(From The Medical World)
ERCKLENTZ describes four cases of diabetes treated with a diet chosen freely by the patient himself. The condition of the first patient, a man of 40 years, was unstabilized on 50 grammes of carbohydrate with insulin ranging from 70 to 120 units. He was asked what he would like to eat, and chose a diet of 2,600 calories containing 390 grammes of carbohydrate, 80 grammes of protein and 121 grammes of fat. His insulin was increased from 120 to 150 units. In the following days carbohydrate was increased to 494 grammes and insulin was reduced to 130 units. For 10 days he took 473 to 500 grammes of carbohydrate with 130 to 150 units of insulin.
He felt extraordinary well and had a good appetite. He put on weight. His sugar excretion remained at from 6 to 11 grammes a day. At the end of the course carbohydrate had been gradually reduced to 150 grammes and the patient was taking 130 to 150 units of insulin. He had gained 14.4 kilograms (32 lbs.) in weight and had become bright mentally and physically. The second patient, a male, aged 41 years, had a nine months history. On a carbohydrate intake of 45 grammes he was excreting 142 grammes of sugar, his blood sugar figure was 416, and he had acidosis.
His carbohydrate intake was raised abruptly to400 grammes, with insulin 105 units, and the blood sugar was now 200. Later, on a diet containing 300 grammes of carbohydrate, the insulin required was 60, 40 and finally 30 units a day. The blood sugar fell to 125 and he gained 12.6 kilograms (28 lbs.) in weight. The third patient was a woman of 57 years, with a diabetic sister. In three months she had lost 18.0 kilograms (40 lbs.) in weight, and on admission to hospital was in precoma with 6.2 per cent. sugar in the urine and a blood sugar level of 570. Her carbohydrate intake was rapidly raised from 60 to 300 grammes and then to 400 grammes.
The insulin dose was 100 units on admission, but never again, and eventually it was dispensed with. Glycosuria ceased entirely and the blood sugar dropped to normal. The fourth patient, a female, came into hospital with a blood sugar figure of 430, glycosuria and acetonuria, She had been taking 50 grammes of carbohydrate and excreting 80 grammes of sugar. Her carbohydrate was rapidly increased to 150 grammes and insulin to 70 units. On this there was no glycosuria, and presently the insulin was gradually reduced to nil without return of the glycosuria. Her blood sugar level remained at about 205.
The other 100 patients behaved in almost the same way. Some of the older diabetics required strict dieting, presumably because in them the pancreas could not respond to the stimulus of increased carbohydrates. The following routine was adopted. Every diabetic admitted to hospital if not comatose, was for the first two days given milk only, one litre per diem (carbohydrate 48 grammes, protein 32 grammes and fat 35 grammes=672 calories). The result indicated whether the condition was severe or not.
If the glycosuria disappeared and the blood sugar was low, insulin was dispensed with. Otherwise a mixed diet was given, containing carbohydrate 1.0 to 2.0 grammes and protein 1.0 to 1.5 grammes per kilogram of body weight, and not more than 70 grammes of fat. If a patient on this diet excreted sugar he was given insulin. For a daily excretion of 20 grammes of sugar the dose of insulin was 10 to 15 units three times a day, and more if necessary to abolish glycosuria. After some days of this “mixed diet” the patient was allowed to choose his own diet, keeping to the same amounts of protein and fat, but satisfying his craving for carbohydrate.
Often he took 300 grammes of carbohydrate or more. With each increase of carbohydrate the insulin dose was adjusted, but as a rule the insulin did not have to be increased proportionately. After a while the craving for carbohydrate subsided and the patient voluntarily reduced the amount, usually to 150 to 250 grammes. Coincidentally with this reduction of carbohydrate the insulin dose must be reduced or omitted altogether to avoid hypoglycaemia.
The patients condition was now considered to be stabilized and he was allowed to go, being given a leaflet instructing him as to diet, insulin injections, hypoglycaemic attacks, coma, etc. The mental effect of this treatment was remarkable, especially in severe chronic diabetes. Joie de vivre and efficiency for the daily round were regained. It is suggested that actual regeneration of the islets is produced, and this suggestion is supported by the absence of relapses of patients on these high carbohydrate diets. Deutsche Medizinische Wochenschrift, November 29th, 1935.