The Dietetic Management And The Allen Treatment Of Diabetes Mellitus. Part 4
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This section is from the book "Lectures On Dietetics", by Max Einhorn. Also available from Amazon: Lectures on Dietetics.
The Dietetic Management And The Allen Treatment Of Diabetes Mellitus. Part 4
Usually it is necessary to wait over night to determine the amount of sugar present. This is quite a disadvantage. Qualitatively, however, - and this is really the most important point to ascertain, - it is possible to discover the presence of sugar within half an hour after performing the test. In my paper entitled "Zum Gahrungs-sacharometer," I showed that 1 per cent, of sugar, and even less, down to 1/4 per cent, can be positively recognized after a half hour's time. One-tenth of 1 per cent of sugar can be recognized after one hour, provided the test is made with a control specimen of normal urine at the same time. In the urine containing sugar a few bubbles appear at the top of the saccharometer pretty soon after the test has been performed. I herewith give an illustration of the tiny bubbles forming, taken from the paper, just mentioned.
1Deutsch. Med. Wochenschr. 1891, No. 13.
A = Control Urine B = 1% Sugar Urine.
C = 1/2% "
T = 26,4°C.
After 15 Minutes | A = |
| ; B = | 1/5 ccm; C = |
D = |
| |||
" 30 " | A = |
| ; B = | 1 ccm; C over 1/5 ccm. |
D = |
|
i
Fig. 2 - The bubbles forming on the top of saccharometer soon after performing the test.
With regard to ketonuria, the following tests are of importance:
Acetone Test
Urine, 5 cc.
Acidify with glacial acetic acid.
Add few drops sol. sod. nitroprusside (aqueous) 10 per cent.
Shake. Add ammonia hydrate until alkaline. Reaction = Purple color indicates acetone.
Diacetic Acid.
Urine, 5 cc.
Add excess of ferric-chloride.
Reaction = Burgundy red indicates diacetic acid.
Quant. Ammonia Test
Urine, 5 cc.
Add 1 cc. of sat. sol. potass, oxalate.
Add gtt. 2 sol. phenolphthalein.
Add N/10 NaOH to faint pink color.
Add 1 cc. formalin (neutral).
Add N/10 NaOH to faint pink color.
Each cubic centimeter of N/10 NaOH used in last titration = 1 cc. N/10 ammonia or .0017 grams, ammonia.
Multiply this by number of cubic centimeter N/10 NaOH used in last titration = Number of grams, of ammonia in 5 cc. urines.
In order to more easily arrange the bill of fare for the diabetic patient, two tables of the most common foods are herewith given, one arranged according to the per cent of carbohydrate after Joslin, the other stating the content of the nutritive material, - proteins, carbohydrates, and fats (caloric value).
I. Foods Arranged According To Per Cent Of Carbohtdbate (Joslin 1)
Vegetables1 (fresh or canned) 5 per cent | 10 per cent | 15 per cent | 20 per cent | |
Lettuce Cucumbers Spinach Asparagus Rhubarb Endive Marrow Sorrel Sauer kraut Beet greens Dandelions Swiss chard Celery | Tomatoes Brussels sprouts Water cress Sea kale Okra Cauliflower Egg plant Cabbage Radishes Leeks String beans Broccali | Pumpkin Turnip Kohl-rabi Squash Beets Carrots Onions Mushrooms | Green peas Artichokes Parsnips Canned lima beans | Potatoes Shell beans Baked beans Green corn Boiled rice Boiled macaroni |
Ripe olives (20 per cent fat) Grape fruit | Lemons Oranges Cranberries Strawberries Blackberries Gooseberries Peaches Pineapple Watermelon | Apples Pears Apricots Blueberries Cherries Raspberries Huckleberries | Plums Bananas Prunes | |
Nuts | ||||
Butternuts Pignolias | Brazil nuts Black walnuts Hickory Pecans Filberts | Almonds Walnuts- (English) Beechnuts Pistachios Pine nuts | Peanuts | |
40 per cent Chestnuts | ||||
Miscellaneous Unsweetened and unspiced Pickle, clams, oysters, scallops, liver, fish roe | 1 Reckon available carbohydrates in vegetables of 5 per cent group as 3 per cent. Reckon available carbohydrates in vegetables of 10 per cent group as 6 per cent. | |||
1E. P. Joslin: "The Treatment of Diabetes Mellitus," Phila., 1916.
As an example of the management of diabetic cases, I give the exact bill of fare of patient P. during her stay in the German Hospital. (See pp. 140-146).
II. Table Of Foods Frequently Used In Diabetes: With Nutritive Values In 100 Grames
Protein, grams | Fat, grams | Carbohydrate, grams | Total, calories | |
Asparagus (canned)....... | 2.0 | 1.0 | 3.0 | 30.0 |
String beans (fresh cooked) | 1.0 | 1.0 | 2.0 | 22.0 |
Lettuce (raw).......................... | 1.0 | 0.3 | 3.0 | 19.0 |
Cauliflower (raw)........ | 2.0 | 0.5 | 5.0 | 33.0 |
Spinach................................... | 2.0 | 0.3 | 3.0 | 23.0 |
Green peas (raw)......... | 7.0 | 0.5 | 16.0 | 99.0 |
Potatoes (white)...................... | 2.0 | 0.1 | 18.0 | 83.0 |
Peas(dried).............................. | 24.0 | 1.0 | 62.0 | 362.0 |
Butter4................. | .... | 84.0 | .... | 780.0 |
Milk (whole)............................ | 3.0 | 4.0 | 5.0 | 70.0 |
Milk (skim)............................. | 3.0 | 0.3 | 5.0 | 35.0 |
Cheese (neufchatel) "2 1/4 X 1 1/2 X 1 1/4 ........ | 16.0 | 23.0 | 1.0 | 284.0 |
Cream (gravity).......... | 3.0 | 16.0 | 5.0 | 181.0 |
Bacon (raw) 4 slices, 6 X 2..................... | 10.0 | 64.0 | .... | 636.0 |
Bacon (cooked) 4 slices, 6 X 2................. | 10.0 | 46.0 | .... | 468.0 |
Egg3................... | 14.0 | 12.0 | .... | 168.0 |
Oysters (6 large).................... | 6.0 | 1.0 | 3.0 | 46.0 |
Oatmeal (cooked).................. | 3.0 | 0.5 | 12.0 | 66.0 |
Rice (cooked)......................... | 3.0 | 0.1 | 24.0 | 112.0 |
Bread........................................ | 7.0 | 0.5 | 55.0 | 260.0 |
Grapefruit1.............................. | 0.6 | .... | 10.0 | 43.0 |
Orange2.................................... | 0.7 | .... | 9.0 | 38.0 |
Watermelon............................ | 0.4 | 0.2 | 7.0 | 32.0 |
Bananas................................... | 1.0 | 0.6 | 22.0 | 100.0 |
Walnuts.................................. | 18.0 | 64.0 | 13.0 | 722.0 |
Almonds................................. | 21.0 | 54.0 | 17.0 | 658.0 |
Peanuts................................... | 25.0 | 38.0 | 24.0 | 546.0 |
1 Small fruit - 300 grams.
2 Medium fruit = 150 grams.
3 1 Egg (medium) = 50 grams.
4 One-forth-inch cube = 30 grams.
Mrs. P., Weight 132 Pounds, Entered Hospital Jan. 16, 1917, at Noon.
Date and hour | Food intake | Total for 24 hours | Urine | |||||||||
Proteid | Carbohydrate | Fat | Calories | Amount in 24 hr. | Specific gravity | Sugar | Albumin | Acetone | Ammonia | |||
1/16/17 | ||||||||||||
11:30 a.m. | Broth, 3v \ | Broth 3xvii: water, 2 quarts (510 gm). | 1500 cc. | 1030 | 3% | 0.7 | ||||||
3 P. M. | Bran biscuits | |||||||||||
5 P. M. | Broth, 3vi | |||||||||||
8:30 | Broth, 3vi J | |||||||||||
2 | 3 | 35.7 | ||||||||||
1/17/17 | ||||||||||||
8 A. M. | Broth, 3iii | Broth, 42 3:gm. 1260 Whiskey, 3i, gm. 30 Water, 2 quarts | 950 cc. | 1.004 | 0.5% | Neg. | Neg. | 0.53 | ||||
10 A. M. | Broth, 3ix | |||||||||||
1 P. M. | Broth, 3xii | |||||||||||
6 P. M. | Broth, 3xii | |||||||||||
8 P. M. | Broth, 3vi | |||||||||||
10 P. M. | Whiskey, 3i | |||||||||||
Total............... | 2 | 3 | 193.2 | |||||||||
1/18/17 | ||||||||||||
8:30 a. m. | Broth, 3xii | Broth, 348: gm. 1440 Whiskey, 3iii gm. 90 Water 2 quarts | 1700 cc. | 1.004 | Neg. | Neg. | Neg. | 0.672 | ||||
8:30 a. m. | Whiskey, 3i | |||||||||||
11:30 | Whiskey, 3i | |||||||||||
1 P. M. | Broth, 3xh | |||||||||||
5 P. M. | Whiskey, 3i | |||||||||||
6 P. M. | Broth, 3xii | |||||||||||
9 P. M. | Broth, 3xii | |||||||||||
Total for 24 hr...... | 2 | 3 | 415.8 | |||||||||
Date and hour | Food intake | Total for 24 hours | Urine | |||||||||
Proteid | Carbohydrate | Fat | Calories | Amount in 24 hr. | Specific gravity | Sugar | Albumin | Acetone | Ammonia | |||
1/19/17 | 900 c.c. | 1.006 | Neg. | Neg. | Neg. | 1.25 | ||||||
8:30 a. m. | Tea with lemon, 3vii | Broth, xvii: gm. 510 String beans: 5x: gm. 300 Cauliflower, 3x: gm. 300 Tea with lemon, 3xiv: gm. 420 Water, 2 quarts | ||||||||||
10 A. M. | Broth, 3xii | |||||||||||
11:30 a. m. | Whiskey, 3i | |||||||||||
12:30 | String beans, o3. x | |||||||||||
3 P. M. | Tea with lemon, 3vii | |||||||||||
4:30 P. m. | Whiskey, 3i | |||||||||||
5:30 | Cauliflower, 3x | |||||||||||
8 P. M. | Broth, 3v | |||||||||||
9:30 | Whiskey, 3i | |||||||||||
Total for 24 hr....... | 26 | 24 | 5.4 | 256 | ||||||||
1/20/17 | Boiled eggs (4): gm 200 | 1000 c.c. | 1.010 | Neg. | Neg. | Neg. | ||||||
8:30 a. m. | Boiled egg (2) | String beans, 3x: gm. | ||||||||||
8:30 | Tea with lemon | 300 | ||||||||||
Bran biscuits (2) | Cauliflower. 3x: gm. | |||||||||||
10:30 | Broth with egg (1) 3xii | 300 | ||||||||||
11:30 | Whiskey, 3i | Broth, 3xvii: gm. 510 | ||||||||||
2 P. M. | Beans, 3x | Tea with lemon, 3xiv: | ||||||||||
3:30 | Whiskey, 3i | gm. 420 | ||||||||||
5:30 | Cauliflower, 3x | Whiskey, 3iii: gm. 90 | ||||||||||
Tea & lemon, 3vii | Bran biscuits (2) | |||||||||||
8 P. M. | Egg (1) | |||||||||||
10 P. M. | Whiskey, 5i | |||||||||||
1 A. M. | Broth, 3v | ------- | ||||||||||
Total for 24 hr...... | 51 | 25 | 29.4 | 900 | ||||||||
1/21/17 | Boiled eggs (4): gm. 200 | 1100 cc. | 1.004 | Neg. | Neg. | Neg. | 1.7 | |||||
8:30 | Eggs boiled (2) | Broth, 3xii: gm. 360 | ||||||||||
Bran biscuits (2) | String beans, 3x: gm. | |||||||||||
300 | ||||||||||||
10:30 | Broth, 3xii | Cauliflower, 3x: gm. | ||||||||||
1 P. M | Beans, 3x | 300 | ||||||||||
Celery, 3x | Celery, 3x: gm. 300 | |||||||||||
Egg boiled (1) | Bran biscuits (2) | |||||||||||
3 P. M | Tea with lemon | Whiskey: 3iii: Km. 90 | ||||||||||
4:30 | Whiskey, 3i | |||||||||||
5:30 | Cauliflower, 3x | |||||||||||
Egg boiled (1) | ||||||||||||
8 P. M. | whiskey, 3i | |||||||||||
Total for 24 hr ............. | 63 | 37 | 30 | 1004 | ||||||||
1/22/17 | 1609 cc. | 1.008 | Neg. | Neg. | Neg. | 2.12 | ||||||
9 A. M. | Eggs boiled (2) | Boiled eggs, (4): gm. 200 | ||||||||||
Bran biscuits (2) | Broth, 3xii: gm. 360 | |||||||||||
Tea with lemon, 3 vii | String beans: 3x: gm. | |||||||||||
10:30 | Broth, 3xii | 300 | ||||||||||
11:30 | Whiskey, 3i | Cauliflower, 3x: gm. | ||||||||||
12:30 | Egg boiled, (1) | 300 | ||||||||||
String beans, 3x | Celery: 3x: gm. 300 | |||||||||||
Celery, 3x | Whiskey, 3iii: gm. 90 | |||||||||||
3 p. M | Tea with lemon, 3vii | Bran biscuit (2) | ||||||||||
4:30 | Whiskey, 3i | |||||||||||
5:30 | Cauliflower, 3x | |||||||||||
Egg boiled (1) | ||||||||||||
9 P. M. | Whiskey, 3i | |||||||||||
Liq. ammon. anis | Total for 24 hr...... | 63 | 37 | 30 | 1004 | |||||||
1/23/17 | 1100 cc. | 1.010 | Neg. | Neg. | Neg. | 2.9 | ||||||
8:30 | Eggs (2) | Boiled eggs (4): gm. 200 | ||||||||||
Bran biscuits (2) | Broth. 3xii: gm. 360 | |||||||||||
Tea with lemon | Cauliflower, 3x: gm. | |||||||||||
10:30 | Broth, 3xii | 300 | ||||||||||
11:30 | Whiskey, 3i | String beans, 3x: gm. | ||||||||||
12:30 | Lamb chops, 3ii | 300 | ||||||||||
Cauliflower, 3x | Celery, 3x: gm. 300 | |||||||||||
String beans, 3x | Brussel sprouts, 3x: | |||||||||||
3 p. M. | Tea with lemon | gms. 300 | ||||||||||
4:30 P. M. | Whiskey, 3i | Lamb chop, 3ii: gm. 60 | ||||||||||
5:30 | Celery, 3x | Whiskey, 3iii: gm. 90 | ||||||||||
Brussel sprouts, 3x | Tea with lemon | |||||||||||
Boiled egg (1) | Bran biscuits (3) | |||||||||||
Bran biscuit (1) | ||||||||||||
9 P. M. | Whiskey, 3i | |||||||||||
Liq. ammon. anis | Total for 24 hr...... | 85 | 50 | 35 | 1194 |
Date and hour | Food intake | Total for 24 hours | Urine | |||||||||
Proteid | Carbohydrate | Fat | Calories | Amount in 24 hr. | Specific gravity | Sugar | Albumin | Acetone | Ammonia | |||
Boiled eggs (3): gm. 150 | 800 cc. | 1.012 | Neg. | Neg. | Neg. | |||||||
1/24/17 | Broth, 3x: gm. 300 | |||||||||||
8:30 | Eggs (2) | Cauliflower, 3x: gm. | ||||||||||
Tea with lemon | 300 | |||||||||||
Bran biscuits (2) | String beans, 3x: gm.: | |||||||||||
10:30 | Broth, 3xii | 300 | ||||||||||
11:30 | Whiskey, 3i | Celery, 3x.: gm. 300 | ||||||||||
12:30 | Lamb chops, 3ii | Brussel sprouts: 3x: | ||||||||||
Cauliflower, 3x | 300 | |||||||||||
String beans, 3x | Whiskey, 3iii: gm. 90 | |||||||||||
3 P. M. | Tea with lemon | Bran biscuits (3) | ||||||||||
4:30 p. m. | Whiskey, 5i | Lamb chop, 3ii: gm. 60 | ||||||||||
5:30 p. m. | Celery, 3x | Tea with lemon | ||||||||||
Sprouts, 3x | ||||||||||||
Egg boiled (1) | ||||||||||||
Bran biscuit (1) | ||||||||||||
9 P. M. | Whiskey, 3i | |||||||||||
Liq. amnon, anis | ||||||||||||
Total for 24 hr...... | 89 | 61 | 18 | 1097 | ||||||||
1/25/17 | Eggs (2) | Boiled eggs (3) | 700 cc. | 1.012 | Nog. | Neg. | Nog. | 2.66 | ||||
8:30 | Tea with (cream; 3ii) | Broth, 3xxii: gm. 660 | ||||||||||
Bran biscuits (2) | Cauliflower, 3x: gm- | |||||||||||
Broth, 3 xii | 300 | |||||||||||
10:30 | Whiskey: 3i | String beans, 3x: gm. | ||||||||||
11:30 | Lamb chops, 3 ii | 300 | ||||||||||
12:30 | Cauliflower, 3x | Brussels sprouts: 3x: | ||||||||||
String beans, 3x | gm. 300 | |||||||||||
Tea with (cream, 3ii) | Lamb chop, 3iii: gm. 60 | |||||||||||
3 P. M. | Whiskey, Si | Raw oysters (6) | ||||||||||
4:30 | Celery, 3x | Whiskey: 3iii: gm. 90 | ||||||||||
5:30 | Sprouts, 3x | Bran biscuit (3) | ||||||||||
Oysters raw, (6) | ||||||||||||
Boiled egg (1) | ||||||||||||
Bran biscuit (1) | ||||||||||||
Liq. ammon. anis m viii t.i.d. | Total for 24 hr........ | 66 | 37 | 17 | 945.4 | |||||||
1/26/17 | 800 cc. | 1.008 | Neg. | Neg. | Neg. | 2.89 | ||||||
8:30 | Eggs (2) | Boiled eggs (3): gm.150 | ||||||||||
Bran biscuit (2) | Broth, 3xxii: gm. 660 | |||||||||||
Tea with (cream, 3ii) | Cauliflower, 3x: gm. | |||||||||||
10:30 | Broth, 3 xii | 300 | ||||||||||
11:30 | Whiskey, 3i | String beans, 3x: gm. | ||||||||||
12:30 | Lamb chops, 3ii | 300 | ||||||||||
Cauliflower, 3x | Brussels sprouts, 3x: | |||||||||||
String beans, 3x | gm. 300 | |||||||||||
3 P. M. | Broth, 3xii | Raw oysters (6) | ||||||||||
4:30 | Whiskey, 3i | Whiskey, 3iii: gm. 90 | ||||||||||
5:30 | Raw oysters (6) | Bran biscuits (3) | ||||||||||
Egg boiled (1) | Lamb chop, 3ii: gm. 60 | |||||||||||
Sprouts, 3x | Tea (with cream, 3iv: | |||||||||||
9 P. M. | Whiskey, 3i | gm.120) | ||||||||||
Liq. amnion. anis, m viii t.i.d. | Total for 24 hr...... | 70 | 41 | 43.9 | 1234 |
Date and hour | Food intake | Total for 24 hours | Urine | |||||||||
Proteid | Carbohydrate | Fat | Calories | Amount in 24 hr. | Specific gravity | Sugar | Albumin | Acetone | Ammonia | |||
1/27/17 | 900 cc. | 1.006 | Neg. | Neg. | Neg. | 2.61 | ||||||
8:30 | Raw apple (1) | Boiled eggs (3): gm. 150 | ||||||||||
Eggs (2) | Broth, 3xxii: gm. 660 | |||||||||||
Roll (1) | Cauliflower, 3x: gm. | |||||||||||
Tea with cream | 300 | |||||||||||
10:30 | Broth, 3x | String beans, 3x: gm. | ||||||||||
11:30 | Whiskey, 3i | 300 | ||||||||||
12:30 | Lamb chops, 3ii | Brussel sprouts, 3i:gm. | ||||||||||
Cauliflower, 3x | 300 | |||||||||||
String beans, 3x | Eggplant, 3x: gm. 150 | |||||||||||
3 P. M. | Broth, 5xii | Raw oysters (6) | ||||||||||
4:30 | Whiskey, 3i | Lamb chop, 3ii: gms. | ||||||||||
5:30 | Raw oyster (6) | 60 | ||||||||||
Boiled egg (1) | Tea (cream, 3iv: gm.120 | |||||||||||
Sprouts, 3x | Bran biscuit (2) | |||||||||||
Bran biscuit (2) | White bread roll (1) | |||||||||||
9 P. M. | Whiskey, 3i | Whiskey, 3ii. gm. 60 | ||||||||||
Liq. amon, anis , m viii t.i.d. | Raw apple, (1) | |||||||||||
Total for 24 hr...... | 79 | 68 | 45 | 1282 | ||||||||
1/28/17 | Boiled eggs (2) gm. 100 | 800 cc. | 1.012 | Neg. | Neg. | Neg. | |||||
8:30 | Eggs (2) | Broth, 3x: gm. 300 | |||||||||
Raw apple (1) | Cauliflower, 3x: gm. | ||||||||||
Roll (1) | 300 | ||||||||||
Tea with (cream, 3ii) | Egg plant, 3x: gm . | ||||||||||
10:30 | Broth, 3xii | 300 | |||||||||
11:30 | Whiskey, 3i | Raw oysters (6) | |||||||||
12:30 | Beefsteak, oz. ii | Beefsteak, 3ii: gm. 60 | |||||||||
Cauliflower, 3x | Tea (cream, 3iv: gm. | ||||||||||
Egg plant, 3x | 120 | ||||||||||
3 P. M. | Tea with (cream, 3ii) | Butter, gm. 4 | |||||||||
4:30 p. m. | Whiskey, 3i | White bread Roll (1) | |||||||||
5 P. M. | Raw oysters, (6) | Whiskey, 3ii: gm. 60 | |||||||||
Egg boiled (1) | Raw apple (1) | ||||||||||
Bran biscuit (2) | |||||||||||
9 P. M. | Whiskey, 3i | ||||||||||
Total for 24 hr...... | 55 | 50 | 60 | 1298 |
Jan. 29, 1917
Patiet discharged from the hospital.
Feb. 10, 1917
She is now taking nourishment amounting to a caloric value of 2000 daily, is not losing in weight and has no sugar in the urine.
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