THE GASTRO-INTESTINAL TRACT

The Diabetic Patient

In any preparation involving restriction of diet, special attention must be
paid to the diabetic subject. Diabetes is relatively common and is the most
common of the metabolic diseases: it is a disorder of the chemical pro
cesses of the body.
There are two types of diabetes:
Diabetes Mellitus, which of insulin secretion
due to deficiency

is
(i)

the pancreas. There may be partial or complete failure of secretion.

by

Diabetes Insipidus, which arises from impaired function of the

(ii)

posterior lobe of the pituitary gland. This very rare condition.

is
a
The first very much more common than the second and the patient
is

who says he diabetic almost without exception will mean that he has
is
a

diabetes mellitus.
Insulin secretion of the islets of Langerhans in the pancreas. Its
is
a

function in the blood stream of sugar which

to control the reserve
is

is
in liver form of glycogen.
and muscle in failure in supply of

A
stored the
insulin immediately raises the level of blood sugar and this condition

is
known as hyperglycaemia. Sugar appears also in the urine and to its presence
the studentwill see the term glycosuria applied.
A disturbance of sugar metabolism in the body associated with im
is

paired combustion of fats, as the one process assists the other. When the
oxidation of fats only partial, certain aceto-acetic acids or ketones are
is

formed in the blood. This condition known as ketosis and leads to

is

diabetic coma in the untreated subject.

Diabetes not curable and must be treated by:
is

Correct diet, maintaining balance of carbohydrate and fat, and

(i)

of proper calorie value.

Insulin administration in all but mild form of the in
(ii)

disease an
a

elderly person.

With this treatment the blood sugar can be kept at normal level, the
free of glycosuria, and his diabetes said to be stabilized. Once
is

patient
is

proper balance has been found, clearly of some significance that

it
is
a

there should be little interference with the diet. Anyone known to be

a

diabetic must receive proper instruction necessary for him

if

becomes
it

to omit or limit normal meal.

a

Such
patient should be asked first he taking insulin. patient who
A
if
is
a

not receiving insulin may postpone meal for short period. He

is

a
a

should be told to omit breakfast, but he must be placed first on the