DIRECTIONS FOR MEASURING THE INTENSITY OF THE GLYCOSURIA.
If it is correct to say that a hard and fast line between "mild" and "severe" forms of diabetes cannot be drawn, then practical ne cessity only prescribes with what measure we shall estimate the de gree of disturbance of the sugar-consuming function. The procedure above described answers all practical needs and has the advantage of pointing out a secure path for the therapy of the disease. For the sake of a better apprehension of the subject I will briefly state once more the measures' to be employed. These are : a. For a few days, gradual withdrawal of carbohydrates from the food.
b. For five days, the standard diet (p. 76).
c. If the urine now becomes sugar-free, a progressively increasing quantity of starch is added to the standard diet until glycosuria re turns. The tolerance is expressed by the formula: Tolerance = standard diet + r gm. starch.
d. If, while the patient is on the standard diet, the sugar disap pears from the urine but returns immediately upon the addition of a small amount of carbohydrate, then 100 gm. of meat may be added. The addition of a larger quantity is unnecessary, as it cannot be uti lized in practice. In general this test has more of a theoretical than a practical value, and may therefore be omitted. The formula reads : Tolerance = standard diet + 0 gm. starch.
= standard diet + 100 gin. flesh meat.
e. If the glycosuria continues after the patient has been put on the standard diet, the amount of sugar in the urine is to be deter mined, its average from the third to the fifth day of the standard diet being estimated, and the condition is then indicated by the formula : Tolerance < standard diet; sugar = a' gm.
By means of this method, which demands only simple and easily executed analyses, the physician may arrive at the most exact appre ciation of the intensity of the disturbance causing the glycosuria.
He can without any further investigation compare one case with another and gather definite data concerning the progress of any given case; temporary improvement or exacerbation will not escape him, and he can accurately estimate the results of dietetic or medicinal treatment.
Besides this method, which always demands a certain control of the patient and can therefore be carried out only in hospitals or pri vate clinics, the following procedure has stood me in good stead: I order a diet which is poor in carbohydrates, but permit no trace of carbohydrates to be ingested after three o'clock in the afternoon. On the following morning the patient, on rising, voids the night urine, and then preserves that passed two hours later, without in the mean while having taken anything to eat or drink. This urine is brought to the physician and examined. Frequently this urine, ex creted while the patient is fasting, contains no sugar at all; at other times the variations in the amount of sugar contained in it enable us to judge of oscillations in the intensity of the disease. The advan tage of the method consists in this, that a sample of urine is exam ined the composition of which is scarcely influenced by the quality of the food ingested (urina sanguinis autorum).
It is hardly necessary to utter the warning not to confine the examination ordinarily to samples of urine excreted only during the morning hours, for were that the rule many cases of diabetes would never be diagnosed at all.