It can be hardly called revolutionary—the transformation has not been that sudden—the the recent changes in diabetic dietary prescription reflect a basic reassessment of principles, practices, and attitudes which prevailed since insulin was discovered half a century ago.
The diabetic diet of the early insulin era was only a short step ahead of the preinsulin Naunyn diet which provided less than 100 gm of carbohydrate a day. Despite the availability of a therapeutic agent capable of ultilizing carbohydrates, physicians were reluctant to abandon carbohydrate restriction. Protein and fat remained the backbone of the diet; carbohydrate was allowed only in amounts sufficient to prevent an unfavorable disturbance of the ketogenic-antiketogenic ratio. The restricted diet was meticulously weighed or measured and strictly supervised by the attending physician. A departure from dietary constraints was a source of remorse for the patient and an invitation to a reprimand by the physician. The latter would