American Journal of Clinical Nutrition, Vol 2, 195-203, Copyright © 1954 by The American Society for Clinical Nutrition, Inc.

REGULATED versus FREE DIET in the Treatment of DIABETES MELLITUS

¹ From the Diabetic Clinic and Medical Service, Maimonides Hospital, Brooklyn, N. Y.

The discovery of insulin had a marked impact upon our ideas about the role of diet in the management of the diabetic. While it naturally allowed for a liberalization of the diet to the point where patients could be provided with their physiological needs for carbohydrate, one school of workers further concluded that it was no longer important to regulate the diet of the diabetic at all and that he should be allowed a free, unrestricted, self-selected food intake.

When one seeks a rational basis for the treatment of the diabetic, that is, to create those conditions in the utilization of foodstuffs which would restore a physiological metabolic equilibrium without endangering the patient with the toxic effects of insulin overdosage, then the advantages of diet regulation become apparent in the form of clinical well-being, weight control, minimal glycosuria, approach to normal glycemia, and freedom from hypoglycemia. While time long-term benefits in the form of protection against degenerative vascular changes, nephropathy and retinopathy are not definitively proved, there are some investigators who find this to be the case.

The disadvantages of a free, self-selected diet are seen in the complications arising from unrestricted glycosuria, hyperglycemia, hypoglycemia, and haphazard insulin dosage.

In the argument that regulation of the diet and diabetes control play no part in the ultimate destiny of the diabetic, there should be more accurate identification of "control" as we understand it today. There appears to be evidence to indicate that diabetes mellitus is a complex disorder in which there occurs a disturbance not only in carbohydrate metabolism, but also in other enzyme systems unrelated to and unaffected by insulin function. This would mean, then, that one should not expect the use of insulin alone to provide the entire answer to the complete control of the diabetic. If that is the case, it does not appear logical to abandon those dietary techniques which make possible a more scientific use of insulin; instead, we should continue our search for those components that may prevent and reverse the collateral phenomena which we recognize as nephropathy, retinopathy, and arterial degeneration.