Suggestions in the Treatment of Diabetes.

FINLEY ELLINGWOOD, M. D., CHICAGO

As I have before remarked I never neglect an opportunity to present to my readers suggestions concerning the treatment of diabetes. So widely prevalent is this disease and so intractable to all ordinary methods of treatment, that every physician feels his powerlessness when he comes in contact with a stubborn case, and suggestions for treatment are considered with interest by every physician.

In the first place it must be borne in mind that pathological research has not revealed the real cause of this disease. The condition is a symptom only, of morbid pathological process, and which of these is present in the case in hand is usually exceedingly difficult to determine. The condition is diagnosed by the presence of a large quantity of urine of a high specific gravity, and by the determination of the fact that the high specific gravity is due to the presence of sugar in the urine. Sugar may be present in an appreciable quantity at various times or continuously over a considerable period, without diabetes being present, consequently the mere presence of sugar does not prove the existence of diabetes.

In the treatment of this condition, experience has proved that the regulation of the quantity of the carbohydrates in the food regulates the escape of sugar, consequently it is important that the patient be treated dietetically as well as medicinally.

In considering the diet of these patients, let it be borne in mind that it is not a good plan to make a sudden change of the diet from ordinary food to an immediate exclusion of all of the starches. Such a course has produced extreme nutritional changes, and has precipitated an attack of diabetic coma. It is necessary to administer for a time sufficient starchy food to protect the tissues of the body, and to antagonize a tendency toward the formation of toxins from this sudden tissue change.

The physician should take from three to six days time, by a gradual change in the character of the food, to eliminate the sugar from the urine. When this is accomplished the diet may be slowly increased in its starchy constituents, watching the urine for an increase of the quantity of sugar. The use of fats is important if the withdrawal of the starch does not exclude the sugar.

Proper metabolism must be sustained and this can be done in some cases by the free use of cream, butter and other pure fats, eliminating, if possible, any butyric acid that may be present. For several years a skimmed milk diet has been advised. I have long been confident that a wholemilk diet, or good, pure, rich milk containing all of its cream is superior.

The starchy substances to be excluded are potatoes, the usual foods made from flour, corn meal and oat meal, as well as those vegetables which contain starch and sugar, such as carrots, beets, parsnips, beans, peas, pie plant and arrow root, as well also as sago, tapioca and macaroni. Among, the fruits grapes, sweet oranges, apples and bananas.

In presenting a diet list to my patients I have made it a rule, however, not to tell them what they could not eat, until I have graphically presented to them all the attractive features of those articles which they should eat. Among these are meats—fresh meats of all kinds, with the exception only of liver. This includes game, domestic fowl and fish. In addition there are eggs, cheese, butter and cream as stated, and any palatable combinations made from these meats, including soups and broths. For vegetable substances greens, asparagus, tomatoes, string beans, radishes, onions, lettuce, celery, cauliflower and cucumbers. In addition there are many of the nuts, with nut flour, that add very materially to the attractiveness of the diet. Some authorities advise peanut flour while others discourage its use. Walnuts, hickorynuts, butternuts, almonds and pecans, all contain a large percentage of fats without starch or sugar, and if the stomach will receive them, they are of value. Other nuts of this character are not objectionable.

The use of gluten flour is common. Many patients can subsist for a long time upon cakes and various forms of bread made from buckwheat flour to a good advantage. When the sugar has been absent from the urine for a considerable period, toasted bread may be permitted as a regular article of diet, or zwieback. This is taken by many patients with enjoyment for a long period.

In the selection of remedies for the cure of this disease we have as yet no specific, but we have a number of remedies which are claimed by various authorities to possess a sugar-eliminating power in certain classes of cases. Diabetes, as stated above, depends upon a different cause in different cases, and undoubtedly upon different conditions, and because these conditions are obscure and are not readily determined, we have not yet been enabled to say immediately which particular remedy is especially adapted to the case in hand. We find it necessary to experiment with the different remedies before one can be adjusted to that particular case.

For twenty years I have used jambul, the powder of the seeds. I have tried it in every case, and have found it of much service in more than half of the cases. I have obtained some benefit in perhaps sixty-five per cent of the cases, the remainder were but little benefited. I have not been able to determine the peculiar conditions that exist in those patients which it has benefited. I usually begin with five grains of the powder three times a day and increase it until the patient is getting, in the extreme cases, from 30 to 60 grains per day. Given with the proper quantity of fats, the nutrition being well sustained, the remedy is one of our best, I think.

While I have used arsenic in various forms, and especially the well known solution of the bromide of arsenic, I have not found so many patients benefited by this as with jambul. I have used ergot, codeine, and other sedatives to restrain the sugar. I have seldom depended upon opium or morphine, as the habit invariably acquired from their use is as serious as this disease. Some excellent authorities, however, advise increasing doses of the opiates and expect to obtain good results. A serious objection, however, is that once begun there is danger in discontinuing this remedy. Where rheumatic or gouty conditions prevail it is necessary to treat the patients with remedies calculated to eliminate the causes of these conditions.

In each individual case a study must be made of each one of the organic functions, and attention must be paid to these functions to be sure that they are working to their full normal ability. The tone of the body must be sustained by the most carefully selected remedy. The various phosphates, lacto-phosphates or glycerophosphates I believe not only sustain the vital force but contribute in some of these cases to the cure of the disease. I am especially partial to some of the tissue remedies of Schussler. I believe there are cases in which they can be correctly adjusted and will prove curative.

As the cases are advanced, serious blood changes must be anticipated, and diabetic coma must be guarded against as the most dangerous sequel. This condition results from blood changes, among which oxybutyric acid being found in the blood. Oxygen-carrying remedies, vegetable alteratives and hypodermoclysis with the normal salt solution must be regularly and persistently employed until the urine becomes plainly alkaline in reaction.

A Dr. Hopkins, from Burlington, Iowa, claims to have cured three deeply seated cases by the use of the following prescription: Nitrate of uranium, 1 to 2 drams; fluid extract of jambul seeds, 1 to 3 drams; glycerin, 2 ounces; water, q. s. to 4 ounces. One teaspoonful four times a day.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.