Definition

Perverted nutrition in which sugar fails to be carried through the regular digestive process and appears in the urine. It is considered that a patient has diabetes if sugar is appearing in the urine daily.

Etiology

This is, a disease of civilization. It is a disease that makes, itself felt in all sections of the country where the cost of high living is well known. In other words, it is a disease peculiar to leisure and luxury. It is said that men are afflicted more often than women. The reason for this is that men indulge themselves in luxuries more than women. Man smokes and drinks, and is more inclined than woman to go to excess in all kinds of stimulants. People who have a tendency to obesity are more disposed to develop this disease than thin people. Mental shocks, nerve strains, overwork, worry, anxiety, all have a tendency to favor the development of this disease. Severe injuries are frequently followed by sugar in the urine.

Metabolism In Diabetes

There is no question but that the foundation for this disease is laid in toxemia; and toxemia is brought on from excessive eating and eating to repletion--eating until there is a chronic state of acidosis, fermentation in the stomach and duodenum, and also putrefaction in the large intestine, with daily absorption of toxins. Just why one case of toxemia will be followed by diabetes, another by Bright's disease, and another by tuberculosis, is not apparent to the lay public; but the real cause is anatomical and physiological. In diabetic subjects there is a tendency for a derangement of the pancreas and liver. It is said that in all cases of extirpation of the pancreas permanent diabetes is established. Then it is reasonable to believe that where there is a constant state of acetous fermentation of the stomach and duodenum, this acid state prevents the enzymes secreted by the pancreas from converting the starch into sugar. Much of the starch will be worked up into alcohol, and quite a good deal will pass off by way of the kidneys as sugar in the urine. The walls of the intestine as well as the liver fail to dehydrate the sugar, and this allows it to pass into the circulation and out by way of the kidneys.

Symptoms

The acute form runs its course more rapidly. The patients become rapidly emaciated. In the chronic form many patients will be showing considerable sugar, without any very material change in the constitutional symptoms, running over a period of several years. The acute form may occur in the aged, but the rule is that people beyond middle life have the chronic form. There are people who have sugar in the urine a great deal of the time, and yet they are not truly diabetic. Those who eat a great deal of sugar, and those who overeat on starch, are very much inclined to have sugar in the urine.

There is a strictly neurotic type of diabetes. Where men are employed in enterprises requiring all the nerve energy they have, and are pushed to the limit in endurance, a nervous state will be developed that will be accompanied by sugar in the urine. The disease is strictly one of perverted nutrition; and unless nutrition is brought back to normal, a permanent cure will not be made.

Polyuria is a state where there is not much sugar in the urine, yet there is a very great quantity of urine passed--as much as a gallon or over in twenty-four hours. This particular type is of nervous origin, and, of course, there is, more or less gastro-intestinal indigestion. A tendency on the part of some cases is to drink a great deal of water or light alcoholics. In most cases the disease develops gradually, the patient not noticing the frequent desire to urinate. He will be troubled in this way not only in the daytime, but also at night. The quantity passed will attract his attention sooner or later. When measured, he will find that he is passing four, five, or six pints in twenty-four hours, instead of three; and he will also be surprised to find that it is of greater specific gravity. It will run from 1,025 to 1,040. The tongue is usually red--sometimes very silky-looking, as though it were varnished. Saliva is usually scanty. The gums are sometimes red and swollen, and sores appear in the mouth. Constipation is the rule in such cases. The appetite is usually enormous; but, in spite of this, the patients with pronounced diabetes will continue to grow thinner and become more emaciated. The skin is usually dry and puffy, and abnormally warm; in fact, the hands and feet will often be quite hot, without showing any fever.

Sometimes there will be great quantities of urine passed in twenty-four hours, and then during the next twenty-four hours the quantity will drop to almost normal; but the patient will have a profuse perspiration, wetting the underclothing, bed-clothing, and bringing on discomfort from the amount of dampness.

Glycogen is found in the urine, and, of course, is due to imperfect digestion. Albumin is frequently found in diabetic urine. Perhaps one-third of the cases show more or less albumin.

Pneumaturia means the amount of gas in the urine due to fermentation taking place in the bladder. This is not met with very often.

Blood is frequently found in the urine.

Among people who live high, diabetes is not infrequent in children. Inasmuch as it is a disease resulting from high living, it would be natural for children of this class to develop the disease. High living usually means eating cake and puddings; food that is extravagantly dressed; food cooked with lots of butter and cream.

Diabetic patients are frequently carried off by pneumonia. Broncho-pneumonia is said to be very common. Albuminuria is also a frequent complication. In such cases there will usually be edema of the feet. Diabetes is frequently associated with arteriosclerosis; in fact, the cause of diabetes is often the cause of arteriosclerosis.

Diabetic Tabes

This is a nervous derangement characterized by shooting pains in the extremities, and the patella reflex is lost. The gait of the patient is that of tabes dorsalis.

Mental Symptoms

Patients with this disease often become morose and despondent.

Special Senses

Cataract is liable to grow, also inflammation of the retina, closely resembling that which accompanies albuminuria. Hemorrhages are also common in the eye.

Sexual Function

Impotency is common, and may develop very early in the case. Conception is rather rare, sterility is established, and, where pregnancy takes place it is liable to be followed by abortion.

Diagnosis

Sugar in anything like unusual quantities, found in the urine daily, is almost diagnostic. It should be present for weeks, and it should show more three hours after a meal than before that time or after. The sugar thrown off is a true grape sugar; an albuminuria or glycosuria is temporary, and always means overeating, especially of the sweets. In such cases, by watching, the patient can soon learn to know what his limitations are in regard to starches or carbohydrates; and then he should respect his limitations. If he does not, he may bring on a real grape-sugar diabetes.

Treatment

The diet should be confined to fruit for one, two, or three weeks, depending upon the severity of the symptoms and the rapidity with which the amount of sugar in the urine is reduced. As soon as the amount is brought down to almost normal, the eating should be about as follows: any kind of fresh, uncooked fruit with tea-kettle tea for breakfast; Tilden salad and teakettle tea for the noon meal; and the evening meal may be fish once or twice a week, eggs (soft-boiled, scrambled, or poached) twice a week, lamb or chicken two or three times a week. With these items of food the patient is to have a Tilden salad. If the amount of urine passed increases, drop the teakettle tea at noon. After several months of absence of sugar in the urine there should be a change in diet. In the morning thoroughly dried out wholewheat bread or shredded wheat may be taken dry, followed with fresh fruit and teakettle tea. The other meals can remain the same.

The eating must be watched. If there is any tendency for sugar to reappear, the patient should drop back to fruit. Then, when the sugar disappears, he should return to the regular routine. Baths should be given every morning, if the bathroom is warm. If not, the bath should be taken in the evening, and it should be of from two to five minutes' duration. Have the water as hot as the patient can possibly endure. Follow the hot bath with a quick cold sponge-bath. Not more than one minute should be required to get the cold water over the body. Then a dry towel-rubbing should be given. If the bath is taken in the evening, a dry towel-rubbing should be given in the morning. Rest is very necessary. The patient should retire at nine and get up late. He should avoid excitement-should stay away from picture shows, theaters, etc., and avoid reading anything that will excite the nervous system. There is no objection to a little brain work in the line of study, but the nervous system must not be overfatigued at any time.

The underwear should be open-woven cotton or linen, and never anything heavier than medium weight in the coldest winter weather. Heavy outside wraps may be worn in cold weather. Everything must be eliminated from the daily habits that uses up nerve energy. The patient is not to use coffee, tea, chocolate, cocoa, alcoholics, or tobacco. These stimulants must positively be stopped, if the disease is to be controlled and the patient brought into a condition where he will not relapse.