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protein is very important in causing glycosuria, and for this reason
the protein intake must be watched as carefully as the carbohydrate.
With adults, it is advisable to give about 1 gram of protein per
kilogram of body weight, if possible; with children 1.5 to 2 grams. It
will be noticed that the diets which follow contain rather small
amounts of fat, a good deal less than is usually given to diabetics.
There are two reasons for this: In the first place, _we do not want
our diabetics, our adults, at any rate, to gain weight; and in the
second place acidosis is much easier to get rid of if the fat intake
is kept low_. If the fat values given in the diets are found too low
for any individual case, fat can very easily be added in the form of
butter, cream or bacon. Most adults do well on about 30 calories per
kilogram of body weight; children of four years need 75 calories per
kilogram, children of eight years need 60, and children of twelve
years need 50.

If sugar appears in the urine during the process of raising the diet,
we drop back to a lower diet, and if this is unavailing, start another
starvation day, and raise the diet more slowly. But it will be found,
if the diet is raised very slowly, sugar will not appear. It is not
well to push the average case; if the patient is taking a fair diet,
say protein 50, carbohydrate 50 and fat 150, and is doing well,
without any glycosuria, it is not desirable to raise the diet any
further. The caloric intake may seem rather low in some of these
diets, but it is surprising to see how well most patients do on 1500
or 2000 calories.

It will be seen that the treatment can be divided into three stages:

(1) The stage of starvation, when the patient is becoming sugar-free.

(2) The stage of gradually working up the diet to the limit of
tolerance.

During the first two stages a daily weight record should be kept, and
the urine should be examined every day. The patient should, of course,
be under the immediate supervision of the physician during these two
stages. It is always well to discharge a patient on a diet somewhat
under his tolerance, if possible.

(3) The stationary stage, when the diet is kept at a constant level.
The patient is at home and going about his business. Most patients may
be taught to test their own urine, and they should do this every other
day. If there is sugar in the urine, the patient should go back to a
lower diet, and if he cannot be made sugar-