TREATMENT OF LIPOGENOUS DIABETES MELLITUS.
The chief principle in the treatment of diabetes is to protect the patient against the loss of albumin. If he has not as yet been re duced in fat, i.e., if the glycosuria has been discovered early enough, the preservation of the proportion is easier than it is later on when he lit:, already lost much flesh. By putting the patient on a purely nitrogenous diet it is not possible even in diabetes to keep his body in a condition of nitrogen-equilibrium. Purely nitrogenous food, meat diet, 500 to 1,000 grams, can only be kept up for a short time because the patient not only soon becomes disgusted with it, but also is scarcely ever able to eat meat enough to prevent further decompo sition of body albumin; or dyspeptic symptoms appear, catarrh of the stomach and intestines necessitating an absolute change of diet.
As in the treatment of obesity the preservation of albumin is closely connected with the taking iu of fat and carbohydrates, and the patient has to take a sufficient allowance of both even in face of the danger that an increase of carbohydrates may also increase his glycosuria. In cases where fat does not well agree with the patient and he has a strong desire to consume large quantities of the carbo hydrates, such are best supplied to him as contain a large proportion of indigestible cellulose, as, for instance, potatoes and black bread, the use of which allows of a further introduction of sufficient butter or other fat; 200 grams of potatoes and 100 grams of black bread correspond only to 100 grams of carbohydrates of which furthermore only about 90 grams are digested and absorbed.
Where the desire for carbohydrates is not so pronounced we can better choose those carbohydrates which take up but a small volume, and permit instead large quantities of nitrogenous food, meat, fatty meat, sausages, and eggs. At the same time bread, cakes baked with
levulose, aleuronat bread, etc., can be given.
Where there is no complication through disturbance of the appe tite, and no disinclination for a preponderance of food rich in albu min, it suffices that the meals have a composition, taking cognizance of the individuality in each case, as is indicated in the diet tables I. and II. already given.
A mode of living adapted to the special case must be adhered to for a long time, often even for years, and can be changed only in case of modification in the nature of the disease, the state of nutrition, and complications arising.
Muscular activity, walking and climbing, exercise at the terrain cure resort, gymnastics, etc., must be brought into requisition not only to encourage burning up of the fat but also to oxidize the sugar and to maintain the strength and substance of the muscles. If dia betic coma is threatened we must exhibit large amounts of carbohy drates in order to retard the decomposition of albumin which occurs rapidly. It still requires careful observation to determine in how far we can accomplish this result.
Medicinal treatment for diabetes does not exist. Mineral-water cures and dietetic treatment in Carlsbad often work favorably and we would not hesitate to let the patient go through the course of treat ment at this resort if it seemed otherwise indicated.