During the early part of this century it was customary to use a very liberal protein fat diet in the treatment of diabetes mellitus. This type of diet was characterized by its high protein content, its relative poverty of carbohydrate and its high caloric value. Mild diabetics did quite well on such a regimen, but the more severely ill patients did not tolerate it without glycosuria and the persistence of diabetic symptoms, and, as pointed out by Joslin, coma was so common that the percentage of deaths in hospitals was greater than in homes. It was necessary to conceive of a mysterious "spontaneous downward progress" to explain the constant loss of tolerance in these cases, and the majority of physicians felt that treatment of the severe cases was a waste of time and energy. This type of diet is not by any means without its supporters today, and it
NEWBURGH LH, MARSH PL. FURTHER OBSERVATIONS ON THE USE OF A HIGH FAT DIET IN THE TREATMENT OF DIABETES MELLITUS. Arch Intern Med (Chic). 1923;31(4):455–490. doi:10.1001/archinte.1923.00110160002001
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