In no disease does diet form a more important part of the treatment than in diabetes mellitus. As is well known, the nature of the disease consists in the fact that the organism is unable either entirely or nearly so to utilize the carbohydrate foods. We thus have to deal with a genuine anomaly of metabolism, and the main points of treatment will consist of a rational and appropriate diet so long as there is no specific remedy for this disease.

As it is possible to live on meat and fat alone without carbohydrates, it was natural to exclude this latter group of food-stuff from the diabetic diet. This was, indeed, done by the earliest observers who had knowledge of the nature of diabetes (Rollo, 1796), and this diet was adhered to with slight modifications until the present time.

1 Remark: This lecture is left as delivered in 1906. It is applicable even now especially in cases not suitable for the Allen treatment. The only restriction will apply to the amount of fats given.

1 Journal American Medical Association, Dec. 29, 1906.

The following disadvantages are attached to a purely animal diet: It offers too little variety and departs too much from the usual mode of life, and in this way will soon pall on the appetite. At the same time it is poor in inorganic salts, thus predisposing to a surcharge of the organism with acids (acidosis) and subsequent comatose conditions.

An absolute meat and fat diet can be borne for only a short period. Such a diet would be about as follows:

Strict Diet

8 a. m.: Two eggs, butter, tea; 11 a. m.: Ham, wine; 1 p. m. : Beef tea, 200 grams of meat or fish, one egg, lettuce or spinach; 4 p. m.: Coffee, two eggs and butter; 7 p.m.: Three eggs fried in lard, or fish with eggs or cold roast.

A trace of sugar is contained even in this diet, but it hardly amounts to over 1 per cent. By the addition of some milk and cream this diet may be made a little more agreeable, although the quantity of sugar is greater.

Such a diet list may be put together about as follows:

Intermediate Diet

Breakfast: 200 grams of milk with 50 grams of cream, two eggs, butter and 100 grams of roast.

Dinner: 200 grams of meat or fish with asparagus or peas, salads.

4 p. m.: 200 grams of milk with 50 grams of cream. Supper: Four scrambled eggs with 120 grams of ham.

C. von Noorden1 determines first how much carbohydrate a patient can assimilate and allows about half of this. Such a procedure appears very rational, but can be conducted only in special clinics and not in general practice. It is best to arrange the diet according to customary principles, varying it slightly to fit the individual requirements of the patient. Whether or not a diet agrees with the patient can best be determined by noting the diminution of the quantity of sugar, as well as the total daily quantity of urine, and secondly and mainly by the patient feeling better and stronger.

According to the experience of most clinicians, it is best to permit diabetics a certain, although limited amount of carbohydrates.

Seegen's2 diet list for diabetics is probably the best known and, therefore, I will quote it in full:

1 C. von Noorden: "Ueber Hafercuren bei schwerem Diabetes mellitus," Berl. klin. Wochschr., 1903, No. 36, p. 817.

2 J. Seegen: "Der Diabetes mellitus," Berlin, 1895; see also Frieden-wald and Ruhräh: "Diet in Health and Disease," 1905, pp. 470-471.

Solids. Allowed In Any Quantity

Meat of every kind, smoked meat, ham, tongue, fish of every kind, oysters, mussels, crabs, lobsters, meat jellies, aspic, eggs, caviar, cream, butter, cheese and bacon. Of vegetables: Spinach, lettuce, endive, Brussels sprouts, pickles, fresh asparagus, watercress, sorrell, artichokes, mushrooms, nuts.

Allowed In Moderate Quantity

Cauliflower, carrots, turnips, cabbage, green beans, berries, such as strawberries, raspberries, currants, also oranges and almonds.

Forbidden Absolutely

All foods made from flour or meal; bread is allowed in moderate quantities, according to the physician's orders; sweet potatoes, rice, tapioca, arrowroot, sago, grits, vegetables, green peas, cabbage, sweet fruits, especially grapes, cherries, peaches, apricots, plums and dried fruit of every sort.

Beverages. Allowed In Any Quantity

Water, soda water, tea and coffee. Of wines: Bordeaux, Rhine wine, Moselle, Austrian and Hungarian table wines - in a word, all wines that are not sweet and that do not contain more than the average amount of alcohol.

Allowed In Moderate Quantity

Milk, bitter beer, unsweetened almond milk, lemonade without sugar.

Forbidden

Champagne, sweet beer, cider, fruit wine, sweet lemonade, liqueurs, fruit juices, water ices, sorbets, cocoa and chocolate.

In general, I use about the same diet as Seegen and give the following:

Various diet cures have proved of value in diabetes. Of these the best known are the "milk cure" of Winternitz,1 the "potato cure" of Mosse, and the "oatmeal cure" of von Noorden.2

1 Winternitz und Strasser: "Strenge Milchkuren bei Diabetes mellitus," Centbl. f. innere Med., 1899, No. 45.

2 C. von Noorden: "Ueber Hafercuren bei schwerem Diabetes mellitua," Berl. klin. Wochschr., 1903, No. 36, p. 817.

Whereas Mosse's potato cure has not proved of much value, the other two cures are useful in suitable cases. They should not be extended over too long a time because a too limited diet is harmful if continued too long. Winternitz's milk cure consists in the patient taking milk exclusively (about four quarts daily).

Von Noorden recommends his oatmeal cure, especially in grave cases of diabetes. He uses either Knorr's oatmeal or Hohenlohe's oatmeal flakes. This substance is boiled in water for a long time with a little salt; while boiling butter and a vegetable albuminoid or, after cooling, the beaten white of eggs are added. Roborant may be employed for this purpose with good advantage. The daily quantity is 250 grams of oatmeal, 100 grams of albumin and 300 grams of butter. The soup prepared in this manner is given every two hours. Cognac or wine or black coffee may also be permitted.

No matter what form of diet is instituted, it is always essential to see that the quantity of food is sufficient. In this respect fat (butter, cream, oil, lard) is of more importance here than in other conditions. Alcohol, taken moderately in the shape of whisky, cognac or wine, is also of value. The body receives in the first place more fuel (as 50 grams of alcohol, which may be put down as the daily quantity, contain about 350 calories), and secondly because the patient, with the addition of wine, can take more of the greasy food than without it.