I have not had much success with aleuronat or almond flours. The soja bean is interesting as to its starch contents. I encourage diabetics to eat these two-thirds grown and green, boiled and well buttered. The meal made from these beans is very low in starch, but is not very palatable. This soja bean is a Japan bean. Grown in Japan it affords much less starch than when grown in this country, as before noted. This is an interesting point as to environment.

Liebig's toast for diabetics: Treat slices of white bread with an infusion of malt for an hour or two, then wash and dry and toast them.

What sweetening shall the diabetic use? Saccharin is probably the best. I am not inclined to recommend glycerin, mannite, or levulose. There is much objection to saccharin generally, but it is probably the best substitute for sugar that we can get.

To what dangers are the diabetics mostly liable? First coma, coming suddenly or gradually. Intense muscular pains and abdominal cramps usually precede it. Poisoning from sugar, acetone, oxy-butyric acid, a fore-runner of acetone, etc., is imminent. Shall we withdraw absolutely all carbohydrates when coma threatens? Yes, if the sufferer has been taking them. Some recommend a change of diet from whatever the patient is then on. Fats in the shape of milk, cream, oils, etc., would be proper, as a rule. All the strongest alkaline waters possible would be proper, and to load ordinary drinking water with bicarbonate of soda would be proper.

Another danger is exhaustion almost to collapse.

Here you must use spirits and the strongest diet, keeping in view the possibility of coma. The question of spirits is then doubtful. If weak and thin, as a rule, give oceans of fats. Fat is a great factor in the diet of the average diabetic. The diet of the diabetic must give him at least thirty-five calories per kilogram of weight per day. The average of a healthy man remember is, say, two thousand five hundred calories per day.

A healthy man takes in his diet 40 per cent. carbohydrates. In the diabetic most of this goes away in the urine and does him no good. The glucose coming to the blood is either insufficiently oxidized or there is too much of it. The trouble comes from one or the other of these causes. The more carbohydrates the diabetic can tolerate, the better for him. Some can tolerate more and some less, and these last are the most difficult to treat. Carbohydrate rest is admirable for diabetics. Make it two days in each week or one week in each month. Milk diet is near absolute rest diet, and skim milk is more so. Of course there is the milk sugar, but the diabetic appears to get away with that. The fat in whole milk makes it better than skim milk. If intestinal catarrhal troubles come on, keep to this milk diet sure, or its equivalent.

The prognosis in all cases of diabetes depends on many factors. The physical and mental peculiarities of the patient, the family history, and the circumstances of the patient count for much, as well as his employment and his environment. The age of the patient is important. Before thirty years of age it is very serious, and is often rapidly fatal, many dying of consumption. Tall, spare, weak people are particularly vulnerable.

As to the general treatment of diabetics, apply the rules now so universally applied to tuberculous patients in forced feeding, sunlight, and open air, and you will get, I am sure, gratifying results. Of course we must observe more or less carefully diabetic diet rules. We must distinguish between glycosuria and true diabetes. The true diabetic usually has a voracious appetite, and he invariably, under such conditions, eats more than he should do. So much sugar passes off in his urine that he must have starches as the material from which to replace it, and he thus craves starches and sugars, and the trouble in practice is, few can resist this craving. As a result of this overindulgence, fermentation of food takes place after it has been eaten. These people are always in great danger, for most of them will overindulge, and an excessive meal of carbohydrates, combined, I think, particularly with oysters and liver and such glycogenic foods, is often followed by severe attacks of acute indigestion and sudden death, for these unfortunates have so little vitality, so little ability to resist the attacks of any disease, as to make them particularly vulnerable to even moderate onslaughts. Such persons should be carefully watched and prevailed upon to reduce excessive quantity of all foods, and especially of carbohydrates and the other sugar-producing materials. Bronze skin sometimes occurs in these cases. Here the haemoglobin is destroyed. Cirrhosis of the liver also occurs.

Ask your physician to find out your tolerance of carbohydrates for you. The worse the diabetes, the more proteids, fats, and alcohol must be used. If you must have carbohydrates, the best forms are in milk sugar, cane sugar, and fruit sugar. You find out your tolerance for the diet you are on by the comparative amount of sugar there is in the urine. If a person appears to have inherited diabetes the case must be very closely watched on all sides. The diabetic is very vulnerable after accidents, in all diseases coming to him, especially pneumonia, and endures surgical operations very badly, but better than in the old days, before antiseptic surgery came into vogue. In all of these conditions the greatest attention must be given to the subject of diet.

In diabetes, you cannot, as I have said, lay down a diet for all cases. You can only give certain general rules, and tell the virtues and vices of certain articles in the lists you may see fit to present. Remember, as the case goes on, if it be intractable, even the albumin of the meats and such, eaten, goes to glucose, and then the sufferer begins to live on his own tissues, the albumin here being converted into glucose, and absolute starvation ensues. In these cases try everything rather than starve.