As has been remarked, there are malignant types of diabetes which defy all treatment. In the majority of cases, however, the course of the disease is materially influenced by proper treatment, which generally succeeds in averting the dangers, either permanently or for a long time. Too credulous diabetics are overrun with advertisements of remedies supposed to have fabulous success. These, however, are worthless, and only serve to fill the purse of the unscrupulous manufacturer. Owing to the conspicuous adver tising, some of these remedies have even deceived physicians. In view of this fact it must be emphasised that there is no sure remedy for diabetes, even if medicine can and must be given for single disturbances.
Treatment is, above all else, dietary. A proper division of rest and work, fresh air, muscular exercise, baths and other applications of water, light, heat, and cold, which act beneficially upon the general condition, are also of importance ; but the welfare of the patient depends essentially upon the character of the nourishment. The fundamental principle in this respect is to limit the amount of sugar-producing articles allowed the patient until no more sugar is excreted. If this is not feasible on account of its effect upon the general well-being of the patient and upon the digestive organs, the limitation of the sugar-producing articles should at least be carried to a certain degree. Just to what extent this may be done can be determined only after careful examination, which demonstrates that each diabetic needs a special alloWance of sugar-producing foods suitable for his individual case. If this specialisation is not carried out, but a general scheme of treat ment adhered to, the result is more harmful than beneficial. Of late, since this fact has been recognised, it has become customary to send diabetics to special institutions or to well-regulated hospitals, where exact observation may be made of the sugar excretion and of the influence exerted thereon by the nourishment, and where the patients may learn to live in accordance with the requirements of their condition. For patients whose circum stances permit it, summer cures at certain health resorts are advisable. In Europe the well-known watering place of Carlsbad holds first rank, although of late Homburg and Neuenahr are also much frequented by diabetics. In the United States, Mt. Clemens, Virginia Hot Springs, and Alma Springs are well thought of. The institutions, however, cannot be replaced by such spas and therapeutic cures ; and if only one procedure is possible, a stay in a suitable sanatorium or hospital should he given the preference.
With regard to the diet, patients should be provided with a list on which the articles of nourishment are divided into groups. The first division embraces foods which, accorded in judicious quantities, are the foundation of the diet. This group contains all kinds of meat, eggs, and cheese, most vegetables, and all fat substances ; the last-named are most valuable, especially butter. A second division includes foods which are to be totally excluded, such as all sugars and foods containing sugar (as honey, syrup, chocolate, sweetened fruits, fruit ices, etc.). If sweetening of the drinks or
food cannot be dispensed with, certain substances may be used which have the virtue of tasting sweet even in small quantity, and which do not harm the body. Of these there are several kinds, the most useful being saccharine and crystallose. These are bought in the form of minute pills or tablets, one of which possesses the sweetening effect of an ordinary lump of sugar. A third group includes foods which, although containing sugar-forming material, cannot be entirely dispensed with. Such are bread, potatoes, leguminous plants, rice, barley, oats, milk, and fruit. After a careful physical and chemical examination, the family physician should give the necessary directions to each patient as to the quantity to he eaten. The most difficult part of the diet to regulate is the quantity of bread and fruit, as both are very important for the well-being of the body, and particularly for the organs of digestion. Special breads are made for diabetics. These contain less flour and more albumen than the ordinary kind. The best known are the aleuronat breads, the gluten breads, and various kinds of pastry made by special processes of manufacture. \Vali these products it is easier to satisfy the patient's craving for bread, without harm from excess, than with the ordinary wheat and rye breads. These special kinds of bread are more expensive than ordinary breads ; in fact, the entire diet required for a diabetic is more expensive than an ordinary diet.
Of late, fruit has been recognised as a useful addition to the diet of a diabetic. Certain fruits contain very little sugar ; for instance, sour apples, sour cherries, early oranges, cranberries, and huckleberries. On the other hand, many fruits, as usually prepared, are so rich in sugar that they should be given only in the smallest quantities and only in mild cases. As in the case of bread, attempts have been made to diminish the quantity of sugar in preparing fruits for the use of diabetics. Similar attempts have been successfully made with drinks, particularly with sparkling wines. These may be found free from sugar in almost all large distilleries. Regarding alcoholic drinks the patient. may not choose for himself, but must obtain advice, the same as for the necessary articles of nourishment. This applies especially to beers. Small quantities of light, thin beer are generally per missible ; the actual quantity will differ in each case. As a rule, the light, mild, domestic beers deserve the preference, as they are much poorer in sugar than the renowned Pilsener beer or the darker, sweeter beers.
Thus it will be seen that there are many details to be observed in the diet of a diabetic in order to accomplish the desired result—to keep up the nutrition of the body While excluding an excess of carbohydrates, which class of foodstuffs are not oxidised by the body as they should be.
DIAPHORETICS.—See DOMESTIC REMEDIES.
DIARRHEA.—See INTESTINES, DISEASES OF.