Cooking

Care should be exercised in the preparation and cooking of the food for diabetic patients that injurious ingredients are not added for the purpose of flavouring or thickening. For this reason all the articles of diet should be cooked as simply as possible, and rich sauces containing flour should be forbidden. Melted butter may be used as a substitute. Roast beef should not be basted with flour, and meat soups must not be thickened. Vegetables which have been boiled for a long time in a large bulk of water have most of their sugar dissolved out, and on that account are less injurious.

Very acid fruits may be sweetened with saccharin or cooked with a little sodium or potassium bicarbonate to neutralise their acidity.

Beverages. Water

It is an important matter to decide to what extent to restrict the quantity of water and other fluids drunk by diabetics. When so much urine is voided that the patient's rest at night is disturbed by acts of frequent micturition, it is always annoying, and may be even serious. The increased work thrown upon the kidneys is less harmful than might be at first supposed, for the water of the urine is excreted chiefly by a simple process analogous to filtration, which no doubt taxes the renal epithelium less than the excretion of some of the solids of the urine. At all events, protracted cases of diabetes do not necessarily exhibit serious renal degeneration.

For these reasons, if the water drunk is restricted, it should be so more on account of relieving the patient of an uncomfortable condition than from fear that the act of passing so much urine may be injurious per se, and the restriction should never be enforced too suddenly. As a rule, when dietetic regulation reduces the glycosuria and improves the patient's condition there is, pari passu, a reduction in the quantity of urine voided. In other words, this symptom takes care of itself. A reasonable restriction of the fluids allowed is to be recommended, but when thirst is extreme it becomes unendurable torture to withhold them rigidly, and, moreover, the water is apparently needed to wash out the sugar which would otherwise accumulate in the blood and tissues. In fact, the occurrence of impending coma has been postponed by flushing the circulation by means of large draughts of water or enemata of salt water.

When the thirst leads to excessive drinking, salt foods and condiments should be withheld, and some relief may be obtained by sucking a slice of lemon or by using a little potassium bitartrate and lemon juice, or dilute phosphoric acid in water. The patient should drink only from a small glass, for there is more satisfaction in draining it than in taking the same quantity of fluid from a large goblet which one is not allowed to empty.

The meat diet, if not too salt, diminishes the desire for fluids very much as compared with a vegetable diet, for usually thirst increases in direct proportion to the amount of sugar contained in the blood.

It is important not to distress the patient so much by denial that the nervous system suffers in consequence.