When obesity is not present or when it is desirable to prevent any further loss of fat, the choice as to kind and amount of food should not be left wholly to the patient. It usually answers the purpose to induce him to increase the amount of fatty food in his diet; for ex ample he should always butter his bread and potatoes very freely and should take every day some fat meat (such as bacon and the like), eggs, and some of the more fatty sorts of cheese (see the list of fatty foods at the end of this article). As a rule this general exposi tion of the significance of fat suffices. When it does not, and the emaciation increases, we must institute the dietary which will be de scribed later as appropriate for cases of mild glycosuria in young persons and for those of the moderately severe forms.
(2) Driok. —As drink, in addition to one-half to three-quarters of a litre of light wine, may be taken small quantities (one-third to one-half litre) of beer, and to the morning coffee or tea and the after dinner coffee may be added some kind of a carbonated table water (Apollinaris, Birresborn, Gerolstein, Harzer Sauerbrunnen, Nieder Selters, Boisdorf, and the like) or a alkaline mineral water, such as the Salzbrunner Kronenquelle, Biliuer Sauerbrunnen, etc. The daily amount of these waters may reach one-half to one litre (one or two pints).
(3) Muscular patients should on no account, unless the presence of certain organic diseases furnishes a contra indication, fail to take bodily exercise. This exercise is to be regu lated as to its extent and kind according as it is prescribed more in the interest of general hygiene or with the special object of effecting a certain reduction in flesh.
Special (Wes—When the patient's circumstances permit, he should be ordered every year to take a several weeks' course of the waters at Carlsbad or some other place of the same character, or, if he is more delicate and needs rather gentle treatment, at some resort with simple muriatic or alkaline muriatic springs. The latter pos secs an undoubted advantage in cases in which the diabetes is en grafted upon a gouty constitution. After the use of the waters for ten days or two weeks we often see in such cases the outbreak of a paroxysm of gout, which is to be regarded as of favorable omen. Drink-cures carried out at home have not the same effect. A severe course of the waters instituted for the purpose of reducing the pa tient's flesh should be avoided.
For further consideration of the management of this class of cases the reader is referred to the remarks on general hygienic measures in a preceding section.
b. Mild Forms of Glycostfria in Yoany Persons.—This form of the disease is less frequently associated with obesity or gout, but more commonly follows some morbid change in the nervous system. In deed it often looks as though the diabetes owed its origin to over irritation and exhaustion of the nervous system. Therefore the general rules for the management of neurogenous diabetes which have been considered above (p. 126) are applicable to many of the cases falling in this category.
(1) Diet.—Whatever the special indications may be in individual cases there is one general rule applicable to all, viz., we must be much more cautious about allowing carbohydrates to young patients with mild glycosuria than to the elderly, and the more so the younger they are, for the reason that the results of carelessness in diet are much more evident and the danger that the glycosuria may assume a pro gressive character is much more threatening. The diet must be so regulated as to provide for an intake that is sufficient as regards calorie values, while at the same time there is no, or at most a very insignificant, excretion of sugar. In view of the varying intensity of the glycosuria in young persons, it is advisable that an exact deter mination of the limits of tolerance, according to the formula previ ously given (p. 80), should be made at least twice a year. For on the one hand it is undesirable to reduce the amount of carbohydrate in the diet of these patients below what is absolutely necessary in order to keep the glycosuria in check, and on the other it is injurious to exceed the tolerance to any appreciable extent.
We can very profitably make use of the easily decomposed carbo hydrates (see pp. 81 and 136) in these cases, and preferably of milk sugar which is fortunately combined with other nutritive mate rials in milk. Often, indeed, formal milk cures are serviceable (see below). The other sorts of sugar are less suitable for this purpose: levulose (fruit sugar) is not good because it cannot easily be taken for any length of time in sufficient amount; cane sugar is not, because if allowed at all it is often consumed in quantities beyond the pre scribed limit; furthermore, its withdrawal from the food, to which the patients quite readily become accustomed, opens up the possibil ity of allowing more bread and potatoes, a matter of much greater importance in the long run. Where the patient cannot accustom himself to do without sweetening in certain dishes and drinks he had better employ saccharin.