Soya bread always contains a considerable amount of starch.
Bread made with flour obtained from the embryo of wheat, after the separation of its starchy endosperm, is recommended by Danype, and is used in France for diabetics, and is said to be very poor in starch.
Cocoa Nut, Aleuronat, and Roborat breads are also procurable, and are valuable changes from the gluten and almond feeding-stuffs.
Casein bread is relished by many diabetics who cannot use gluten and almond preparations. Williamson recommends Casein made into a custard by adding to a tablespoonful of the powder one egg, a little salt, and a teaspoonful of baking powder, and baking it for thirty minutes. It is a good practice to order through the patient's chemist a tin of assorted breadstuffs (biscuits, cakes, rolls, &c.) from a reliable London firm like Bonthron, Canard, or the Protene Co., who also supply non-saccharin jams and jellies, so that the diabetic can not only have a large variety, but may find a food which will constantly meet his individual tastes.
Lmvulose and Inulin are recommended; Hale White suggests the use of dahlia tubers boiled as a vegetable, on account of their starch being in the form of inulin.
Tea, Coffee, and Cocoa made from nibs, may be freely partaken of, sweetened with Saccharin or Glycerin, and containing good Cream. There is little use in trying to diminish the amount of fluid consumed; thirst may be assuaged by acidulated drinks made with Cream of Tartar, Phosphoric Acid, Lactic Acid, or fresh Lemons. A very palatable liquid is made by dissolving a dessert-spoonful of pure Citric Acid in a quart of water, and adding Glycerin to sweeten it according to taste. Sour Buttermilk may be permitted when the amount of sugar is small in the urine. Water charged with Oxygen has been extolled as a beverage, and sometimes seems to diminish glycosuria. Alcoholic stimulants should be sparingly used, and, when given, should consist of whiskey, brandy, or Hollands, or light bitter ale like Pilsener. Sweet wines are decidedly injurious.
Donkin's method of treating diabetes consists in an exclusive diet of skimmed milk. About one gallon or more is the daily allowance. This treatment has met with general condemnation. The writer has seen, however, excellent results in obese patients from an exclusive milk diet, and it is invaluable in alhuminuric cases. Lepine advises that the milk be fermented, and Ilutchinson's sterilised non-saccharin milk can be obtained.
Poor hospital patients who gain admission for a few weeks or even months, and are compelled to leave and return to their homes, find that milk is their only available diet. Severe cases of diabetes will, un fortunately, be often found where milk acts most injuriously. In agricultural districts, good buttermilk turned acid is a very valuable diet for the poor diabetic.
Van Noorden's Oatmeal treatment need only be mentioned to be con demned. Janeway found that when oatmeal was given beyond the assimilating power of the patient the whole of the carbohydrate was eliminated in the urine, and the same is true of potatoes. The so-called " potato cure " has been vaunted by many; as a routine it must be con demned. Many diabetics undoubtedly do well on potatoes given up to the limit of their assimilative power, but the range of their usefulness is limited, and like most of the crazes which appear in connection with the therapeutics of this disease it is the evidence of a revolt against a too rigid dietary. The physician, as stated before, should aim at supplying carbohydrates in every case short of the degree in which these can be thoroughly assimilated, and there is no doubt that often harm is done by a too strict enforcement of a rigorous dietary, and the excessive use of animal food and fats adds to the danger of acetonxmia.
Fasting or starvation diet has been successfully employed by Allen for clearing all sugar from the urine. For several days no food is given except small quantities of diluted alcohol, and as soon as the sugar disappears the diabetic dieting is commenced in which green vegetables and meat are administered in gradually increasing amounts. The hours of work, sleep and excercise should be carefully regulated, and the patient should as far as possible be saved from bodily fatigue, worry, or heavy brain work. Against changes of temperature he should be provided by being well clad in flannel, and should wear thick-soled boots. Gymnastic exercises may be advised, when weather and other contra-indications forbid exposure. Most authorities lay stress upon the necessity of constant open-air exercise, and many recommend cycling and riding, but rest should be strictly enforced in all acute or grave cases. All cases of glycosuria should be treated by a restricted diet as if they were examples of mild diabetes.