 114
-------------------------+--------+---------+-----+---------+----------
| | 32.9 |163.2| 26.3 | 1728
=========================+========+=========+=====+=========+==========
DIABETIC DIET NO. 4
=======================================================================
50-60 Proteins
30-40 Carbohydrates
2000-2500 calories
-------------------------+--------+---------+-----+---------+----------
|_Weight_|_Protein_|_Fat_|_Carbo-_ |
_Food_ | _Gm._ | _Gm._ |_Gm._|_hydrate_|_Calories_
| | | | _Gm._ |
-------------------------+--------+---------+-----+---------+----------
Dinner: | | | | |
Veal steak (roast) | 100 | 19.9 | 10.8| | 177
Onions | 126 | 1.9 | .4| 11.9 | 49
with cream | 50 | 1.1 | 20.0| 1.5 | 190
Tomatoes | 150 | 1.8 | .3| 6.0 | 35
with butter | 30 | .3 | 25.5| | 231
Fruit salad-- | | | | |
Lettuce | 10 | .1 | | .3 | 2
Celery | 50 | .6 | | 1.6 | 9
Grapefruit | 80 | .6 | .2| 8.1 | 37
Whipped cream | 30 | .7 | 12.0| .9 | 114
Tea--Broth | | | | |
| | | | |
Supper: | | | | |
Cream of celery | | | | |
soup-- | | | | |
Celery | 50 | .6 | | 1.6 | 9
Cream | 75 | 1.6 | 30.0| 2.2 | 285
Broth to fill bowl | | | | |
Boiled ham | 30 | 6.1 | 6.7| | 85
Custard-- | | | | |
2 egg yolks | | 4.7 | 10.0| | 109
Cream | 90 | 2.0 | 36.0| 2.7 | 343
Tea | | | | |
| | | | |
Breakfast: | | | | |
Eggs (2) | | 13.4 | 10.5| | 148
with butter | 30 | .3 | 25.5| | 231
Coffee with cream | 20 | .4 | 8.0| .6 | 76
Broth | | | | |
-------------------------+--------+---------+-----+---------+----------
| | 56.1 |195.9| 37.4 | 2130
=========================+========+=========+=====+=========+==========
~Nurse's Directions for Collecting and Testing the Urine in Diabetes
Mellitus.~--The first urine voided in the morning at 7 A.M. should be
thrown away, after which the entire quantity during the ensuing
twenty-four hours, including that at 7 A.M. the following morning,
should be collected in a thoroughly clean, wide-mouth bottle
sufficiently large to contain the entire quantity. This should be kept
in a cool place to prevent decomposition. After the urine has been
measured, four or five ounces are removed for testing purposes. There
is no necessity for having an elaborately equipped laboratory for
making the simple tests of the diabetic urine. The nurse is only
required to make the simple tests, leaving the more elaborate one for
the physician. The articles necessary for these tests must be kept
perfectly clean in order to make the tests accurate. The bottle in
which the urine is collected must be washed and sterilized daily
before the collection begins. One small three-inch white enameled or
porcelain dish, one 10 c.c. graduated pipette, 6 test tubes, 1 small
alcohol lamp or Bunsen burner, 1 box of sodium carbonate, 1 box
talcum, and the reagents necessary for making the test, namely,
Benedict's solution, Fehling's solution, and Haines's solution.
SUMMARY
~Diabetes Mellitus~ is a disease in which the body becomes more or
less unable to utilize the sugars and starches, consequently there is
an abnormal amount of glucose in the urine.
~Manufacture of Sugar~ in the body from other food constituents
besides carbohydrates has been proved with regard to proteins, hence
the intake of nitrogenous substances must be restricted in
diabetes--to a less extent, however, than the sugars and starches.
~Acetone Bodies.~--Diacetic acid, oxybutyric acid, and acetone
develop in diabetes as a result of the breaking down of the fats and
the lack of certain neutralizing agents found chiefly in carbohydrate
foods.
~Acidosis~ is a form of intoxication due to the retention of these
toxic acids in the body. If not combated and overcome, it will result
in the diabetic coma which is fatal in so many cases.
~Diet Treatments.~--The best known treatments are those devised and
used by Drs. Allen and Joslin "The Starvation Treatment for Diabetes
Mellitus," and the "High Fat Diet" formulated by Drs. Newburg and
Marsh. All cases cannot be handled alike and it is for the physician
to determine the treatment calculated to give the best results in the
definite case.
~Training for Diabetic Nursing.~--So much depends upon the
administration of the treatment in this pathological condition that in
many hospitals special training is being given to the nurses in the
care of diabetic patients that they may be able intelligently to carry
out the necessary regime, both in the hospital and in private
practice.
~Symptoms.~--She must be able to recognize symptoms both from the
findings resulting from the urinalysis and from those manifested
otherwise by the patient.
~The Record.~--She must keep an absolute record of all that occurs
during the course of treatment and instantly report any unusual
happening.
~Urine Tests.~--It is advisable to make the tests in the morning;
those for sugar and diacetic acid should be made every day or, in some
cases, every other day, as directed by the physician, and those for
ammonia and albumen about once a week.
~Weighing the Patient.~--Patient should be weighed each day before
breakfast, and the weight of the clothes also carefully recorded
separately.
~The Bowels~ must move daily, even if it is necessary to resort to
mild laxatives or an enema.
~Formulating and Calculating the Dietary.~--The menus of the day must
be formulated and the chemical composition and nutrient value of the
foods calculated. The vegetables belonging to the five per cent. group
should be in readiness and the amount to be used weighed after they
have been boiled in clean, separate water to reduce their carbohydrate
content still further.
~Commercial Diabetic Foods.~--It may be well to mention the danger of
putting faith in the so-called diabetic foods so widely advertised.
Some of these foods are of undoubted worth, but it is never safe for
the nurse or the patient to judge of the merits of the various
diabetic foods without first knowing their chemical composition, and
not even then without the definite directions from the physician.
~Diabetic Flours.~--The diabetic flours used in the recipes included
in this text have been approved by some of the leading specialists in
diabetes in this country, but the nurse should not include them in the
diet for her patient unless they are prescribed by the physician in
charge.
PROBLEMS
(a) Outline test diets for determining the severity of the
disturbance.
(b) Give examples of diets used in testing for tolerance of
carbohydrates, fats, proteins.
(c) Give an example of a diet order showing the use of the high fat
method of feeding. Why is it used?
FOOTNOTES:
[137] Allen's Paradoxical Law, quoted from "Treatment of Diabetes
Mellitus," p. 18, by Joslin.
[138] "Treatment of Diabetes Mellitus," p. 305, Joslin.
[139] "Food for the Sick," by Strouse and Perry.
[140] Courtesy of Dr. Joslin and Thomas Groom & Co., Boston.
[141] The giving of coffee or clear broth, with or without whisky,
does not materially affect the starvation and serves to make the
patient more comfortable during this trying period.
[142] Dr. Joslin has given a very complete schedule in his "Treatment
of Diabetes Mellitus," from which the above schedule is taken.
[143] Hill and Eckman's "Starvation (Allen) Treatment of Diabetes."
[144] See 5% vegetable, p. 383.
[145] Table used by Dr. Joslin in his treatment of diabetes mellitus.
It is convenient, and many changes in the diet may be made by
substituting one food for another of like carbohydrate content. This
table can be purchased on cards from Thomas Groom & Co., Boston, Mass.
[146] Table devised by H. O. Mosenthal showing accessory diets rich in
carbohydrates. "Medical Clinics of North America," July, 1917.
[147] "h" represents household measure.
[148] Mosenthal: "Medical Clinics of North America," July, 1917.
[149] "Starvation Treatment of Diabetes," by Hill and Eckman.
[150] "Practical Dietetics," by Alidia Pattee.
[151] "Food for the Sick," p. 62, by Strouse and Perry.
[152] Sweetened with saccharin.
[153] "Starvation Treatment of Diabetes," by Hill and Eckman.
[154] Courtesy of R. Eckman and D. M. Stewart, University of Michigan
Hospital, Ann Arbor, Michigan.