It is my aim in this paper to give as short, concise, terse, as practical a discussion of the correct management of diabetes in most of its phases as possible. Realizing that among practitioners at large these metabolic diseases are handled so poorly, it is my endeavor in this paper to improve our therapeutic skill in this branch of medicine. Too many times a patient with simple and uncomplicated diabetes mellitus is handed the insulin outfit and ordered to take a “shot” three times a day and not to eat sweets and carbohydrates, without any more specific instructions and actions on the part of the physician than that.
Too many times an open sore on the toes is treated for simple infection in a senile individual or one too fat, without any regard as to the possibility that this individual may be a diabetic of the most severe type. Precious moments are lost before the patient is desugarized, diabetic gangrene sets in and then amputation is done.
I wish to take up each condition separately and show how each is best treated and even cured.
Do not consider insulin the cure-all and lean on it as a crutch. Diet should be considered first in the treatment of diabetes. I believe insulin is one of the greatest discoveries of modern times, but this I use only as a tool to accomplish a certain end.
When a diabetic is first seen and urine found full of sugar, the physician should consider such patient an emergency and should not go to bed until he is reasonably assured that that patient is sugar-free. There should be no excuse for any doctor to permit a patient to go into that dreadful complication of diabetic coma. Perhaps when I know homoeopathy better I will be taught to look for my remedy first, but just now I have had excellent results in desugarizing them first and then …..
looking for my indicated remedy later. This I do by giving insulin 10 to 15 units every half hour to one hour until sugar free, taking my urine specimens before each hypodermic and being guided accordingly. As the urine ceases to turn my Benedicts qualitative solution so deeply I cut my doses of insulin down to 5 or 8 units. Then I start them off on Medium Carbohydrates Diet No.1, which consists of CH.25. Prot.60, Fat 70, Cal. 1000.
Then they are advanced to Nos. 2,3 and 4, all the time testing a 24- hour specimen of urine for sugar. If at any time it shows up, test divided specimens of urine, 7-7 night, 7-11 a.m., to 3 p.m. to 7 p.m. to find out just when the patient is spilling the sugar and give the insulin accordingly. Never change the insulin and the diet at the same time. Gradually reduce your insulin until you are sure that the patient is going to remain sugar-free on a given diet. Then boost up the diet. These diets are all splendid and can be obtained from the New York Postgraduate Medical School and Hospital of Columbia in New York City.
So much for the simple diabetic or even the severe case threatening to go into acidosis and coma. If you are unfortunate enough to be called into a case where the patient is already in coma, then heroic measures must be taken, the patient hospitalized, blood sugar taken and insulin administered every half hour intravenously, 1 unit covering each 22 gram excess in the blood stream.
Doses of insulin are here estimated by the catheterized urine specimens every half hour. Stomach lavages of soda bicarbonate and saline, leaving in a pint of warm normal saline until the acidosis is controlled. When the patient revives, an acidosis diet is preferred for a time, also procured from the same place: CH.20, Prot.30, Fat 4, Cal. 242.
Suppose you are dealing with a case of infected diabetic ulcer. Here the desugarization is more stubborn because any infection adds further fuel to the diabetic fire. Likewise the diabetic state makes the person more susceptible to infection. So we must break the vicious cycle somewhere. Routine diabetic measures are instituted plus continuous wet dressings of sterile boric acid, elevated under an incandescent light cradle.
All the excess calluses must be carefully trimmed away, allowing none of the serous material to undermine the skin because this seems to be a very destructive fluid. With our extra armamentarium of specific remedies we have the further advantage of carrying these patients on to a cure. Especially do we have so many fine remedies for gangrenous complications when these set in. As an example I wish to relate a case.
I first saw Mrs. D.H. last March 30 with right foot gangrenous and ulcerated. Urine was full of sugar that it was sticky when she steeped in it where she had lost some between her bedroom and the bathroom. She had been under other treatment while the big toe only was infected. A few weeks prior she stated that a large ulcer on the other foot was healed up by other treatment. March 30, Lach. 1M.
No improvement after several days. Patient was removed to hospital where Buergers exercises were started. Foot was dressed twice a day and continuously irrigated with catheters stuck into the flesh. After she was sugar free there followed prescriptions of Aur.iod. 6x. and 200, SEc. aM. and 50M., Sulph.30, Hepar 200, Sil.200, Sulph. 1M., until finally on April 23 she was discharged from the hospital out of danger.
Then followed daily dressing in the home until discharged June 15 with a final dose of Ars. 1M. to clear up a gangrenous tendency of the skin on the dorsum of the foot. I really think after all this was her true Similimum because it was only right at the last that they told me she had burned her foot in too hot water when soaking it, in its earlier stage, to overcome the infection.
A few words may be said on senile gangrene. Here we have many times a purely pathological state on which to prescribe, with no other symptoms obtainable. The condition of the artery has to be considered and for this we have such a splendid remedy as Aur.iod., together with the use of Buergers exercises and contrast baths.
I wish to report one case, Mr. M.H., aged 94, starting dry gangrene in the end of first big toe. Alcohol packs… locally together with the other measures suggested. REsult: loss of only end of toe as far as the nail. Died at 97 of other causes.
If by writing this paper I have succeeded in saving any other legs from amputation, which surely would have happened under the “old school” methods, I shall be happy. GREENS FORK, IND.
Antimonium Crudum: Avoids company; cannot bear to be touched or looked at. ugly, mad, sullen. Face pale, or muddy expression. Nostrils cracked and sore. Sour foods aggravate. Skin rough or harsh; corns, calluses; sensitive skin. Nails brittle, perhaps broken or thickened. Teeth sore, < nights and from cold water. Alternate soft and hard stool, or mixed; with mucus. White thickly coated tongue.
A two-year-old boy had been under the care of a former student of my father for about three weeks without improvement. My father was called in, and great improvement followed quickly the prescription of Ant.crud. He asked my father what remedy was given, to which my father replied, “You forgot what I often told you: consider the mental symptoms, and also the prodromal symptoms.”- V.M. JOHNSON, M.D.