Abstract
As low protein diets have been recommended in treatment of diabetes by Joslin, 1 Petren, as quoted by Joslin, 2 Newburgh and Marsh, 3 and others, a study of long continued low protein diet was made in this case. The patient was a man, age 32, with a history of moderately severe uncomplicated diabetes for the past 2 1/2 years.
Observations extended over a period of 6 months. The diets were carefully weighed and the nitrogen in the food calculated from the Atwater tables. No analyses of food were made. Total nitrogen in the urine was determined daily by the Kjeldahl method. Nitrogen partition products were not determined. Nitrogen in stools was determined for two ten day periods by the same method. Daily weights were recorded.
The patient received a diet of 2000 calories with 50 grams of protein for 15 days before reduction of protein was started. The protein was gradually lowered by drops of 10 grams each until a 20 gram level was reached. Three or 4 days were allowed at each level for the patient to adjust himself to his new diet. The patient remained at this level for 106 days. The calories remained the same during the entire period. Carbohydrate and fat were changed from time to time so that the fatty acid-glucose ratio varied between 0.9 and 3.0. In this change the carbohydrate varied from 132 grains to 30 grams in successive steps, the calories being replaced by fat. The nitrogen excretion was not noticeably affected. This suggested that fat served to spare protein as efficiently as carbohydrate. Insulin was required during the entire period. There was no glycosuria. Moderate acetonuria appeared on fatty acid-glucose ratios above 1.5.
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