In order satisfactorily to carry out the dietetic treatment of a diabetic patient it is necessary to examine the urine daily. The initial physical sign of diabetes is the excretion of sugar; stop this, and the symptoms of thirst, dryness of the mouth, lassitude and weakness are arrested. The effect of excluding starch and sugar from the diet can only be accurately ascertained by discovering if the excretion of sugar by the urine is arrested or diminished. There are various ways of testing the presence of sugar in the urine. The following is the easiest, and is one which can be well practised by a nurse. To a small quantity of urine in a test tube add half the amount of liquor potassae or liquor sodae, and boil. If sugar is present, a yellowish brown colour soon makes its appearance. This brown discoloration of the urine becomes more intense as the boiling is continued, and will be the deeper in tint the larger the proportion of sugar contained, becoming finally almost black if the quantity is very large. The coloration is produced by the colourless sugar being turned into brown molasses by heat, much in the same way as a deep brown sticky fluid is produced when a piece of lump sugar is burnt in a candle. If now to the coloured fluid in the test tube be added a few drops of nitric acid, the brown coloration disappears, and there is an odour of burnt molasses. To ascertain the amount of sugar present is a more difficult laboratory process; but any nurse who has charge of a diabetic patient, or anybody who is closely watching the effect of diet on a diabetic person, should once a week, or at least once a month, collect the total quantity of urine passed in the twenty-four hours, and send a specimen to a doctor or a chemist for analysis and report. This analysis will be her chart, showing her how to direct her course of dietetic treatment. For her compass she needs to take daily the specific gravity of the urine, and to ascertain roughly, though with fair correctness, the amount of urine daily passed. As it would be troublesome and unadvisable for the patient to collect the whole of the urine passed in the twenty-four hours, a sufficiently accurate estimate can be obtained by collecting the amount of urine passed at night in the bedroom. This should be measured every morning, and the specific gravity taken. The record should be entered in a book, and kept for comparison with the record of the dietary of the patient, so that the effect of the food taken can be judged by watching its influence on the amount and the specific gravity of urine excreted. The normal specific gravity of the urine is about 1.025. This varies greatly, even in healthy persons, and may rise to 1.030 or fall to 1.015 without any deviation from health, but if the specific gravity is found to be constantly at or above 1.030, sugar may be suspected. The normal amount of urine excreted by a healthy man is about three pints; in the diabetic this may be very much increased.

A Diabetic Record

The following extracts from the record of a diabetic patient, which was kept for several years, will show exactly what I mean, and how a nurse or a non-scientific person may easily check and ascertain the effects of diet on the patient under observation.

In this patient, who for ten years was carefully and successfully dieted, any indiscretion, such as was committed when dining out, or in taking treacle pudding, was immediately detected by the specific gravity bulb, which, it will be found, gives sure and faithful directions as to the course of dieting to be pursued.