Dietetics for NursesProudfit, Fairfax T. (Fairfax Throckmorton)
Science
Dietetics for Nurses
Proudfit, Fairfax T. (Fairfax Throckmorton)
Diet in disease
~Protein Tolerance.~--In making the test for the protein tolerance it
is necessary to wait until the urine has been sugar free for
forty-eight hours; 20 grams of protein is then given. This is
equivalent to 3 eggs, and daily additions of 5 grams protein are made,
usually in the form of meat, until the patient is receiving 1 gram of
protein to every kilogram of his body weight per day unless his
carbohydrate tolerance is zero, in which case it is wise to add only
three-fourths of a gram of protein per day.
~Fat Tolerance.~--A determination of the fat tolerance is made
coincidently with that of the protein. No additional fat is allowed
until the protein tolerance reaches 1 gram per kilogram of body
weight, unless the patient's tolerance for protein is less than that.
After which 25 grams of fat per day are added until there is no
further loss of weight, taking care never to allow more than 40
calories per kilogram of body weight.
~Reappearance of Sugar.~--Should the urine again show the presence of
sugar, another period of fasting lasting for twenty-four hours, or
until the urine is again sugar free, must be instituted. After the
second fast the increase in the diet may be twice as rapid as used
after the first fast. However, it is not advisable to increase the
amount of carbohydrates to more than half of that determined by the
former tolerance for a period of two weeks, during which time the
urine has been entirely sugar free, then the increase is made more
slowly and the amount given should not exceed 5 grams a week.
~Weekly Fast Days.~--One day in seven should be set aside by the
diabetic patient for fasting, when the carbohydrate tolerance is less
than 20 grams. When, however, the tolerance is between 20 and 50 grams
of carbohydrates, the patient may take one-half of his daily allowance
of protein and fat and a certain amount of 5% vegetables as well upon
the weekly fast day. When the tolerance reaches between 50 and 100
grams per day, vegetables of a higher carbohydrate content may also be
included. If the carbohydrate tolerance should exceed 100 grams per
day, the carbohydrates upon the fast day may be simply half of the
amount allowed upon other days.
~The Giving of Alkalies.~--If acidosis is evident, as may be indicated
by an excretion of diacetic acid, oxybutyric acid, or acetone in the
urine, alkalies may be given. Bicarbonate of soda may be given in
doses of 2 grams every 3 hours, as suggested by Hill and Eckman,[143]
but this is not as a rule necessary, for, as Jacobi aptly remarks:
"Prevention is the treatment of acidosis in children, and those
susceptible to acidosis should not have fat." What he has said for
children holds good for adults. However, it is likewise true that fat
must constitute a large part of a diabetic diet and the only way to
prevent it poisoning, is to raise the fat in the diet gradually until
the tolerance is determined.
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