The Starvation Treatment of DiabetesHill, Lewis Webb
Science
The Starvation Treatment of Diabetes
Hill, Lewis Webb
Diabetes; Diet in disease
Most adults do well on about 30 calories per
kilogram of body weight; children of four years need 75 calories per
kilogram, children of eight years need 60, and children of twelve
years need 50.
If sugar appears in the urine during the process of raising the diet,
we drop back to a lower diet, and if this is unavailing, start another
starvation day, and raise the diet more slowly. But it will be found,
if the diet is raised very slowly, sugar will not appear. It is not
well to push the average case; if the patient is taking a fair diet,
say protein 50, carbohydrate 50 and fat 150, and is doing well,
without any glycosuria, it is not desirable to raise the diet any
further. The caloric intake may seem rather low in some of these
diets, but it is surprising to see how well most patients do on 1500
or 2000 calories.
It will be seen that the treatment can be divided into three stages:
(1) The stage of starvation, when the patient is becoming sugar-free.
(2) The stage of gradually working up the diet to the limit of
tolerance.
During the first two stages a daily weight record should be kept, and
the urine should be examined every day. The patient should, of course,
be under the immediate supervision of the physician during these two
stages. It is always well to discharge a patient on a diet somewhat
under his tolerance, if possible.
(3) The stationary stage, when the diet is kept at a constant level.
The patient is at home and going about his business. Most patients may
be taught to test their own urine, and they should do this every other
day. If there is sugar in the urine, the patient should go back to a
lower diet, and if he cannot be made sugar-free this way, he should be
starved again. A semi-starvation day of 150 grams of vegetables, once
a week, whether or no the urine contains sugar, is of value for the
purpose of keeping well within the margin of safety and of reminding
the patient that he is on a strict diet.
_It is very important for a diabetic to take a considerable amount of
exercise: he can utilize his carbohydrate better, if he does._
If this treatment is to be successful, it is absolutely necessary for
the patient to adhere very strictly to the diets, and to measure out
everything very carefully; the meat especially should be weighed.
It will be noticed that in some cases the calories in the diets do not
tally exactly with the protein, fat and carbohydrate values. The
reason for this is that for the sake of convenience the calories have
been given in round numbers--5 or ten calories one way or the other
makes no difference.
The essential points brought out by Allen's treatment are as follows:
(1) It is not dangerous to starve a diabetic, and two or three days of
starvation almost always make a patient sugar-free, thus saving a good
deal of time, as contrasted with the old treatment of gradually
cutting down the carbohydrate.
Public-domain text, read in full here on John Shaqi.
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