This section is from the book "The Home Hand-Book of Domestic Hygiene and Rational Medicine. Volume 2.", by J. H. Kellogg, M.D.. Also available from Amazon: The Home Hand-Book of Domestic Hygiene and Rational Medicine, Volume 2.
All physicians of experience are agreed that in the treatment of this disease by far the most important measure is the regulation of the diet. Sugar, starch, and all foods containing them, should be, as far as possible, excluded from the dietary. This requires that the patient should abstain from the use of sugar in any form, from bread, potatoes, peas, beans, rice, oat-meal, com-meal, and other grains, chestnuts, and all other farinaceous articles of food. Sweet fruits also must be avoided with equal care. The diet should consist chiefly of meat of different kinds, including fowl. Greens, green beans, lettuce, yellow beets, asparagus, cucumbers, and radishes may also be eaten. Most acid fruits may be taken in moderate quantities, such as lemons, oranges, strawberries, peaches, and currants. In many cases skim-milk, sour milk, or buttermilk may be taken without increasing the proportion of sugar, and hence without injury. Several eminent physicians claim to have cured a number of cases of this disease by means of an exclusive milk diet, the patient being confined to this one article of food for several weeks. The milk should be carefully skimmed. The quantity required per day is from two to three quarts. By the employment of a diet free from sugar or starch, sugar may in many cases be made to disappear from the urine. When this is the case it may be looked upon as a very favorable indication, and often so long as the patient continues to abstain from those kinds of food which occasion the production of sugar the disease will be held in check.
In many cases, however, the disease does not yield to a restriction of the diet. For this class of cases nothing can be done except to confine the patient to a flesh diet. This can be done but for a short time, however, on account of the great repugnance to meat which will be developed and the derangement of digestion which will result from so large a quantity of animal food. On this account, cases of this sort seldom derive much benefit from treatment. The patient suffers most from being deprived of bread, and this article of food should not be wholly interdicted. The patient should not, however, be allowed to eat fine-flour bread, as this combines a very large portion of starch with little nutritive value. The bread eaten should consist of as large a proportion as possible of the nitrogenous elements with the smallest possible amount of starch. There are various formulas for making what is termed diabetic bread. That which is most effective in restraining the production of sugar is made of bran which has been washed several times, and after being dried is made into a sort of bread with butter and eggs. This, however, is very difficult of digestion, and often contains so little nutritive value that the patient will derive very little benefit from its use. Much better bread is that recommended by the eminent Dr. Pavy of England, which is made from almonds. The directions for making this bread will be found under the head "Diabetic Bread" in the section on "Medical Dietetics" Iceland moss may also be advantageously used for bread, being made into cakes with milk and eggs. Its use does not increase the production of sugar. The best of all breads for patients suffering with diabetes is made from gluten flour, which can generally be obtained of druggists.
It is a good plan in the dietetic treatment of diabetic patients to follow the method suggested with reference to the dietetic treatment of obesity; namely, to employ a strict diet for several days or two or three weeks, and then allow the patient to take a little more liberal diet for a few days, so that the appetite may not be so greatly impaired as to cause much decrease of the patient's strength. A diabetic patient should not be deprived of fluids, but should be cautioned to control the desire for drink within as reasonable limits as possible, and especially to take small quantities of fluid at a time. The intolerable thirst will often be re moved by holding bits of ice in the mouth. The great discharge of fluid from the body is not the result of excessive drinking, but is the cause of the great thirst, which is simply an expression on the part of the system of the lack of water in the blood, Consequently the intolerable thirst by which this disease is characterized is as much a real demand for fluid as is the thirst experienced in health.
In addition to the dietetic measures recommended, the most that can be done in many cases is to employ all suitable measures for securing and maintaining a general healthy condition. This should be done with the full understanding, however, that in quite a large proportion of cases of persons suffering from this disease the most that can be done is to mitigate the symptoms and prolong the patient's life, as a radical and permanent cure rarely occurs. The plan of treatment which we have adopted in the management of cases of this class has been substantially the following, with such modifications as are indicated by peculiarities of temperament, general condition, etc.:A short warm bath should be taken two or three times a week, with inunctions of olive-oil or cocoa-nut oil every other day. Sun-baths should be taken daily when possible. The use of faradic electricity as a tonic, and the application of galvanism to the spine, is attended with much benefit. The patient should also be required to take a large amount of exercise in the open air, horseback riding, walking, etc, in addition to the daily practice of calisthenics. The results obtained by this mode of treatment have been very encouraging, and in some cases very remarkable. Persons in whom several years ago the disease was well marked are still alive and enjoying comfortable health, though they still find it necessary to observe great care in diet in order to prevent a recurrence of the disease. In some cases, special benefit has seemed to be derived from a strong current of galvanism applied to the base of the brain and the sympathetic nerve, when no apparent effect could be obtained in any other way. Although numerous drugs have been at times highly recommended for the relief of this disease, it is generally considered that few, if any, have any effect upon it except by impairing the patient's nutrition, and thus producing a diminution of sugar by depressing his vitality. It need not be said that the injury done by remedies of this class must be much greater than any possible good which can result from their use. Morphia exercises more influence over the production of sugar than any other known drug, but at the same time interferes with the nutrition of the patient, so that its employment cannot be considered in any way as a curative measure. The want of success in the treatment of this disease may be in part attributed to the lack of knowledge respecting its real nature, which still continues, notwithstanding the numerous investigations of the subject. It is to be hoped that when the causes and character of the disease are better known, more successful remedial measures may be discovered.
In conclusion, we would call attention to the fact that a sudden and very great decrease in the amount of urine should be regarded as of unfavorable import when it cannot be fairly attributed to treatment. This fact is well illustrated by the following case, observed while this work was in press: We were suddenly called by telegram to see a patient in consultation at a distance who had suffered for several years from diabetes, passing about two gallons of urine daily. We found the patient in a state of unconsciousness, the pupils widely dilated, pulse barely perceptible, in which condition she had been for about thirty hours. Upon inquiring into the history of the case we found that three or four days previously she had had a severe ague chill, since which time she had been rapidly failing until she had reached the condition in which we found her. Upon making inquiry of her medical attendant concerning the condition of her bladder and the amount of secretion, we found that within the last thirty-six hours not more than thirty ounces had been formed, which was less than one-tenth of the usual quantity. The other nine-tenths, of course, which remained in her system, had so poisoned the nerve centers as to bring the patient into the comatose condition in which we found her. The patient, finding the quantity of urine about that usual in health, had not compared it with the amount she had been habitually secreting up to the time of her sickness, and hence had failed to discover the real cause of the sudden change in symptoms. In a case of this kind the treatment suggested should be applied promptly and thoroughly, namely, alternate hot and cold applications to the small of the back over the kidneys, and packing the patient with hot bottles, bricks, etc., to induce profuse perspiration. The patient should also be given hot teas, or warm drinks of other kinds in abundance, so as to encourage the sweating process. By this means the poison may be eliminated from the blood, and life maintained until the kidneys become able to resume their functions.