It has long been known that if the nutritional needs of a diabetic can be reduced, the disease sometimes disappears. If a diabetic has been under stress and the stress is removed-for instance, a sick child who caused worry has recovered -he may no longer need insulin. Overweight diabetics can frequently stop insulin after reducing. In each of these cases, the body requirements have decreased, and the effect is the same as if the diet were improved.

Adequate nutrition stimulates insulin production in a variety of ways. The insulin output has often increased after diabetics have taken vitamin C; and guinea pigs given too little vitamin C produce insufficient insulin, have high blood sugar, and lose sugar in the urine. This vitamin is needed before several amino acids that form insulin can be utilized. Deficiencies of protein, pantothenic acid, and particularly vitamin B2 reduce insulin synthesis in rats; and conversely, generous amounts of these nutrients stimulate insulin production, as does a factor in yeast. A lack of vitamin B12 or potassium causes rats to have prolonged high blood sugar. Cortisone injections normally increase insulin production, but such an increase cannot occur if vitamins B1, B12 and pantothenic acid are deficient.A wide variety of animals develop diabetic symptoms when given 2 meals daily but not if allowed to eat frequently.

Diabetic patients have improved remarkably and many have been taken entirely off of insulin when 300 to 600 units of vitamin E have been given daily. Results have been especially striking when 3 tablespoons or more of lecithin were taken daily with vitamin E. Natural insulin production has been increased by giving patients vitamin B1, vitamin C unusually large amounts of protein, pantothenic acid, and small frequent meals each containing some carbohydrate.

After diabetes has been diagnosed, the diet should be made. As long as any pancreatic cells are able to produce insulin, the emphasis should be on keeping these cells healthy and on helping them to increase insulin production. The conclusion that diabetes is permanent is justified only when the insulin-producing cells have been largely or completely destroyed.

Nutritional needs are high. The dietary requirements of a diabetic are undoubtedly many times greater than those "of a healthy individual. Because the urinary losses of water-soluble nutrients are unusually high, to improve health the diet must more than compensate for these losses. For example, inositol was isolated from diabetic urine over 100 years ago; and the urinary losses of this vitamin are much greater than in other persons, a fact that contributes to the tragic incidence of severe atherosclerosis. Both the urinary losses and the requirements of magnesium and vitamin B are markedly increased. Although the National Research Council considers : milligrams of vitamin B adequate for adults, conscientious objectors obtaining this quantity from army rations excreted excessive amounts of xanthurenic acid.

Every time when acidosis develops or the blood sugar falls below normal an alarm reaction to stress is set off, increasing the need for protein, vitamin C, pantothenic acid, potassium, and other nutrients. Cortisone given as a medication, which simulates the body's reaction to stress, has caused both diabetes and inflammation of the pancreas in patients.

If pantothenic acid is undersupplied, the blood sugar drops so quickly after insulin is given that the danger of insulin shock, or a blackout, is tremendously increased.

Certain individuals, known as "brittle" diabetics, are so unusually sensitive to insulin that their blood sugar falls rapidly from extremely high to extremely low, causing insulin shock to be common. This condition appears to result largely from a deficiency of pantothenic acid, though brittle diabetics also have unusually high requirements for potassium, protein, vitamins B2 and C, niacin amide, and lecithin. When these nutrients have been increased, the sensitivity to insulin has disappeared.

Similarly, when diabetic diets have appeared to be adequate in vitamin B1, neuritis has developed, and was relieved as soon as larger amounts of this vitamin were given. Vitamin B1 is said to be especially valuable in preventing damage to the brain during diabetic acidosis. The more insulin needed, the higher is the requirement for vitamins B1, pantothenic acid, and biotin. Because of stress, urinary losses, and destruction by saccharine and other artificial sweeteners, the vitamin-C requirement is also unusually high in diabetes, and huge amounts of this vitamin sometimes bring unexpected results.

Diabetic patients are frequently deficient in potassium, which, though needed to utilize sugar, drops far below normal when the blood sugar falls or acidosis develops. The loss of potassium caused by salt retention during stress is especially dangerous to diabetics who suffer from high blood pressure or heart disease and increases the likelihood of a heart attack. Because a potassium deficiency can also be induced by eating too much salt, diabetics should not eat such foods as ham, smoked fish, and salted nuts when under stress or spilling sugar unless they take potassium. During severe acidosis a lack of potassium can be fatal. Low blood potassium also has been found to increase to normal if magnesium is given.

When diabetic patients with coronary disease have been given 2 to 5 grams of potassium chloride by mouth before an insulin injection, it has prevented an excessive drop in blood sugar and an increase in blood pressure and pulse rate; when given after the blood sugar fell, blood pressure and pulse have immediately decreased and the blood sugar and electrocardiograms quickly changed toward normal. It is probably wise for diabetics to use-with their doctor's permission-potassium chloride generously as a salt substitute and to carry I-gram tablets of potassium chloride to take at the first indication of insulin shock. If either stress or a pantothenic-acid deficiency has been prolonged, however, ordinary table salt (sodium) is needed rather than potassium.