660 INSULIN IN HOSPITAL AND HOME
very well as tests to show whether gain in weight is bringing any
recuperative power to the pancreas. From the series of cases here
recorded it is too early to express any opinion in this regard.
The gain in calories has been in calories of carbohydrate, pro-
tein, and fat. When one considers that a patient can live for years
upon 15 grams of carbohydrate, but that to do this the diet must
be restricted to 5 per cent. vegetables, a little cream and occasion-
ally a few strawberries or grape fruit, the change in range in diet
which insulin has brought is evident. The average number of
grams of carbohydrate which these 53 patients were taking at the
beginning of treatment was 37, but at the latest report was 45,
which is an increase of 22 per cent. The greatest increase in
carbohydrate recorded for any patient was 132 grams, or 80 per
cent., and the least increase was 1 gram. The actual gain in carbo-
hydrate utilized averaged more than 8 grams, because more of the
carbohydrate was lost in the urine at the beginning of treatment.
From what follows it will also be seen that the total glucose
(Woodyatt) utilized very greatly increased. With protein, too,
considerable increases were made, but as a rule, especially in
young children, the protein was not allowed to go over 3 grams
per kilogram body weight. So many of our patients were upon a
very low protein diet at the beginning of treatment that this
component of the diet was raised proportionately more than
carbohydrate. The patients were very glad to have an increase
of only 20 per cent. in carbohydrate if their protein could be
increased 50 per cent. The average number of gramns of protein
was 36, or 1 gram per kilogram body weight, at the beginning of
treatment, and at the end was 55 grams, or 1.4 grams per kilo-
gram. The greatest increase in calories was in the form of fat.
At the commencement of treatment the average number of grams
of fat was 62, and at the end was 105 grams. It will be noted
that for an average gain of 8 grams of carbohydrate, there was an
average increase of 41 grams of fat; in other words, a ratio of 1
gram of carbohydrate to 5 grams of fat. If one estimates the
ketogenic antiketogenic ratio in the first diet it will be found to
be 1.1 and in the second 1.2, each a ratio which is well below the
limits of acidosis.
Age of Patients at Beginning of Treatment with Insulin
Our experience with insulin shows that it can exert its full
power from babyhood to old age.