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[IP] DM Ladder Diet



Here is the Ladder Diet prescribed for DMers before the percentages of CHO,
Fat, Protein diet came about. I believe this is when sugar was found in the
urine because doctors were tasting it. A Benedictine test, however, was also
mentioned in the book. Perhaps Spot knows? In 1950 the exchange plan was
developed:

(ppg 147-150 The Pathology & Treatment of Diabetes Mellitus; George Graham,
Oxford Medical Pub 8 1923)

DM LADDER DIET Rx'd IN 1920s (INSULIN DISCOVERED IN 1921)

The treatment should be started with 1 or 2 hunger days.

DAYS 1 & 2: As much weak tea, coffee, or fresh lemonade as desired. Meat
essence should be given at 2 meals.

DAYS 3 & 4
Breakfast: 2 eggs, butter 1.4 oz., weak tea or coffee.
Lunch: 1 egg beaten up in weak tea/coffee, 2 oz. lettuce or tomato.
Midday meal: 6oz. green veg, > oz. butter, 10oz. meat ess.
Tea: 2 eggs, < oz butter, weak tea/coffee, 2oz. lettuce or tomato. Supper: 6
oz. green vegetables, 1/2 oz. butter, 10 oz. meat.
Eight agar bran biscuits may be eaten in the day.
Total: 5 eggs, 1-> oz. butter, 12 oz. green cooked veg; meat ess. One oz.
cream may be exchanged for = oz. butter.
Protein 36 g.; fat 70 g.; sugar 14 g.: caloric value 838.
If the urine still contains sugar, 1 or more hunger days should be ordered
with 1 or more egg-&-veg days interposed until either the urine contains no
sugar or the attempt to make it so is stopped.


DAYS 5 & 6
If the urine contains no sugar, 2 oz. meat or 3 oz. fish may be added to the
midday meal for 2 days.
Protein 51 g.; fat 80 g.; sugar 16 g.; cal val 990.

DAYS 7 & 8
If the urine contains no sugar for 2 days, 2 oz. ham may be added to the
evening meal and 1 egg deducted from this meal.
Protein 54.1 g.; fat 94.9 g.; sugar 16 g.; cal val 1138.

DAYS 9 & 10
If the urine contains no sugar for 2 days, 2 oz. bacon may be added to the
breakfast and 1 egg deducted from the breakfast.
protein 57.7 g.; fat 117.9 g.; sugar 16 g.; cal val 1358.

DAYS 11 and 12
If urine contains no sugar 2 days, add 4 oz. milk over the whole day. Protein
62.2 g.; fat 122.5 g.; sugar 20 g.; cal val 1428.

DAYS 13 and 14
If the urine contains no sugar for 2 days, add = oz. bread in two portions <
oz. at the other 2 meals of the day, so that the 1 oz. of bread is divided
into four equal portions.
Protein 64.2 g.; fat 122.8 g.; sugar 35.0 g.; cal val 1498.

DAYS 17 and 18
If the urine contains no sugar after 2 days, add = oz bread in 2 portions of <
oz., = 2 meals have = oz & the alternate meals
< oz. Protein 65.2 g.; fat 123 g.; sugar 42.5 g.; cal val 1533.

DAYS 19 and 20
If the urine contains no sugar 2 days, add = oz of bread in two portions of <
oz. The patient will have = oz. of bread at each meal. He should be told that
it is very important to divide up the bread into 4 equal portions & not to
take it all at 1 meal or two.
Protein 66.2 g.; sugar 60 g.; sugar 50 g.; cal val 1568

The patient should be kept at this level for another 4 WEEKS. If still
sugar-free, 1 oz. butter may be added & the bread cau- tiously increased up to
4 oz: = oz. being added every 14 days.
Protein 70 g.; fat 144 g.; sugar 80 g.; cal val 1910.
If all goes well another oz. butter may be added to raise cal val.
Protein 70 g.; fat 184 g.; sugar 80 g.; cal val 2090.
If sugar reappears when meat/ham/or bacon is added. 1 or 2 hunger days should
be repeated & the whole ladder reCLIMBED.

If sugar appears at any time after this point is reached, give one hunger day
& return to the full diet less some butter or bread. If the nitro-prusside
test for aceto-acetic acid is very intense at any time, either give 1 or 2
hunger days or remove all fat from diet.
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