e pressure.

~The Nurse~ should instruct the patient on the points necessary for
the saving of the heart. She should teach the necessity for keeping
the meals small and having them more frequently if necessary; of
limiting the fluids at meals to a few ounces or leaving them out
altogether at this time. She should know how necessary is the
reduction of the fluid. She should also warn against the taking of
alcoholic beverages except with the permission and advice of a
physician.

~Excitement and Worry~ increase the blood pressure, hence must be
avoided by individuals suffering with any form of heart disease.

PROBLEMS

(a) Write a diet order for an elderly patient with severe cardiac
disturbance.

(b) Outline the method of administering the Karell diet.

FOOTNOTES:

[134] See Karell Cure, p. 342.

[135] "Food for the Sick," p. 150, by Strouse and Perry.

[136] See Salt-poor Diets, p. 341.

CHAPTER XX

DIABETES MELLITUS

~Definition.~--Diabetes is a disease which is characterized by an
inability on the part of the body to utilize the carbohydrates, in
consequence of which there is abnormal excretion of glucose in the
urine.

~Sugar in the Urine.~--The appearance of sugar in the urine may not
necessarily signify diabetes, it may be merely a temporary glycosuria
due to certain pathological conditions, such as infectious diseases,
diseases or trauma which affect the pancreas, and which disappear upon
the recovery from the disease. But any appearance of sugar in the
urine should be looked upon with suspicion, since the future welfare
of the patient depends largely upon an early diagnosis in any form of
diabetes.

~True Diabetes.~--Allen claims that true diabetes may always be
distinguished from nervous glycosuria by the application of the laws
governing these conditions (Allen's Paradoxical Law[137]), which is
"whereas in normal individuals the more sugar given the more is
utilized, the reverse is true in diabetes."

~Manufacture of Sugar from Other Foods.~--If the carbohydrate foods
alone caused all the trouble in diabetes, the disease might be more
easily controlled. This, we found, however, not to be true, since in
certain conditions the body utilizes the protein foods for the
manufacture of glucose also. Consequently in diabetes if the absolute
sugar output of the body is to be controlled, the intake of
nitrogenous foods must be likewise adjusted.

~Functions of Carbohydrates.~--In the c