DIABETES MELLITUS

Categories: Constitutional Diseases

A disorder of nutrition in which sugar accumulates in
the blood and is excreted in the urine, the daily amount of which is

greatly increased.



Causes. Hereditary influences play an important role and cases are on

record of its occurrence in many members of the same family. Men are more

frequently affected than women, the ratio being about three to two.

Persons of a nervous temperament are often affected. It is a isease of

the higher classes. Hebrews seem especially prone to it. The disease is

comparatively rare in the colored race; women more than men in the negro,-

nine to six. In a considerable proportion of the cases of diabetes the

patients have been very fat at the beginning of or prior to the onset of

the disease. It is more common in cities than in country districts. The

combination of intense application to business, over-indulgence in food

and drink, with a sedentary life, seem particularly prone to induce the

disease. Injury to or disease of the spinal cord or brain has been

followed by diabetes. It is much more frequent in European countries than

here. Acute and chronic forms are recognized in the former.



Symptoms. The only difference is that the patients are younger in acute

forms, the course is more rapid and the wasting away is more marked. The

onset of the disease is gradual and either frequent passing of urine (six

to forty pints in twenty-four hours) or inordinate thirst attracts

attention. When it is fully established, there is great thirst, the

passage of large quantities of sugar urine, a terrible appetite, and, as a

rule, progressive emaciation. The thirst is one of the most distressing

symptoms. Large quantities of water are required to keep the sugar in

solution and for its excretion in the urine. Some cases do not have the

excessive thirst; but in such case the amount of urine passed is never

large. The thirst is most intense an hour or two after meals. The

digestion is generally good, but the appetite is inordinate. Pain in the

back is common. The tongue is usually dry, red and glazed, and the saliva

is scanty. The gums may become swollen. Constipation is the rule. The skin

is dry and harsh and sweating rarely occurs. The temperature is under

normal. In spite of the enormous amount of food eaten a patient may become

rapidly emaciated. Patients past middle life may have the disease for

years without much disturbance of the health; on the other hand I have

seen them die after that age. Progress is more rapid the younger the

person. Death usually occurs from coma of diabetes. This is most common in

young patients.






1. There is a sudden onset after exertion of weakness, feeble pulse,

stupor, coma, death in a few hours.



2. Sudden headache, coma, death in a few hours.



3. After nausea, vomiting or a lung complication, there are headache,

delirium, abdominal pain, rapid labored breathing, sweetish odor of the

breath, stupor, rapid feeble pulse, coma and death within a few days.



Recovery. Instances of cure in true diabetes are rare.



Treatment. Preventive. The use of starchy and sugary articles of diet

should be restricted in families with a marked disposition to this

disease. Sources of worry should be avoided and he should lead an even

quiet life, if possible, in an equable climate. Flannel and silk should be

worn next to the skin, and the greatest care should be taken to promote

its action. A lukewarm and, if tolerably robust, a cold bath should be

taken every day. An occasional Turkish bath is useful.



Diet. Let the patients eat food of easy digestion, such as veal, mutton

and the like, and abstain from all sorts of fruit and garden stuff. In

Johns Hopkins' Hospital these patients are kept for three or four days on

the ordinary ward diet, which contains a moderate amount of

carbo-hydrates, in order to ascertain the amount of sugar excretions. For

two days more the starches are gradually cut off. They are then placed on

the following standard non-carbohydrate diet.



Breakfast: 7:30, six ounces of tea or coffee; four ounces of beefsteak,

mutton chops without bone, or boiled ham; one or two eggs.



Lunch: 12:30, six ounces of cold roast beef; two ounces celery, fresh

cucumbers or tomatoes with vinegar, olives, pepper and salt to taste, five

drams of whisky with thirteen ounces of water, two ounces of coffee

without milk or sugar.



Dinner: 6:00 P. M., six ounces of clear bouillon; seven and a half ounces

of roast beef; one and one-half drams of butter; two ounces of green salad

with two and a half drams of vinegar, five drams of olive oil, or three

tablespoonfuls of some well-cooked green vegetable: three sardines; five

drams of whisky with thirteen ounces of water.



Supper: 9:00 P. M., two eggs, raw or cooked, thirteen ounces of water .



The following is a list of articles which a diabetes patient may take as

given by one of the best authorities in the world on diabetes:



Liquids: Soups. Ox tail, turtle bouillon and other clear soups. Lemonade,

coffee, tea, chocolate and cocoa; these to be taken without sugar, but

they may be sweetened with saccharin. Potash or soda water and

appollinaris, or the Saratoga-vichy and milk in moderation may be used.






Animal Food. Fish of all sorts, including crabs, oysters, salt and fresh

butcher's meat (with the exception of liver), poultry and game, eggs,

buttermilk, curds and cream cheese.



Bread. Gluten and bran bread, almond and cocoanut biscuits.



Vegetables. Lettuce, tomatoes, spinach, chickory, sorrel, radishes,

asparagus, water-cress, mustard and cress, cucumber, celery and endives;

pickles of various sorts.



Fruits. Lemons and oranges, currants, plums, cherries, pears, apples

(tart), melons, raspberries and strawberries may be taken in moderation.

Nuts, as a rule, allowable.



Must Not Take--



Thick Soups and Liver. Ordinary bread of all sorts (in quantity), rye,

wheaten, brown or white. All farinaceous (starchy) preparations, such as

hominy, rice, tapioca, arrowroot, sago and vermicelli.



Vegetables: Potatoes, turnips, parsnips, squashes, vegetable-marrows of

all kinds, beets, common artichokes.



Liquids: Beer, sparkling wine of all sorts and the sweet aerated drinks.



Medicines. Codeine. A patient may begin with one-half grain three times a

day, which may be gradually increased to six or eight grains in the

twenty-four hours (under the doctor's care); withdraw it gradually when

sugar is absent or reduced as far as possible.