Published Science

The general acceptance of the principle of restriction of the total caloric intake in the dietetic management of diabetes mellitus in contrast to the older principle of overfeeding has increased the importance of an accurate knowledge of the minimum amount of protein that will maintain nitrogenous equilibrium in the diabetic patient. The ultimate effect of long continued gradual loss of body nitrogen is not known, but it seems probable that such a condition is very undesirable. The subject whose nitrogen excretion is constantly higher than his nitrogen ingestion is certainly suffering for want of one of the most important of the tissue repairing elements, and a diet so arranged as to induce this negative balance, even though not lethal, must produce a severe grade of inanition.

The following experiments were undertaken in an effort to determine the minimum protein ingestion that will safely maintain nitrogen balance in patients with diabetes

While the majority of clinicians have admitted the existence of renal glycosuria, the number of entirely acceptable cases that have been reported is small. Allen¹accepts only two, those of Bönninger²and Tachau,³and Foster⁴found no others above suspicion. Recently, several cases have been reported, some of which present the characteristics of mild diabetes mellitus. With the introduction of simple, accurate methods for determining the sugar content of the blood, it has been possible to establish the diagnosis on a firm basis.

The subject has been discussed in detail by several modern authors, notably Goto,⁵Bailey⁶and Lewis and Mosenthal.⁷It is important to remember that extreme caution should be used in making the diagnosis of renal glycosuria, rather than that of diabetes mellitus; the disastrous injustice of assuring a diabetic that he has the innocuous disease that the former seems to be, and of failing to regulate his

In a previous communication¹we discussed in outline the advantages of the use of a high fat diet in the treatment of diabetes mellitus. We reported briefly the results of an investigation of the effect of a diet whose energy came largely from fat, to which was added sufficient protein to maintain nitrogen balance and the minimal carbohydrate necessitated in making up a diet that a human being can eat over a long period of time. It was shown that with such a diet, glycosuria was avoided in severe diabetics, and that acidosis was not produced.

The first paper stated the method employed and, in a general way, the results obtained. Freedom from glycosuria, however, does not necessarily mean normal glycemia. In this communication we shall deal with the effect of this type of diet on the blood sugar.

Blood sugar determinations, sufficiently numerous to permit drawing conclusions concerning the

The treatment of diabetes mellitus has been very greatly improved in the recent past, owing to the work of Allen¹and his colleagues. It has been shown by him that the urine of the severest diabetics can be made sugar free by sufficiently prolonged starvation and will remain sugar free if the total energy intake is kept sufficiently small.

It has been the general custom to make up the diet largely of protein, because of the undoubted desirability of omitting carbohydrates, and because of the almost universal fear of precipitating a dangerous acidosis by allowing more than a minimum of fat. This high protein, low fat, low carbohydrate diet, given in quantities sufficient to maintain metabolic needs, is accompanied by a glycosuria in the severe diabetics. In order to prevent glycosuria, it is necessary to restrict the total energy intake so much that inanition results. In other words, this leaves

The winter of 1916-1917 was passed in Melville Island by seventeen members of the Canadian Arctic Expedition. The expedition vessel, thePolar Bear, had failed to reach the island and we expected to live the winter entirely on fresh or dried musk-ox, reindeer, seal and bear meat. During the darkness of winter, however, our sleds got their steel shoeing worn out through a traveling party getting lost among some rocky hills where the sleds had to be dragged scores of miles, mainly over rock. This necessitated my sending a party in midwinter to Winter Harbor on the same island (where in the past several vessels have wintered) to see if they could find abandoned iron or steel and shoe the sleds for the spring work. Some of our people made another trip to the same place during the winter for a different purpose.

At Winter Harbor our men found, besides

Alimentary glycosuria, as exhibited in the renal excretion of sugar when undue amounts of carbohydrates are ingested by persons who fail to manifest this symptom under ordinary conditions of diet, has long been recognized and investigated. The prominence which the clinical estimation of the sugar-content of the blood has assumed in recent months, and the diagnostic importance which has been attached to the variations in this blood-constant as a possible index of incipient metabolic disorder, have seemed to call for a careful determination of the precise effect which the ingestion of carbohydrate may exert in altering the quantum of blood-sugar under well controlled conditions in otherwise healthy persons. The determination of normal values and physiologic deviations from them is always essential as the rational beginning in the establishment of a new scheme of diagnostic procedure. Such an undertaking has lately been carried out in the medical clinic of the University