Abstract
Since relatively large amounts of fats are used in the construction of maintenance diets in the treatment of diabetes mellitus it is important to know the limits within which fat may be employed with safety. The normal composition of fat demands that carbohydrates shall be simultaneously oxidized. Zeller 1 has shown in two normal men and two normal dogs that of the total calories, the protein intake being kept low, 10 per cent. must be yielded by carbohydrate if 90 per cent. arises from fat in order to prevent the production of the ketone bodies. In commenting on these experiments Lusk 2 calls attention to the fact that it is possible that for the proper oxidation of fat, the end product of which is B-oxybutyric acid, the burning of one triose molecule may be necessary for the normal oxidation of one molecule of B-oxybutyric acid. The attempt has been made in this work to establish the proportion of available carbohydrate to fat when ketone bodies appear in the urine.
Diabetic cases are treated as follows: Freed from sugar and acetone body excretion, sugar tolerance ascertained and then the following experiment. The individual is put on a diet having a protein intake that will enable nitrogen equilibrium to be maintained with the fat and carbohydrate given. During different periods the protein intake is kept constant and the amount of carbohydrate and fat are varied isodynamically, the proportion of carbohydrate being reduced in proportion to the fat until ketone bodies show a definite increase in the urine.
The following table shows the percentage relationship of fat and carbohydrate and total available carbohydrate in the diet of the patients at the point in the experiment where the ketone body excretion shows a marked increase.
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