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Mild Forms of Glycosuria

carbohydrates, patient, amount, sugar, quantity, food and urine

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It is common to all the mild forms that the withdrawal of carbo hydrates from the food causes a disappearance of sugar from the urine. I shall consider here, however, only those cases iu which a certain amount of carbohydrates may be taken without causing gly cosuria, while those eases in which a sugar-free urine can be obtained only by complete abstinence from carbohydrates I have placed, for practical reasons, in the class of moderately severe forms of glycosuria.

The determination of the intensity of the glycosuria, according to the method which I have previously described (p. 80), would lead to the formula : Tolerance = standard diet + x (from 50 to 150 gm.) starch.

On practical grounds I make a distinction between mild forms of glycosuria in elderly patients and those occurring in early life.

a. Mild. Glycosuria in Elderly Persons.—It is not necessary to de termine with special accuracy the tolerance in persons of somewhat advanced age (say over forty-five or fifty years), usually more or less corpulent or gouty, in whom a small amount of sugar (0.5 to 2 per cent.) is excreted under ordinary conditions, which amount is reduced to a mere trace by a considerable abstraction of carbohydrates from the food. That would be carrying a striving for exactitude to need less leng:ths.

The form of the glycosuria is benign. The patient is, indeed, not secure from all complications, but the glycosuria will not greatly re duce his strength unless lie be maltreated. Unfortunately that often happens. I know of cases of this sort iu which a whole pharmacopoeia of drugs have been poured into the unfortunate patient, and in which the sufferer has been made so anxious by the saccharophobic physi cian that he hardly dared to satisfy his hunger, seeing the carbohy drate-ghost in every dish, giving up the use of wine to which he had become accustomed during a long and industrious lifetime, and falling before his time into a hypochondriac and wretched old age—and all that without the slightest necessity. Of course, careless neglect would be just as inexcusable.

The following is the plan of treatment that I would advise : (1) Diet.—It would be to little purpose and would lead to unnec

essary anxiety to lay down minute directions as to the choice and quantity of food. It is sufficient to forbid certain aitiAes which con sist entirely or in great part of carbohydrates and which experience teaches are often taken in excess, and to reduce the ingestion of cer tain other articles.

Forbidden: Sugar, sweetmeats, pastry, sweet wines (especially sweet champagne), gruels, dishes made of flour or flour preparations (such as maccaroni and flour puddings), rice, preserves, and sweet jellies.

Permitted in Reduced Amount : Beer, in quantity of not more than one-third to one-half litre (one or two glasses) a day ; heavy wines, which, however, had better be replaced by the lighter sorts.

The patient should take his meals at the ordinary times with the family, and may be allowed to eat bread and potatoes according to his desire and take no special account of the proportion of starch contained in the vegetables set before him. On this diet in most cases the quantity of sugar in the urine is insignificant; as a rule the excretion of sugar amounts to from 10 to 20 grams in the twenty-four hours. It is better to put up with such a slight glycosuria than to get rid of it by a rigid exclusion of carbohydrates.

When the quantity of food, under this diet, is left to be regulated by the patient's appetite there is apt to be a gradual loss of flesh, due to the restriction in the amount of carbohydrates; especially when the muscular exercise is increased above that which the patient has been accustomed to take. Only in the case of the most robust patients should an average loss of weight of about 100 grams a week be exceeded; and in any case the emaciation should not be allowed to proceed very far, for it must be remembered that diabetics feel better and are better protected against danger when their body weight, that is to say their store of fat, is above that desirable for the healthy individual. The older the patient is and the longer the corpulence has existed, the more cautious should the physician be in this respect.

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