GENERAL CONSIDERATIONS CONCERNING DIET IN DIABETES.
a. Preservation of the Body Albumin; Calorie Value of the Food.— Under all circu-mstances, the diet in diabetes must be so ordered that the strength of the patient may be thereby maintained and as far as possible increased. As the strength depends essentially upon the stability of the body albumin, that is to say, of the tissues which contain it, the blood, glands, and muscles, the above condition, translated into the language of the doctrine of metabolism, would read: The nourish ment supplied to the patient is to be so ordered that the store of albumin in the body may remain stationary or even be increased.
Fat, which represents only dead fuel, may when necessary be sac rificed; in spare individuals of course as little as possible, but in the obese by preference. Nevertheless, it must be remembered that en ergetic and rapid reduction of adipose tissue is as a rule badly borne by diabetics. Any diet which is not adapted to assure the mainte nance of the diabetic's store of albumin is in my opinion unsuitable for long-continued use; it may be employed temporarily, but as a permanent thing it is objectionable and dangerous.
In order to insure the preservation of the body albumin an amount of food adapted, in accordance with general physiological laws, to the needs of the organism is necessary. If the amount sinks below these needs, that is to say, below the output for the time being of the organism (dependent upon the weight of the body, the loss of heat, work done, etc.), the deficit must be met by a destruction not only of the fat but always also of the albumin of the body. The only ex ception to this is in the case of corpulent individuals, for whom, regard being had to certain necessary precautions, the diet may be so regulated that waste of albumin stored in the body does not take place (von Noordeu and Dapper ").
We know that a grown man, taking moderate exercise, consumes nutritive material to the value of at least 35 calories per kilogram a day (see p. 87). Spare individuals consume somewhat more, fat per sons considerably less. In the case of a man of average weight, say
70 kilograms (154 lbs.), the average of the daily consumption would be represented by about 2,500 calories.
I think it is expedient to take this figure as the standard in our further considerations. Of course the reservation must be made that this is only an average which is to be changed according to the body conditions present (size, amount of adipose tissue, weight, age) and according to whether the individual leads an active or sedentary life. With this reservation I would formulate the following proposition : The diet of the diabetic must be so constituted that it will furnish available material to the value of at least thirty jive calories per kilogram, per diem.
b. The Depreciation, of the Carbohydrates of the Food through Gly cosuria.—In order to obtain the necessary amount of nutritive values the healthy individual must make use of the carbohydrates in very considerable quantity. In most men they meet 40 per cent., and often much more, of the entire daily nutritive requirements. But the carbohydrates, of the greatest value for the healthy man, are for the diabetic a nutritive material of subordinate rank, since they are excreted in part unused in the urine. The greater is this part the more worthless are the carbohydrates as a building material and the more must they be regarded as mere waste matter in nutrition. The difficulty of affording nourishment to the sufferer from diabetes is therefore increased in inverse proportion to the tolerance of carbohy drates. While in the case of one diabetic we are able to give such an amount of carbohydrates that, although a certain small propor tion is lost in the urine, the large remainder suffices to cover a quantitatively important part of the daily tissue change, in another no advantage worth mentioning accrues from the ingestion of carbohy drates, give them in what quantities we will. For example: Diabetic A. Carbohydrates of the food, 200 grams = 820 calories. 44in the urine, 20 " • - Available for the body, 180 grams -= 73S calories.