Further Observations on Latent Tolerance in Diabetics.

Abstract

A recent report on the stimulating effects on carbohydrate tolerance of successive short periods of a dietary high in sugar and low in protein and salt, with added insulin dosage, included data obtained on 2 mild cases in which improvement was maintained without interruption of the high sugar regime after withdrawal of insulin. Substitutions and additions were made to the diet of one of the patients, a young man 26 years old, until it was essentially normal in character. His condition was followed for 6 months without recurrence of the diabetic status. The present study is an attempt to determine how patients who were formerly insulin cases would react to an essentially similar procedure.

H., a student, age 20 years, was discharged from the hospital Nov. 26, 1928, on a maintenance diet with 12 units of insulin daily; his last blood sugar was 155 mgm. Thereafter he was managed as an out-patient, reported at short intervals to the laboratory, and received his meals from the therapeutic diet kitchen. He was able to discontinue insulin 3 weeks after his discharge after reductions to 7 units and 5 units daily. A high sugar diet period with insulin was started Jan. 4, 1929. Insulin was reduced daily until withdrawn on Jan. 11. As this summary is submitted, he has been 40 days on the high sugar and carbohydrate diet without insulin. Blood sugars 2 hours after breakfast have been normal, but afternoon determinations have been irregular and somewhat higher than the morning figures,

Two more patients have been studied. R., age 18 years, had been able to dispense with insulin as the result of successive short periods of high sugar diet. F., age 23 years, had been managed carefully over a period of 2 years. Both responded satisfactorily for a time on high sugar diet when insulin was withdrawn, 11 days for R. and 16 days for F., until increasing and irregular blood sugars indicated that they be returned to the previous diabetic diet.