The Starvation Treatment of Diabetes by Lewis Webb Hill (books for 10th graders TXT) π
The Allen treatment was started with two starvation days. On the second he was sugar-free--but showed 2.6 grams of sugar the following day on 12 grams of carbohydrate and 40 grams of protein. (This was one of the earlier cases when the diet was raised too quickly after starvation.) After one more starvation day and two vegetable days he stayed sugar-free while the diet was raised slowly to 30 grams of carbohydrate and 45 grams of protein, calories about 2000. Discharged sugar-free on this diet.
Weight at entrance, 109 pounds. Weight at discharge, 110 pounds.
* * * * *
Case 3. A man of 35, a severe diabetic, entered Dec. 28, 1914. He had been in the hospital the previous July for a month and could never be made sugar-free with the old method of treatment. At entrance he was putting out 2.5% of sugar (135 grams) per day with strongly positive acetone and diacetic acid tests. Tw
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This is a more delicate test than Fehling's.
[1] Fehling's solution is prepared as follows:
(a) Copper sulphate solution: 84.65 gm. of copper sulphate dissolved in water and made up to 500 c.c.
(b) Alkaline tartrate solution: 125 gm. of potassium hydroxide and 178 gm. of Rochelle salt dissolved in water and made up to 500 c.c.
These solutions are kept in separate bottles and mixed in equal volumes when ready for use.
[2] Benedict's solution has the following composition:
Copper sulphate, 17.8 gm.
Sodium citrate, 178.0 gm.
Sodium carbonate (anhydrous), 100 gm.
Distilled water to 1000 c.c.
Quantitative Sugar Tests.
(1) The Fermentation Test:βThe fermentation test is the simplest quantitative test for sugar, and is quite accurate enough for clinical work. It is performed as follows: The specific gravity of the 24Β° urine is taken, and 100 c.c. of it put into a flask, and a quarter of a yeast cake crumbled up and added to it. The flask is then put in a warm place (at about body temperature) and allowed to remain over night. The next morning a sample of the fermented urine is tested for sugar. If no sugar is present the urine is made up to 100 c.c. (to allow for the water that has evaporated) and the specific gravity taken again. The number of points loss in specific gravity is multiplied by .23, and this gives the percentage of sugar in the urine.
(2) Benedict's Test:βThe best quantitative test for dextrose (excepting polariscopic examination, which is too complicated for ordinary work) is Benedict's test.
It is performed as follows: Measure with a pipette 25 c.c. of Benedict's solution into a porcelain dish, add 5 or 10 gm. (approximately) of solid sodic carbonate, heat to boiling, and while boiling, run in the urine until a white precipitate forms.
Then add the urine more slowly until the last trace of blue disappears. The urine should be diluted so that not less than 10 c.c. will be required to give the amount of sugar which the 25 c.c. of reagent is capable of oxidizing.
Calculation: 5, divided by the number of c.c. of urine run in, equals the per cent. of sugar.
Benedict's quantitative solution is prepared as follows: Dissolve 9.0 gm. of copper sulphate in 100 c.c. distilled water. (The copper sulphate must be weighed very accurately.) Dissolve 50 gm. anhydrous sodic carbonate, 100 gm. sodic citrate, and 65 gm. of potassium sulpho cyanate in 250 c.c. of distilled water.
Pour the copper solution slowly into the alkaline citrate solution. Then pour the mixed solution into the flask without loss, and make up to 500 c.c.; 25 c.c. of this solution is reduced by 50 mgm. of dextrose, 52 mgm. of levulose or 67 mgm. of lactose.
(3) Acetone Test:βTo 5 c.c. of urine in a test tube add a crystal of sodium nitro prusside. Acidify with glacial acetic acid, shake a moment, and then make alkaline with ammonium hydrate. A purple color indicates acetone.
(4) Diacetic Acid Test:βTo 5 c.c. of urine in a test tube add an excess of a 10% solution of Ferric chloride. A Burgundy red color indicates diacetic acid.
Quantitative Test for Ammonia.
To 25 c.c. of urine add 5 c.c. of a saturated solution of potassium oxalate and 2 to 3 drops of phenolphthalein.
Run in from a burette decinormal sodic hydrate, to a faint pink color. Then add 5 c.c. of formalin (40% commercial) and again titrate to the same color.
Each c.c. of the decinormal alkali used in this last titration equals 1 c.c. of n/10 ammonia, or .0017 gm. of ammonia. Multiply this by the number of c.c. n/10 sodic hydrate used in the last titration; this gives the number of grams of ammonia in 25 c.c. urine.
Note:βThe potassium oxalate and the formalin must both be neutral to phenolphthalein.
1 calorie = The amount of heat necessary to raise the temperature of 1 kilogram of water 1 degree Centigrade.
1 gram fat = 9.3 calories.
1 gram protein = 4.1 calories.
1 gram carbohydrate = 4.1 calories.
DIETS.
In the diet tables following, the vegetables listed, excepting lettuce, cucumbers, celery, and raw tomatoes, are boiled. In the very low carbohydrate diets they are thrice boiled. When possible to obtain the figures, the analyses for boiled vegetables have been used. It has been estimated that four-tenths of the carbohydrate will go into solution when such vegetables as carrots and cabbage are cut into small pieces, and thoroughly boiled, with changes of water. It must be remembered that bacon loses about half its fat content when moderately cooked.
A number of more or less palatable breads may be made for diabetics, but the majority of the so-called "gluten" and "diabetic flours" are gross frauds, often containing as much as fifty or sixty per cent. carbohydrate. Gluten flour is made by washing away the starch from wheat flour, leaving a residue which is rich in the vegetable protein gluten, so it must be remembered that if it is desired to greatly restrict the protein intake, any gluten flour, even if it contains only a small percentage of carbohydrate, must be used with caution. The report of 1913, Connecticut Agricultural Experiment Station, Part I, Section 1, "Diabetic Foods", gives a most valuable compilation of analyses of food products for diabetics. We have found some use for soya meal, casoid flour and Lyster's flour, "akoll" biscuits, and "proto-puffs," but generally the high protein content of all of these foods interferes with giving any large quantity of them to a severe diabetic over a long period of time. The flours mentioned below we know to be reliable.
Some recipes which we have found useful are given below. The use of bran is meant to dilute the protein, increase the bulk, and incidentally to aid in preventing or correcting constipation.
BRAN AND LYSTER FLOUR MUFFINS.[3]
2 eggs
4 tablespoons heavy cream, 40% fat
2 cups washed bran
1 package Lyster flour
1/2 cup water or less
Tie dry bran in cheesecloth and soak 1 hour. Wash, by squeezing water through and through, change water several times. Wring dry.
Separate eggs and beat thoroughly. Add to the egg yolks the melted lard, cream and 2 beaten egg whites. Add the Lyster flour, washed bran and water.
Make eighteen muffins.
Total food value: Protein 99 grams, fat 68 grams, carbohydrate 2 grams, calories 1049.
One muffin = protein 5 grams, fat 4 grams, carbohydrate, trace, calories 58.
[3] Lyster's Diabetic Flour prepared by Lyster Brothers, Andover, Mass.
BRAN CAKES.
2 tablespoons melted butter
2 whole eggs
1 egg white
1/2 teaspoon salt
1/2 grain saccharine
Tie bran in a piece of cheesecloth and soak for one hour. Wash by squeezing water through and through. Change water several times. Wring dry. Dissolve saccharine in one-half teaspoon water. Beat the whole eggs. Mix the bran, beaten eggs, melted butter, and saccharine together. Whip the remaining egg white and fold in at the last. Form into small cakes, using a knife and a tablespoon. Bake on a greased baking sheet until golden brown.
This mixture will make about 25 small cakes. One cake represents 16 calories. A sample cake made by this recipe was analyzed and found to contain neither starch nor sugar.
SOYA MEAL AND BRAN MUFFINS.[4]
1 level tablespoon (15 grams) butter
1 ounce (30 c.c.) 40% cream
1 cup of washed bran (see method given elsewhere)
1 egg white
1 whole egg may be substituted for 1 egg white
1/4 teaspoon salt
1-1/2 teaspoons baking powder
Mix soya meal, salt and baking powder. Add to the washed bran. Add melted butter and cream. Beat egg white and fold into mixture. Add enough water to make a very thick drop batter. Bake in six well-greased muffin tins until golden brownβfrom fifteen to twenty-five minutes.
Total food value:
Carbohydrate, 2 grams. Calories, 304.
One muffin = protein, 2 grams; fat, 4.5 grams.
Carbohydrate, trace. Calories, 50.
[4] Soya Bean Meal, Theodore Metcalf Co., Boston, Mass.
CASOID FLOUR AND BRAN MUFFINS.[5]
1 level tablespoon (15 grams) butter
1 ounce (30 c.c.) 40% cream
1 egg white
1 whole egg may be substituted for 1 egg white
1/4 teaspoon salt
1-1/2 teaspoons baking powder
1 cup washed bran
Method as in previous rule. Bake in six muffin tins.
Total food value:
Carbohydrate, 1 gram. Calories, 300.
One muffin = Protein, 3 grams. Fat, 4 grams.
Carbohydrate + Calories, 50.
[5] Casoid Diabetic Flour. Thos. Leeming & Co., Importers, New York City.
LYSTER FLOUR AND BRAN MUFFINS[6]
1 level tablespoon (15 grams) butter
1 ounce (30 c.c.) 40% cream
1 egg white
1 whole egg may be substituted for 1 egg white
1/8 teaspoon salt
1 teaspoon baking powder
1 cup washed bran
Method as in previous recipe. Bake in six muffin tins.
Total food value:
Carbohydrate, 1 gram. Calories, 310.
One muffin = Protein, 3 grams. Fat, 4 grams.
Carbohydrate, trace. Calories, 50.
In order to guard against a monotonous diet, some recipes for special dishes suitable for diabetics are given, most of which can be used in the diets of moderate caloric value. They are taken from "Food and Cookery for the Sick and Convalescent" by Fannie Merritt Farmer.
[6] Lyster's Diabetic Flour prepared by Lyster Brothers. Andover, Mass. Barker's Gluten Flour, Herman Barker, Somerville, Mass.
Note.βIn the three preceding recipes one whole egg may be substituted for one egg white. The food value will be slightly increased but the texture of the finished article is improved.
RECIPES.
BUTTERED EGG.
Put one teaspoon butter into a small omelet pan. As soon as the butter is melted break one egg into a cup and slip into the pan. Sprinkle with salt and pepper and cook until white is firm, turning once during the cooking. Care must be taken not to break the yolk.
EGGS AU BEURRE NOIR.
Put one teaspoon butter into a small omelet pan. As soon as butter is melted, break one egg into a cup and slip into the pan. Sprinkle with salt and pepper and cook until white is firm, turning once during the cooking. Care must be taken not to break the yolk. Remove to hot serving dish. In same pan melt one-half tablespoon butter and cook until brown, then add one-fourth teaspoon vinegar. Pour over egg.
EGG Γ LA SUISSE.
Heat a small omelet pan and place in it a buttered muffin ring. Put in one-fourth teaspoon butter, and when melted add one tablespoon cream. Break an egg into a cup, slip it into muffin ring, and cook until white is set, then remove ring and put cream by teaspoonfuls over the egg until the cooking is accomplished. When nearly done sprinkle with salt, pepper, and one-half tablespoon grated cheese. Remove egg to hot serving dish and pour over cream remaining in pan.
DROPPED EGG.
Butter a muffin ring, and put it in an iron frying-pan of hot water to which one-half tablespoon salt has been added. Break egg into saucer, then slip into ring allowing water to cover egg. Cover and set on back of range. Let stand until egg white
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