DIABETES MELLITUS A SYSTEM OF DIETS HERMAN O. MOSENTH. PAUL B. HOEBER, PUBLISHER Columbia Uniuersitp ' 3 2-1 intijeCitpof Jietogorfe College of pfjpstcianfi ano burgeons Reference ?tttirarj> j: ; iii I Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/diabetesmellitusOOmose 4 DIABETES MELLITUS A SYSTEM OF DIETS NOTE The various diet tables given in this book may be obtained in pad form, 50 sheets to the pad, as follows: Xo. 1 — Starch-Free Diet, Qualitative List, (page 11.) Xo. 2 — Minimal Fat, Starch-Free, Measured Diet, (pages 1&-17.) Xo. 3 — Minimal Fat, Starch-Free, Weighed Diet, (pages 22—23.) Xo. 4 — Low Fat. Starch-Free, Measured Diet, (pages 1S-19.) Xo. o — Low Fat, Starch-Free, Weighed Diet, (pages 26-27.) Xo. 6- — Accessor}- Diet, Rich in Carbohydrates, (page 29.) Per set of 6 pads, So. 00; single pads, SI. 00. Special prices on large quantities quoted on application. PAUL B. HOEBER, Publisher, 67-69 East 59th Street, New York City DIABETES MELLITUS A SYSTEM OF DIETS HERMAN O. MOSENTHAL, M.D. Assistant Professor of Medicine and Attending Physician, New York Post-Graduate Hospital and Medical School NEW YORK PAUL B. HOEBER 67-69 East 59th Street, New York Copyright, 1921 By PAXIL B. HOEBER Published January, 1921 Printed in the United States of America IS; PREFACE The art of prescribing diets in diabetes mellitus has distinctly outstripped the ability of the patient or average nurse to meet the situation. The result has been that only the minority of diabetics, favored by dietitians or a specially trained member of the household can indulge in varied and accurate diets measured in grams of proteins, fats and carbohydrates. In many hospitals the same condi- tion holds true; those having large resources have a sufficient number of dietitians to carry out the dietetic prescriptions properly while the majority rely on a few, usually very inadequate, food lists to meet the needs of the patient. The present system of diets has been designed with the object of allowing any patient or nurse, without special training in dietetics, to carry out the proper rationing for cases of diabetes mellitus. These diet lists have been in successful use in a number of hos- pitals and clinics for several years. It is proposed to issue the individual lists in pad form, so that they may be of more general use. The plan upon which these diets depend was first published in the Medical Clinics of North America; subse- quently the scheme for the "Measured diets" was printed in The American Journal of Medical Sciences by Herbert Wiener and the author. TABLE OF CONTENTS Page Comment on the Diets 9 Diet Lists: Starch-free diet, qualitative list 11 Measured diets: 1 . Minimal fat, starch-free diet 16 2. Low fat, starch-free diet 18 Weighed diets: 1. Minimal fat, starch-free diet. 22 2. Low fat, starch-free diet 26 Accessory diet, foods rich in carbohydrates 29 Discussion of Diets: Starch free diet, qualitative list :- 10 Starvation 13 Measured diets ' 14 Weighed diets 20 1. Minimal fat, starch-free diet 20 2. Low fat, starch-free diet 24 Accessory diet, foods rich in carbohydrates 28 COMMENT ON THE DIETS THE diet lists virtually explain themselves. Variety in the weighed or measured diets is obtained by resorting to the vegetable or meat and fish lists. If finer gradations than 250 calories are desired in increasing or diminishing the food this can easily be done by adding or taking away only a fraction of the foods by which the diet in use differs from the next higher or lower one. A word of explanation as to the reason for the particular proportion of proteins and fats employed and as to the method of prescribing the diets may be of some value. The minimal fat diets are intended to be emergency diets only. They are to be used when acidosis is to be combated. The most efficient means at hand to-day, to prevent the accumulation of acid substances within the body, in diabetes mellitus, is to cut the fat intake to a minimum. The so-called low fat diets are those intended for prolonged administration. After some experimentation it was found that the lowest amount of fat, which serves to make the food palatable in the long run, is present in a starch free diet when the fats and pro- teins are approximately equal to each other gram for gram. At the same time such a restriction of fat serves to keep the acidosis in check. It is realized to-day that the diabetic can lose weight without detriment; what is not so generally appreciated is that this loss of weight should occur in the fat content of the body and not in the proteins of the muscles and glands. If a depletion of proteins takes place not only is weight lost, but strength and efficiency as well. In a "Starch- free" diet the only form of food which has the ability to conserve protein are the proteins themselves; fat and alcohol appear to be without value in this regard (Mosenthal, H. O., and Harrop, G. A., Jr., Arch. Int. Med., 1918, XXII, 750). Hence the feeding of an excessive quantity of fat is not justified. By clinical observation it was determined that small persons could be maintained in a condition of nitrogen (that is protein) equilibrium on the present low fat, starch free diets of 1500 calories, larger individuals required 1750 calories (Mosenthal, H. O., and Clausen, S. W., Arch. Int. Med., 1918, XXI, 269). Basing a mode of procedure upon this fact, the aim has been to have the patient acquire a sugar free urine while a diet of 1500 or 1750 calories is taken before starchy food is added. The food rich in carbohydrates may be subsequently used. The table giving the foods in units of starch equivalent to one slice of bread will be found useful in carrying out this plan. None of the proprietary foods have been advocated in the present tables. If it is desired to employ them it is wise to be guided by the list of analyses of diabetic foods, as furnished by the Connecticut Agricultural Experiment Station at New Haven, Con- necticut. STARCH-FREE DIET QUALITATIVE LIST Many mild cases of diabetes mellitus do not require a weighed or measured diet to maintain a sugar-free urine and to control their disease. For them the starch-free diet, qualitative list, upon the opposite page will suffice. In the blank space at the bot- tom of this diet sheet, starch containing foods may be indicated, for use in suitable cases. The list tabulating the accessory diet of foods rich in carbohydrates will be of service in this connection. STARCH-FREE DIET QUALITATIVE LIST MAY EAT: Soups — Clear meat broths, which may contain the vegetables indicated below. Meats — All kinds of meat, fresh, smoked or cured, except liver; all meats must be prepared without flour or bread-crumbs. Fish — All kinds of fish, but no clams, oysters or scallops. Eggs — Eggs in any form, prepared without milk, flour or sweetening (sugar, jam, etc.). Butter — Butter, oil and lard. Cheese — All kinds of cheese. Vegetables — Asparagus, asparagus tips, brussels sprouts, cabbage, cauliflower, celery, cucumbers, egg plant, endive, greens from beets, kohlrabi, leeks, lettuce, pickles (sour or dill), pumpkin, radishes, rhubarb, sauerkraut, sorrel, spinach, string beans, swiss chard, tomatoes, water cress, wax beans. Desserts — Gelatine jellies (use sour white wine, brandy or coffee for flavoring). Beverages — Tea, coffee and cocoa made from cracked cocoa (cocoa nibs), sweetened with saccharine (without sugar or milk); claret, burgundy, sour white wine, and whiskey in moderate amounts; carbonated waters. Condiments — Pepper, salt, mustard, oil, vinegar, saccharine. MUST AVOID EATING: Sugar in any form. Bread, biscuits, and cakes of all kinds. Toast, crackers, rice, oatmeal (and all cereals); sago, tapioca, macaroni, vermicelli, potatoes, carrots, parsnips, beets, corn, beans, peas. All fruits, fresh, preserved and dried. Jams and jellies. Pastry, puddings and ice cream. Sauces and gravies thickened with flour. MUST AVOID DRINKING: Milks, ales, porter, stout, beer, cider, all sweet wines, port wine, liqueurs, sparkling wines, syrups. BESIDES ABOVE MUST EAT: 11 STARVATION When complete abstinence from food is indicated and the so-called "starvation treatment" is employed the following articles of food, whose nutritive value is negligible, are allowed: Clear broth, black coffee, plain tea, saccharine, salt and pepper. In some instances the use of alcohol is permissible. Alcohol does not increase the production of sugar ; it has a tendency to further the oxidation of the acid substances along normal channels, thus diminishing acidosis, and it has an appreciable food value. These facts point to alcohol as an ideal food for the diabetic. However, its use has been largely dis- continued, especially during starvation, as there are many patients in whom the alcohol is prone to disagree and cause nausea and vomiting. When it is desired to use alcohol, whiskey, brandy, claret or sour white wine may be ordered. There is one point well worth bearing in mind in administering the starvation treat- ment. This is the fact that under this form of diet the patient frequently loses a great deal of water from the tissues. This results in a feeling of weakness and lassitude which often is very marked and in advanced cases of diabetes may assume a serious aspect- Such a loss of fluid from the body may be prevented by the administration of considerable amounts of salt in the broth or the use of bicarbonate of soda. If a slight degree of edema ensues it does no harm though it should not be allowed to reach undue proportions. THE MEASURED DIETS The following lists have been prepared in order to bring weighed diets to their simplest possible terms. They have been designed especially for diabetic patients who are able to be up and about attending to their routine duties, and not endowed with unlimited means. The successful management of such patients depends largely upon the ease with which they are enabled to follow the prescribed dietary regime. By the use of these diet lists the physician can readily control the total caloric intake as well as the relative amounts of proteirj , fat and carbohydrate consumed, while at the same time the essential cooperation of the patient is reduced to a minimum in time and mental effort. The measured diets in the modern treatment of diabetes must meet two require- ments: (1) Control of the glycosuria, and (2) control of the acidosis. The first of these is accomplished by regulating the consumption of the carbohydrates and proteins, and the second by adjusting the fat intake. The greatest recent advance in the management of diabetes melhtus is the recognition of the fact that a curtailment of the fatty foods will prevent or postpone acidosis and coma. Two sets of diets are necessary, therefore: (1) In which the fats are reduced to a minimum, and (2) in which fats are allowed more fiber- ally, but in limited amounts. The latter is the preferable diet to use when possible, as it is much the more palatable when continued for a long time. Accordingly, two diets have been designed, one the so-called "minimal fat diet" and the other the "low fat diet;" in both of them the only carbohydrate is that contained in the green vegetables. The minimal fat diet is graded by 250 calory steps from 500 to 1250 calories. It is not feasible to increase the diet beyond this point, because when proteins make up the greater part of the nourishment, as they necessarily do in the minimal fat diet, the bulk of food becomes too great. It is even problematical whether all patients can consume the amounts designated under the 1250 calory diet. However, the safest way to curtail the food in diabetics suffering with severe acidosis or threatened coma is first to restrict the fats. By means of the present list, this can easily be done. Carbohydrates may be added if it is thought advisable. For practical purposes of rough measurement the table and teaspoonful portions are adequate and exact within a reasonable margin of error. The portions of meat and fish are calculated to within the nearest 3^-ounce value. One-quarter ounce is probably closer than the average scales of the butcher or home can weigh accurately, but in giving the amounts in these fractions an indication is furnished on what side allowances should be made. The actual use of these diet lists is self-explanatory. A concrete idea of the proportion of proteins and fats in these diets may be gained from the following tables. In the minimal fat diet the ratio of protein to fat is found to be about 3 to 1 when round steak is eaten as the meat or fish, and 17 to 1 when blue fish is used. This, in either case, furnishes a very low fat intake. When the lowest possible quantity of fat is required it is evident that fish is more desirable than meat. 14 MEASURED DIETS Approximate Quantities of Protein, Fat and Carbohydrate in the Minimal Fat, Starch- free Diet when Round Steak or Blue Fish are Used as Meat or Fish Minimal fat diet whe 500 calories. 750 calories. 1000 calories . 1250 calories. 126 159 Minimal fat diet ' used: 500 calories . . . 750 calories . . . 1000 calories.. 1250 calories. . . Fat, Carbohydrate, 148 193 244 The next table gives the relative values of protein, fat and carbohydrate when roast beef, round steak or flounder are used as the meat or fish in the low fat diet. These particular foods were selected because they represent a high, average and low fat con- tent for these diets. When roast beef is eaten the fat is higher than the protein; with the flounder the ratio is reversed. The low fat diet, when the patient chooses his own food, has been calculated and found to contain, as a rule, proteins and fats approxi- mately equal gram for gram. Approximate Quantities of Protein, Fat and Carbohydrate in the Low Fat, Starch-free Diet when Roast Beef, Steak or Flounder are Used as Meat or Fish c" o o> a •S a fcfi 1 a a 8 j= £ fl - S a Pti J> Low fat diet when £ 6 Low fat diet wher Low fat diet when roast beef is used: s*eak is used: flounder is used: 500 c 22 39 12 500 calories 44 29 12 500 calories 73 16 12 750 c alories 33 71 12 750 calories 72 -44 12 750 calories 122 22 12 1000 c alories 39 83 15 1000 calories 87 64 15 1000 calories 149 37 15 1250 c alories 50 106 17 1250 calories 105 83 17 1250 calories 172 52 17 1500 c alories 66 126 IS 1500 calories 134 97 18 1500 calories 217 59 18 1750 c alories 75 149 19 1750 calories 147 118 19 1750 calories 235 77 19 2000 c aIories 85 169 19 2000 calories 164 136 19 2000 calories 259 92 19 In the low fat diets there is no difficulty, as far as bulk of food is concerned, in con- suming as much as 2000 calories. As Mosenthal and Clausen have shown a carbohy- drate-free diet of 1500 to 1750 calories, containing approximately the same proportion of protein and fat as the present list, will maintain the nitrogen equilibrium of the diabetic and may be considered to furnish the patient with enough food to make him mentally and physically efficient. If the carbohydrate tolerance of the patient permits of a still further increase in the food it is best to add starch-containing foods and not proteins or fats. The above food lists are presented in the belief that they will furnish a practical means of regulating the diet of sufferers from diabetes mellitus who are not receiving hospital treatment, and who, while under medical supervision, are dependent upon their own resources for the details of dietetic control. These diets are not intended in any way to supplant the more accurate and ideal means of weighing and measuring food, as are detailed in the subsequent diets, the weighed diets. As printed on the following pages, the diets and their supplementary lists are printed face to face. In pad form they are printed back to back, so that one sheet furnishes a complete dietary scheme. 15 O "tf m » H "3 o ■* P "3 Q "3 pq tH o ■* o ■* <3 ■* pq -* o pq -* 3 g S H a3 rr r/i tfl c- pq bfi T W 03 _g a;2 - - "5 c •S 3 a a a .03 1 g| 2 S o 3 <2 a? <» 03 c ag m 03 05 ."£ 3 & B O oi 03 qq ^ _ o 3 » • 1 (g 3| £ ° a 5^> Si raw ft o pq j5 « ^ S a. 2 m -a * o 3 "O -a « u to o a -° if £ °3 05 o o $ ^r c 1 03 , i 03 - .3 J3 1—1 a 2 ° «S G5 o g (-1 «** CO 03 O 03 ^ 05 J3 o lO 03 oT lT CI fl5 ft o 3* g 03 "S g 3 * o 5 o ft § S> PQ w ft 03 v-t CO CO MINIMAL FAT STARCH-FREE DIET— MEASURED DIET Meat and Fish Portions i of food weighed : Portion MEATS Beef: Soup meat, fore-shank, lean. . . Dried beef Lean round steak Lean roast beef (no visible fat) Kidney Chicken Lean leg of lamb (no visible fat) . Tripe Lean veal (no visible fat) FISH (Fresh only) : Bluefish '. Codfish Flounder Haddock Sea Bass Sheepshead Smelts Weakfish A B C D 3 4M 7H 9 IK 2M m 5 2% 3M 5% 7 2M 3M 6 7 3 4M 7H 9 3 4M 7H 9 1% 2K 4 5 5% m 14 16% 2% 4 7 8 4 6 m. 11% 4H 6K 11 13 5M SH 14 16H m 7 im UK 4^ GK ioH 12M 3 4M 7K 9 4 6 10 11% 3% 5M 9% 11 E 11% 6% 9^ 9% 12 12 6% 22 11 ISM 17M 22 19 16K 12 15M 14% Vegetables {Fresh or Canned) Asparagus Asparagus tips Brussels sprouts Cabbage Cauliflower Celery Cucumbers Egg plant Endive Greens from beets Kohlrabi Leeks Lettuce Pickles, sour or dill Pumpkin Radishes Rhubarb Sauerkraut Sorrel Spinach String beans Swiss chard Tomatoes Water cress Wax beans 17 (M f=5 CO C3 O £ O P5 « Q >>^ 2 S o o ^r ? ~ o « . ~ ^ « <£ o^i ,"§ | IP'S J § > n m »2°. w +" £ e««^ 18 LOW FAT, STARCH-FREE DIET— MEASURED DIET Meat axd Fish Portions Ounces of food weighed i MEATS Portion Bacon, fried, fat thrown away Brain Chicken (to be boiled or broiled) Chicken (to be roasted) Corned beef -. Dried beef Duck Ham, smoked (to be boiled or broiled) Guinea hen Kidney Lamb chops Lamb (to be roasted) Mutton (to be boiled) Mutton chops, lean Mutton (to be roasted) Pork (to be roasted) Pork chop, lean (to be broiled) Roast beef Soup meat, fore-shank, lean (to be boiled) - Squab Steak, round, lean Steak, sirloin, lean Tongue, fresh (to be boiled) Tongue, boiled, smoked, cold Veal, roast or chop, lean FISH, fresh (To be boiled or broiled) Bass, black Bass, sea Bluefish Butterfish Codfish Flounder Haddock Halibut Kingfish Mackerel Perch Pike Porgy Salmon Portion Smelts Weakfish Whitefish Canned or Smoked Herring, smoked Salmon, canned Sardines in oil Sturgeon, smoked Tunnyfish in oil, canned . A 1M 2K 2Y 2 iK 1 IK 1M 1 2 2K 1 1M 2M 1 1.4 2 2K 1'2 2 m m 1 2M A 3 3K 3K m 3K m 4 2K 3K 2 34 3% 2K m 2M 3K 3 4 1 IK 1 m 1 B C IK 2% 3 3K 3 5K IVi m IK 2K IK 3 IK 2H IK 2K 2K 4K 3 5K. 1 IX IK 2K 2 4 2K 1% 1 2 m 3 2K 4 1 w 3 3.K m 3 2K 4M 2 3M m 4 1 2 2K 4H D 3 6 6 2M 2K ZM m 2H 4K 6 2 2K 4Ji 5K 2K SK 4Ji 2 6 3M 4M 4 4K 2K ■5K B c 3K 6K 4M 7X 4 7K 2 3K 4K 8 5K 10K 4% 8H 2?4 5K 4 7K 2M 4K ±K 7K m 8 m 5K IX 3 3 5K 4 7K 3K 6K 4M 8K IK 2K IK 3K IK 2K IK 3 IK 2K D 8K 7X 4 8K 11 9K 5K 8 5 8K 8M 5K 3K 6 S 7K 9K 2K 3K 2K 3K 2U E 3K 7K 7K 3K 2K 4K 3K 3 5K 7K 2K 3 5K 6K 2K 4K 5K 2K 7K 4K 5X 5 5K 2K 6K E 9 10K 9M 5 11 14 12 7K 10 6K 10K 11 7K 4K 7K 10 9K 12 3 4K 3 4 3 F 5 94 10 4K 3K SK 4K 4 7K 10 3K 4 7 8K 3K 5K 7 3K 9K 5K 7K 6K 7 3K 8K F UK 13' o 12K 6K 14 IS 15K 9K 13 8 13K 14 9K 5K 9K 13 12 15K 3K 5K 4 5K 4 Vegetables (Fresh or Canned) Asparagus Asparagus tips Brussels sprouts Cabbage Cauliflower Celery Cucumbers Egg plant Endive Greens from beets Kohlrabi Leeks Lettuce Pickles, sour or dill Pumpkin Radishes Rhubarb Sauerkraut Sorrel Spinach String beans Swiss chard Tomatoes Water cress Wax beans THE WEIGHED DIETS These diets may be employed when the means are at hand to weigh the food with some accuracy. They are preferable to the measured diets. The patient or intelligent attendant can learn to use these lists in a very short time and provide menus which pre- sent a considerable variety, please the patient's taste, as far as this is possible on a starch- free diet, and are adapted to the needs of the sufferer with diabetes mellitus. MINIMAL FAT, STARCH-FREE DIET, WEIGHED DIET This set of diets is intended for use in those emergencies when the lowest possible amount of fat is to be administered so as to control acidosis. When the means of weigh- ing the food are not at hand the minimal fat, starch-free measured diet may be resorted to. These diets are not intended for long continued use. On account of the bulky character of the proteins, which make up the greater part of the ration, it is not feasible to raise these diets above 1250 grams. A summary of the food values is as follows: Minimal Fat, Starch-free Diet, Weighed Diet Summary of Food Values 750 Protein, gm Fat, gm Carbohydrate, gm Actual calories. . . . 33 6 15 253 67 15 18 494 111 24 19 556 145 34 23 1002 183 43 26 1257 If meat or fish containing less fat and more protein than the round steak be substi- tuted, the fat content of these diets may be lowered still further. The individual food values for some of these diets are given in the subsequent tables. A reference to these figures will enable the physician or dietitian to make finer gradations or other modifications in these diets without recourse to more elaborate tables for food values. 20 WEIGHED DIET MINIMAL FAT, STARCH-FREE DIET, WEIGHED DIET 500 calories Breakfast: Steak,* round, lean, gm. Vegetables from list, gm Black coffee or plain tea Dinner: Clear meat broth, cc. . . . Steak,* round, lean, gm. Vegetables from list, gm Black coffee or plain tea Supper: Clear meat broth, cc. . . . Steak,* round, lean gm. Vegetables from list, gm Black coffee or plain tea 60 200 200 70 200 200 60 200 16.6 2.0 4.4 19.3 2.0 4.4 16.6 2.0 4.6 0.4 5.4 0.4 4.6 6.0 6.0 6.0 111 33 22 129 33 22 111 33 15.4 18.0 MINIMAL FAT, STARCH-FREE DIET, WEIGHED DIET 1000 calories Breakfast: Steak,* round, lean, gm Vegetables from list, gm Black coffee or plain tea Dinner: Clear meat broth, cc ■ Steak,* round, lean, gm Vegetables from list, gm Pot cheese, gm Gelatin jelly flavored with coffee and sac- charine, gm Black coffee or plain tea Supper: Clear meat broth, cc Steak, * round, lean, gm Vegetables from list, gm Black coffee or plain tea 120 200 200 150 250 40 200 150 250 33.1 2.0 9.2 0.4 11.6 0.4 6.0 4.4 41.4 2.5 0.4 11.6 7.5 221 33 22 278 41 45 22 278 41 144.7 33.6 * Other meats and fish may be substituted for the round steak according to their caloric equivalents from the accompanying list. On the next two pages the figures for the minimal fat, starch-free, weighed diets as they are to be used are given. In pad form, the two pages which face each other are printed back to back, so that one sheet furnishes a complete dietary scheme. 21 MINIM-AX FAT, STARCH-FREE DIET, WEIGHED DIET BREAKFAST— Steak,* round, lean, gm. Vegetables from list, gm Black coffee or plain tea as desired. . DINNER— Clear meat broth, cc Steak,* round, lean, gm Vegetables from list, gm Pot cheese, gm Gelatin jelly flavored with coffee and saccharine, gm . Black coffee or plain tea as desired 20 60 100 120 100 200 200 200 200 200 200 200 30 70 100 150 200 200 200 250 30 40 60 70 160 250 180 300 50 70 SUPPER— Clear meat broth, cc Steak,* round, lean, gm Vegetables from list, gm Black coffee or plain tea as desired SPECIAL ORDERS— Saccharine as desired. 200 200 200 200 20 60 100 150 200 200 200 250 250 200 300 * Other meats and fish may be substituted for the round steak according to their caloric equivalents from the accompanying list. 2-2 MINIMAL FAT, STARCH-FREE DIET— WEIGHED DIET Caloric Equivalent of 10 Gm. of Lean Round Steak in Meat or Fish MEATS : Round steak, lean Chicken Dried beef Guinea Hen Kidney Mutton chop, lean Mutton, boiled, lean. . . . Roast beef, very lean. . . Steak, round, lean Sweet breads Veal, roast or chop, lean FISH: Bass, black Bass, sea Bluefish Codfish Flounder Haddock Halibut Perch Pike Porgy Shad Roe Smelts Trout Weakfish Whitefish FISH, PRESERVED: Cod, salt Protein, Fat, gm. gm. 10 2.8 0.8 11 3.5 0.5 9 3.5 0.5 12 2.8 0.8 17 2.8 0.8 14 3.2 0.6 11 3.4 0.5 17 4.0 0.3 10 2.8 0.8 11 4.4 0.1 14 4.0 0.2 19 3.9 - 0.3 2.3 4.6 0.1 13 3.4 0.6 19 4.1 0.1 30 4.3 0.2 19 4.2 0.1 15 3.1 0.6 17 3.3 0.7 24 4.5 0.1 16 3.0 0.8 15 3.1 0.6 22 3.5 0.4 17 3.6 0.4 20 3.6 0.5 12 2.7 0.8 17 4.6 0.1 19 19 19 19 19 19 19 19 19 19 18 19 20 20 18 20 18 18 20 19 20 18 18 18 19 19 20 Vegetables Fresh or Canned Asparagus Asparagus tips Brussels sprouts Cabbage Cauliflower Celery Cucumbers Egg plant Endive Greens from beets Kohlrabi Leeks Lettuce Pickles, sour or dill Pumpkin Radishes Rhubarb Sauerkraut Sorrel Spinach String beans Swiss chard Tomatoes Water cress Wax beans LOW FAT, STARCH-FREE DIET— WEIGHED DIET This series of diets is intended for routine use in those cases in which: 1. Restriction of protein is necessary to control the glycosuria. 2. There is no indication to curtail fats to the utmost because of a severe acidosis, or threatening coma. 3. The means of weighing the diet are at hand; if this is not the case the low fat, starch-free diet, measured diet, must be resorted to. As previously stated, it requires 1500 calories of this diet series to prevent loss of protein from the body in small persons, whereas larger individuals require approximately 1750 calories to accomplish this. Foods rich in carbohydrate, according to the accessory diet list, may be added when a tolerance for the diets that prevent the loss of protein, is acquired. A summary of the values for protein, fat, carbohydrate and calories for these diets is as follows: 750 1000 1250 1750 2000 Protein, gm Fat, gm Carbohydrate, gm. Calories, actual . . . 40.4 31.0 12.0 503 59.2 49.2 12.0 750 71.2 71.6 12.0 1006 89.5 89.6 12.5 1252 99.9 110.7 12.5 1489 124.4 128.1 12.5 1753 135.7 144.4 21.7 1986 The individual food values for some of these diets are given. A reference to these figures will enable the physician or dietitian to make finer graduations or other modifi- cations in these diets without recourse to more elaborate tables for food values. 500 Calories Food Gm. or Protein, gm. Fat, gm. C-H, gm. Calories Calories per meal Breakfast : 50 40 150 40 200 5 150 40 200 5 6.6 4.2 3.3 9.4 2.0 0.1 3.3 9.4 2.0 0.1 6.0 7.6 0.3 4.1 4.3 0.3 4.1 4.3 6.0 6.0 83 SS 16 77 33 40 16 77 33 40 Dinner: Butter 166 Supper: 166 40.4 31.0 12.0 503 1 The bacon is weighed uncooked. The fat and protein is calculated for the cooked product. 2 The caloric equivalent of other meat or fish should be frequently substituted from the list on page 27 to furnish variety in the diet. 3 Two or three different vegetables should be chosen from the list on page 27 which tabulates the vegetables containing 5 per cent, or less of carbohydrates. 24 1000 CALORIES Breakfast: Eggs (2) Bacon (see foot note 1, page 24). . . . Butter Black coffee Dinner: Broth Steak (see foot note 2, page 24) Vegetables (see foot note 3, page 24) Olive oil Butter Black coffee Supper: Broth Steak (see foot note 2, page 24) Vegetables (see foot note 3, page 24) Butter Tea (plain) 150 100 200 3.3 17.9 2.0 12.0 9.6 4.3 Calories per meal 1500 CALORIES Food Gm. or Protein, gm. Fat, gm. C-H, gm. Calories Calories per meal Breakfast: 100 60 10 150 140 200 20 15 15 150 50 100 200 15 13.2 6.4 0.1 3.3 33.5 2,0 5.2 0.2 3.3 6.6 23.9 2.0 2 12.0 11.5 8.6 0.3 14.3 6.7 15.0 12.9 0.3 6.0 10.2 12.9 6.0 0.5 6.0 166 133 80 16 270 33 86 140 120 16 83 193 33 120 379 Dinner: Olive oil 665 Supper: Vegetables (see foot note 3, page 24) Butter 445 99.9 110.7 12.5 1489 2000 CALORIES Food Gm. or Protein, gm. Fat, gm. C-H, gm. Calories Calories per meal Breakfast: 100 75 15 100 160 160 300 30 20 15 160 100 140 300 20 13.2 15.2 0.2 1.0 3.5 38.2 3.0 7.8 0.2 3.5 13.2 33.5 3.0 0.2 12.0 16.8 12.9 0.3 16.3 10.1 17.2 15.0 0.3 12.0 14.3 17.2 3.0 9.0 0.7 9.0 166 219 120 16 17 308 49 129 160 140 17 166 270 49 160 Ham 521 Dinner: Broth Supper: Eggs (2) Steaks (see foot note 2, page 24) Vegetables (see foot note 3, page 24) 135.7 144.4 21.7 1986 On the next two pages the figures for the low fat, starch-free, weighed diets as they are to be used are given. In pad form, the two pages which face each other, are printed back to back, so that one sheet furnishes a complete dietary scheme. 25 LOW FAT, STARCH-FREE DIET, WEIGHED DIET BREAKFAST— Eggs, gm. Bacon,* gm Ham, gm Butter, gm Vegetables,** gm Black coffee . . DINNER— Broth, cc... Steak (Sirloin),*** gm. Vegetables,** gm Cream cheese, gm Butter, gm Olive oil, cc Black coffee (1)50 40 (1)50 40 150 40 200 150 90 200 5 10 (2)100 (2)100 50 60 5 5 150 150 100 125 200 200 20 10 15 10 10 (2)100 (2)100 (2)100 60 75 ■ 75 10 ,' 15 Ml ioo 150 140 200 20 15 15 150 160 200 25 15 15 160 160 300 30 20 15 SUPPER— Broth, cc Eggs, gm Steak (Sirloin),*** gm Vegetables,** gm 200 Butter, gm Tea (plain) 150 150 150 150 150 (1)50 40 70 75 100 100 200 200 200 200 200 5 5 10 10 15 150 j 160 (1)50 (2)100 140 j 140 200 ! 300 20 20 SPECIAL ORDERS— Saccharine as desired. * The bacon is weighed uncooked. The fat and protein content is calculated for the cooked product. ** Two or three different vegetables should be chosen from the accompanying list which tabulates the vege- tables containing 5 per cent, or less of carbohydrates. ** The caloric equivalent of other carbohydrate-free meat or fish should be frequently substituted from the accompanying list to furnish variety in the diet. 26 LOW-FAT, STARCH-FREE DIET— WEIGHED DIET Caloric Equivalent of 10 Gm. of Sirloin Steak in Meat or Fish Meals: Sirloin steak Bacon, fried, fat discarded Brains, beef Capon Chicken Corned beef Dried beef. Duck Ham, fresh Ham, smoked Ham, smoked, boiled Ham, smoked, fried Guinea hen Kidney Lamb chop. Lamb, roast Mutton chop, lean Mutton, boiled, lean Mutton, roast Pork chop, lean Pork, roast Roast beef Roast beef, very lean Squab Steak round, lean Steak sirloin, lean Steak, tenderloin Sweet breads Tongue beef Turkey, roast Veal, roast or chop, lean. . Fish, fresh: Bass, black Bass, sea Bluefish Butterfish Codfish Flounder Haddock Halibut Mackerel Perch Pike Porgy Salmon Shad Shad roe Smelts Trout Weakfish White fish Fish, preserved: Cod, salt Herring, smoked Mackerel, salt Salmon, canned Sardines, canned Gm. Protein, gm. Fat, gr 10 2.4 1.0 7 0.9 1.6 16 1.4 1.5 9 2.4 1.0 11 3.5 0.5 6 0.9 1.6 9 3.5 0.5 6 1.0 1.6 5 O.S 1.7 4 0.7 1.6 7 1.4 1.6 5 1.1 1.7 12 2.8 O.S 17 2.8 O.S 5 1.1 1.5 10 2.0 1.3 14 3.2 0.0 11 3.4 0.5 6 1.5 1.4 12 3.1 0.7 9 2.6 0.9 5 1.1 1.4 17 4.0 0.3 7 1.3 1.6 10 2.8 0.8 10 2.4 1 .0 7 1.7 1.4 11 4.4 0.1 12 2.3 1.1 7 2.0 1.3 14 4.0 0.2 3.9 4.6 3.4 2.0 0.7 0.1 3.5 0.4 3.6 0.4 3.6 0.5 2.7 O.S 4.6 0.1 2.2 1 .0 1.0 1.6 Vegetables (Fresh or Canned) Asparagus Asparagus tips Brussels sprouts Cabbage Cauliflower Celery Cucumbers Egg plant Endive Greens from beets Kohlrabi Leeks Lettuce Pickles, sour or dill Pumpkin Radishes Rhubarb Sauerkraut Sorrel Spinach String beans Swiss chard Tomatoes Water cress Wax beans THE ACCESSORY DIET OF FOODS RICH IN CARBOHYDRATES If the patient's urine continues to be sugar free on a "carbohydrate-free" diet of sufficient caloric value (1500 to 1750 calories), carbohydrate-containing foods may be added and the carbohydrate tolerance of the patient be determined. In those cases able to utilize a considerable amount of starch, the accessory diet may be varied from day to day, and use may be made of the following table, which gives the carbohydrate equivalent of one slice (1 ounce or 30 grams) of white bread, containing approximately 15 grams of starch. 28 THE ACCESSORY DIET OF FOODS RICH IN CARBOHYDRATES EACH PORTION CONTAINS APPROXIMATELY 15 GRAMS OP CARBOHYDRATES Foods Household Measure Gm. Uncooked FLoiirs, etc.: Barley 1 h. tbsp. 21 Buckwheat 1 h. tbsp. 19 Cornmeal 1 h. tbsp. 20 Farina 1 h. tbsp. 20 Hominy 1 h. tbsp. 18 Macaroni 1 h. tbsp. 20 Noodles - IJj K. tbsp. 20 Oatmeal 1 h. tbsp. 22 Rice 1 h. tbsp. 18 Rye flour 1 h. tbsp. 18 Spaghetti 1)4 h. tbsp. 20 Vermicelli 1% h. tbsp. 21 Wheat flour 1 h. tbsp. 20 Bread and Crackers: Bread 1 slice. 30 Breakfast biscuit (Huntley & Palmer) 3 18 Cornbread 1 slice. 32 Roll (Vienna) K 25 Uneeda Biscuit 3 18 Zwieback 1)4 20 Cooked Cereals: "Force" 5 h. tbsp. 18 Farina 2)4 h. tbsp. 125 Grapenuts 1)4 h. tbsp. 20 Hominy IK h. tbsp. 90 Macaroni 2 h. tbsp. 100 Oatmeal 2)4 h. tbsp. 130 Rice IK h. tbsp. 60 Shredded wheat biscuit M 22 Cooked Vegetables: Artichokes 1 medium. 320 Beans (baked — canned) 2 h. tbsp. 75 Beans, lima 1J^ h. tbsp. 50 Beets 6 h. tbsp. 2Q0 Carrots 13 h. tbsp. 440 Okra 4 h. tbsp. 200 Onions 3 300 Parsnips 4 slices. 120 Peas, green 3 h. tbsp. 100 Potato (baked) )4 medium. 60 Potato (boiled) )4 medium. 70 Potato (mashed) .--, 1J£ h. tbsp. 80 Potato, sweet (boiled) J£ medium. 35 Squash 2 h. tbsp. 100 Turnips 3 h. tbsp. 210 Foods Fruits: Apple Apricots Banana (without skin) . Cherries Gn 1 medium. 120 2 large. 120 }£ medium. 75 90 Currants 5 h. tbsp. 120 Grapefruit y 2 small 150 Huckleberries 3J^h tbsp. 90 Lemons 2 medium. 210 Muskmelon y, 300 Nectarine 1 100 Olives, green 20 180 Orange K large. 150 Peaches iy medium. 150 Pear 1 small. 100 Pineapple 3 slices. 150 Plums 2 medium. 75 Raspberries iy h. tbsp. 120 Strawberries 8 h. tbsp. 200 Watermelon Large slice. 300 Dried Fruits: Apples 3 small. 22 Apricots 3 large. 24 Currants \y 2 tbsp. 20 Dates 3 19 Figs 1 large. 12 Prunes 2 large. 24 Raisins 10 large. 23 Milk and Cream: Buttermilk \y tumbler. 300 Cream, 16 per cent 1)4 tumbler. 300 Cream, 40 per cent \y tumbler. 300 Koumiss \y 2 tumbler. 300 Whole milk IK tumbler. 300 Nuts: Almonds 60 90 Brazil 30 180 Chestnuts (roasted) 15 40 Cocoanut 1 slice (3X2 in.) 50 Filberts 100 100 Peanuts : 40 80 Pecans 35 110 Pistachio 190 95 Walnuts 30 125 Paul B. Hoeber, 67-69 East 59th Street, New York. COLUMBIA UNIVERSITY LIBRARIES Mosenthal Diabetes mellitus. RC660 M852 1921