The Starvation Treatment of DiabetesHill, Lewis Webb
Science
The Starvation Treatment of Diabetes
Hill, Lewis Webb
Diabetes; Diet in disease
(2) It is not desirable for all diabetics to hold their weight. Some
cases may do much better if their weight is reduced ten, fifteen, or
even twenty pounds.
(3) After starvation, the diet must be raised very slowly, to prevent
recurrence of glycosuria.
(4) An excess of protein must be regarded as producing glycosuria and
an excess of fat ketonuria, and the protein and fat intake must be
restricted a good deal more than has usually been the custom in
treating diabetes.
Case Reports.
It is thought worth while, for the sake of illustration, to include a
few case reports. The adults were treated at the Massachusetts General
Hospital, the children at the Children's Hospital.
Two charts are kept for each case: one a food chart, with the amounts
of the different articles of food taken each day, and the protein,
carbohydrate, fat and caloric value figured out for each foodstuff;
the second (see below) a more general chart, which shows graphically
the progress of the case.
The first three are cases which were treated first with the old method
of _gradually_ reducing the carbohydrate intake and could never be
made sugar-free, running from 0.1% to 0.2% of sugar. On the new
treatment they responded promptly and were discharged sugar-free.
* * * * *
Case 1. A woman of 64, diabetic for two years. She was sent in from
the out-patient department, where she had been receiving a diet of 50
grams of carbohydrate and 50 grams of protein. On this diet she was
putting out 8 grams of sugar a day with moderately strong acetone and
diacetic acid reactions in her urine. When the carbohydrate was cut in
the ward to 30 grams, she put out 3 grams of sugar a day. She
complained of severe pruritus vulvae. After sixteen days of this
treatment she continued to put out from 0.1% to 0.2% of sugar a day.
Allen's treatment was then started, and after one day of starvation
she was sugar-free and remained so for four days on a diet of
carbohydrate, 20 grams; protein, 30 grams; fat, 150 grams. The
itching had gone. Then the protein was raised to 80 grams, with the
carbohydrate at 20 grams, and she immediately showed 1.5% of sugar.
This is very important; the protein should not be raised too quickly.
This we did not realize in our earlier cases.
A second starvation day, followed by two vegetable days, and a more
careful raising of the diet--as follows--kept her sugar-free, and she
was discharged so. Her diets were:
Dec. 12.
Carbohydrate, 20 grams.
Protein, 30 grams.
Fat, 150 grams--1500 calories. No glycosuria.
Dec. 15.
Carbohydrate, 30 grams.
Protein, 30 grams.
Fat, 200 grams--2000 calories. No glycosuria.
Dec. 20.
Carbohydrate, 30 grams.
Protein, 40 grams.
Fat, 180 grams--2000 calories. No glycosuria.
Dec. 26.
Carbohydrate, 40 grams.
Protein, 40 grams.
Fat, 180 grams--2000 calories. No glycosuria.
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