ient, which varies in this condition between very
wide limits. That of diet is of primary importance inasmuch as it has
been proved beyond question that certain kinds of food have a powerful
influence in aggravating the disease, more particularly those consisting
largely of saccharine and starchy matter; and it may be stated generally
that the various methods of treatment proposed aim at the elimination as
far as possible of these constituents from the diet. Hence it is
recommended that such articles as bread, potatoes and all farinaceous
foods, turnips, carrots, parsnips and most fruits should be avoided;
while animal food and soups, green vegetables, cream, cheese, eggs,
butter, and tea and coffee without sugar, may be taken with advantage.
As a substitute for ordinary bread, which most persons find it difficult
to do without for any length of time, bran bread, gluten bread and
almond biscuits. A patient must never pass suddenly from an ordinary to
a carbohydrate-free diet. Any such sudden transition is extremely liable
to bring on diabetic coma, and the change must be made quite gradually,
one form of carbohydrate after another being taken out of the diet,
whilst the effect on the quantity of sugar passed is being carefully
noted meanwhile. The treatment may be begun by excluding potatoes, sugar
and fruit, and only after several days is the bread to be replaced by
some diabetic substitute. When the sugar excretion has been reduced to
its lowest point, and maintained there for some time, a certain amount
of carbohydrate may be cautiously allowed, the consequent effect on the
glycosuria being estimated. The best diet can only be worked out
experimentally for each individual patient. But in every case, if
drowsiness or any symptom suggesting coma supervene, all restrictions
must be withdrawn, and carbohydrate freely allowed. The question of
alcohol is one which must be largely determined by the previous history
of the patient, but a small quantity will help to make up the
deficiencies of a diet poor in carbohydrate. Scotch and Irish whisky,
and Hollands gin, are usually free from sugar, and some of the light
Bordeaux wines contain very little. Fat is beneficial, and can be given
as cream, fat of meat and cod-liver oil. Green vegetables are harmless,
but the white stalks of cabbages and lettuces and also celery and endive
yield sugar. Laevulose can be assimilated up to 1 1/2 ozs. daily without
increasing the glycosuria, an