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Severe Forms of Glycosuria

diet, table, alcohol, patients, treatment, amount, strict, carbohydrates and fat

SEVERE FORMS OF GLYCOSURIA.

Under this heading are grouped those cases in which, in spite of a continued diet as free as possible from carbohydrates, sugar is con stantly excreted in the urine. In order to stop the glycosuria entirely the proteids must be restricted as well as the carbohydrates, or even a complete fast may he necessary. These cases are met with usually in early life and are seldom seen after the fortieth year. There is ordinarily emaciation as well as bodily and mental sluggishness. Complications are frequent, and the course of the disease, even under the best therapeutic management, is steadily toward a fatal issue at the eud of a few mouths or years. Careful dietetic treatment, how ever, in conjunction with other appropriate measures may undoubt edly, in a large number of cases, retard the progress of the disease, prevent many a complication, and delay the fatal issue for mouths or years.

As regards the dietetic treatment, the same rules are to be followed in principle as in the management of the cases just considered. Here also, and in still greater degree, carbohydrates are little more than waste material as regards nutrition (see p. 135), they aggravate the diabetic disturbance (p. 137), and yet cannot be permanently dis pensed with (p. 140). They are always to be regarded as incidental articles of diet or, as it were, luxuries.

It is advisable, a careful watch being kept on the fluctuations of toleration, to order the diet after the following plan : At least three times in tha year, if possible quarterly, the patient must be subjected to a course of strict dietary treatment.

a. The Period of Strict Diet.—This differs from the similar course recommended in the treatment of cases falling in the preceding cate gory in that (1) its duration should be four weeks instead of three, and (2) there must be much more strictness in the choice of food al lowed. Only in cases of the greatest necessity should one or two of the dishes given in Table II. be conceded, and as a rule the choice should be made from the lists in Tables I. and IV. As regards the educational, technical, and culinary aspects of the course the reader is referred to the remarks on page 157.

During the period of strict diet the drinking of mineral waters is to be discontinued; the patients had better enter a hospital or private institution, give up while there all mental and bodily work, sit in the open air as much as possible, take short walks of fifteen minutes' duration, and occasional drives.

b. The Diet in the Intervals.—During this time carbohydrates in restricted quantities are to be allowed. When we have no reason to fear disobedience or deceit on the part of the patient, we must, despite all theoretical opposition, permit the use of carbohydrates to almost as great an extent as in the case of the patients in the preced ing category who are suffering from the moderately severe forms of glycosuria.

The diet will therefore be composed from : Table I., in any desired, but always in large, amount; Table II., three or four articles in the quantity there prescribed; Table III., in amounts equivalent in value to from 80 to 120 grams of white bread. The less of these we can get along with, the better. It is well to vary the amount of food of this kind, giving now more, now less. As regards the use of milk, what was said in speaking of the moderately severe forms of glycosuria holds equally good here.

In order to assure the necessary consumption of fat we must es tablish here also an "iron rule" as to the daily amount, taking the table given on page 160 as a basis and making whatever altera tions may seem to be indicated in special cases. It is even more necessary here to devote especial thought to the best means of main taining permanently the ingestion of fat at the desired figure, for fat is for these patients the only thing upon which they can rely to main tain their strength and prolong their lives.

It is also advisable to give these patients a larger amount of alco hol than we should prescribe in the case of mild forms of glycosuria. We may go as high as 80 grams of alcohol a clay, such a dose being justified by the greater ingestion of fat, the tendency to heart failure, and the general nervous exhaustion. Naturally the alcohblic bever ages which contain no sugar are to be selected. Their. percentage of alcohol is given in the table on page 142. I prefer to distribute the total amount of alcohol through the day as follows: With the luncheon, one pint of Moselle (containing about 25 gm. alcohol).

With the dinner, one pint of good old Burgundy (30 to 35 gin. alcohol).

Three or four times a day, a liqueur-glass of brandy or whiskey with carbonated water or tea (containing in all from 20 to 30 gin. alcohol) .

These patients need to be protected in every possible way. Mus cular exercise may and indeed should be carried to a greater extent during the intervals of strict dietary treatment, but caution in this respect is always necessary. Any occupation which calls for exhaus tive bodily or mental labor should be given up or at least be essen tially lightened.

Warm baths of fifteen minutes' duration two or three times a week are very useful; they should always be immediately followed by rest in bed.

Once or twice a year, after the period of strict diet, the patients should take a course of alkaline sulphur waters, or, when exhaustion is pronounced, of alkaline inuriatic waters. But we must not look for very great results from such a course in these cases.