In this thesis an attempt has been made to show
how the general practitioner may diagnose and treat
his diabetic patient in the most efficient manner.
In the writer's experience no other condition met
with in practice demands the same degree of knowledge
and patience, offers the same degree of success and
earns the same degree of gratitude from the patient
as does the treatment of diabetes. The co-operation of the patient
is required more in this disease than in any other,
and, as the diabetic is almost invariably an intelligent one,
this is obtained in most cases in a whole- hearted
manner.The conclusions arrived at from the study of
current medical literature on diabetics and from
observations made in practice may be summarised as
follows: -1. A study of diabetes emphasises the fact that the
greatest single factor in the promotion and maintenance of good health is a proper diet both from the
quantitative and the qualitative points of view.2. In the production of diabetes mellitus it is
suggested that two factors are always present. It is
thought that obesity, an infection, heredity or any
other recognised associated condition merely acts as
a predisposing or exciting factor and that a "specific
factor" is also present in every case of the disease.
It is further suggested that this "specific factor"
may be an ultramicroscopic virus with a special affinity
for the islet tissue of the pancreas.3. The early recognition of diabetes, as of all
other diseases, is of great importance, and for this
reason the early manifestations of the disease should
be familiar to all practitioners.4. A yearly medical overhaul of each of his patient
is advocated. It is felt that, amongst other conditions many cases of early diabetes would be detected in this way, and consequently a much better
prognosis would result.5. Every case of glycosuria met with in practice
demands a careful systematic search for the type of
sugar present and the cause.6. Only the suspicious case of diabetes requires
the performance of the sugar tolerance test. It is
generally accepted that a fasting blood-sugar of
.13% or over; or a blood-sugar figure of .2% or over
one hour after a meal (except in the aged or in the
presence of such organic diseases as hyperthyroidism;
hyperpituitarism, etc.) denotes true diabetes
mellitus, and sugar tolerance tests should not be
performed in these cases.7. The prognosis of diabetes more than that of any
other disease depends on the treatment and the
success of the treatment depends on the zeal of the
doctor and the perseverance of the patient.8. It is thought that the term "arrested" instead
of "cured" might be used with advantage in those
cases becoming sugar -free under treatment.9. It is considered that the optimum diet for the
diabetic is the minimum one which will sustain his
strength, at the same time keeping his blood- sugar
level within normal limits, to which end insulin
may have to be employed and if employed then a minimum amount of insulin to achieve this purpose
should be administered.10. The careful regulation of the food intake still ! remains the most important factor in the treatment of
the diabetic.11. The aim and ideal of diabetic treatment is to
keep the blood-sugar within normal limits and the
urine sugar -free at all times, thus allowing the
pancreas to regenerate and also preventing the
occurrence of complications.12. Every patient who is having insulin should
receive in the process of determining his insulin
dosage an overdose of insulin for two purposes.
Firstly to establish his insulin level, and secondly
to familiarise him with the symptoms of hypoglycaemia.13. The early clinical manifestations of ketosis
are of great importance to the practitioner; firstly
as a means of preventing the onset of coma in a known case and secondly as a means of recognising
the presence of severe diabetes in an undetected
case.14. Coma demands immediate treatment. Experience
shows that the longer the patient remains in coma
untreated, the more difficult it is to revive him.15. As it appears that the administration of alkalis hinders carbohydrate metabolism, their use in
cases of ketosis is discountenanced.16. The importance of every general practitioner
carrying a 5 c.c. bottle of double strength insulin
in his emergency bag along with his Benedict and ferric chloride reagents is emphasised.17. Expert opinion in this country and in America
considers that insulin is the only successful drug
in the treatment of those cases of diabetes which
do not resnond to dietetic measures alone and in all
cases of ketosis. Without exception insulin substitutes are inefficient.18. In spite of the increasing incidence of
diabetes mellitus, dietetic measures and insulin
are controlling the disease; and, by restoring health
to the mild and medium case and by saving the life of
the severe case, the lives of many useful citizens
are annually preserved
