Dietetics for NursesProudfit, Fairfax T. (Fairfax Throckmorton)
Science
Dietetics for Nurses
Proudfit, Fairfax T. (Fairfax Throckmorton)
Diet in disease
~Loss of Weight.~--The slight loss of weight, which may be noticeable
as the result of starvation, is not undesirable, especially in those
cases where obesity is a prominent feature. In fact care must be
exercised in the follow-up treatment to prevent the taking on of
weight by the diabetic individual, since, according to Allen, it is
often found that even moderately obese patients (180 lb.) continue to
excrete a small amount of sugar so long as they hold this weight, even
upon a low carbohydrate diet, whereas those same patients show no
difficulty in becoming sugar free if the weight is reduced by ten or
fifteen pounds.
SCHEDULE FOR TREATMENT AND METHODS OF DETERMINING FOOD TOLERANCES
A number of schedules have been devised to enable the nurse
successfully to carry out the Allen Treatment. In following out this
treatment and reeducating the organs afterward to tolerate foods which
they have been unable to handle on account of the impairment of the
sugar-making organs, it is necessary to make a series of tests
whereby the diet is gradually increased in its various constituents
until the diabetic patient is able to handle a reasonable amount of
carbohydrates as well as other foods which have given more or less
trouble in the past.
The following schedule, after Joslin,[142] is included, and a careful
study of it is advised in order that the nurse may intelligently carry
out the Allen Treatment.
~Schedule.~--Fasting in many cases begins at once and the patient
experiences no ill effects from it. However, in severe, long-standing
cases many patients do better if the fats are omitted at once and the
rest of the diet left unchanged for two days. Then the proteins in the
diet are omitted and the carbohydrates cut in half. This halving of
the carbohydrates is continued daily until only 10 grams remain, after
which they too are omitted. The fast is thus made complete and remains
so until the urine is entirely free from sugar.
~Carbohydrate Tolerance~ is determined by giving, as soon as the urine
has been sugar-free for twenty-four hours, 150 grams of 5% vegetables.
This is equivalent to from 8 to 10 grams of carbohydrates. After this
5 grams of carbohydrates, or 75 grams of 5% vegetables, are added
daily to the diet until the patient is taking 20 grams. Then the
addition of 5 grams of carbohydrates is made every other day, using
the fruits and vegetables belonging to the 10% and 15% carbohydrate
group, until potatoes and oatmeal and finally bread can be tolerated
unless sugar appears in the urine before this or the tolerance reaches
3 grams to each kilogram of body weight or, in other words, until a
man weighing 150 pounds is consuming 225 grams of carbohydrates per
day.
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