It is commonly believed that diabetes should be managed dietetically by a sugar-and-starch-free regimen, carried to such a degree that excess of sugar no longer appears in the urine. As a matter of fact, such teaching may be very misleading. A diabetic, in the early stages at least, must lead a fairly active life, and requires the usual number of calories for such living. If sugars and starches are removed wholly from the diet, the requisite calories must be derived from protein and fat, and this may prove a strain both on the desire for food and its digestion and utilization. It is therefore rational to allow a certain percentage of carbohydrates, as they occur in such common articles of food as bread, cereals, potatoes, etc., even if they favor the appearance of sugar in the urine. We know that in this disease, the starch and sugar in the diet becomes a poison if carried beyond a certain stage. The tissues then become saturated with saccharine products, and readily succumb to chance infections, the microbes of which behave as they do in sweetened culture media. But in a vigorous subject leading an active life, there is always a point within which the bodily activities are sufficient to oxidize most of the carbohydrate intake; and a certain amount of escape of excess products in the urine is then relatively insignificant.

A characteristic diet is as follows:

(A) First Breakfast

This should consist of lean and fat meat, such as occurs naturally in ham or bacon. For a beverage we may give coffee sweetened with saccharine. If there is a craving for bread, starch-free gluten bread should be added.

(B) Second Breakfast

Cream, eggs, beef juice, kumyss, or other liquid or semi-liquid food.

(C) Noon Meal

A course dinner, beginning with broth enriched with an egg, meat, or bits of green vegetable. To this should be added small portions of fish, roast, entree, game, etc. As extras, salad, cheese, etc. Wine, etc. A small amount of bread and butter and potatoes if craved.

First Evening Meal

Coffee and cream, sweetened with saccharine. An egg added if craved.

Second Evening Meal

This, usually served at bed time, is meant to give the patient a chance to make up for deficiencies. He may indulge especially in sapid food, as fish, oysters, clams, caviare, sardines, etc., with plenty of salad vegetables. Bread and butter, cheese, nuts, etc., if craved during the meals of abstention may be given if allowed.

The foregoing menu is intended for those stages of the disease in which the patient profits by some use of carbohydrates. With the advance of the affection, a point is reached at which such foods are actually pernicious. It then becomes a problem to nourish these individuals with a diet practically free from sugars and starches. It is only necessary for the nurse to have at hand tables of food containing the exact percentage of carbohydrates; for in this way she may protect the sufferer.

A point is reached at last in which a certain excess of carbohydrates may precipitate a fatal termination.