Diabetes mellitus group. Indications for referral to the ITU office for diabetes mellitus. Doctors, tests, examination

Medical and social expertise in diabetes mellitus

Epidemiology

Diabetes affects 6% of the population in developed countries. According to the frequency of disability and mortality, diabetes mellitus ranks 3rd after cardiovascular diseases and oncopathology. Mortality among patients diabetes 2 times higher, acute myocardial infarction on its background - 3 times higher; blindness occurs 10 times more often, gangrene of the lower extremities - 20 times more often than in the general population. Over 30% of patients with chronic renal failure on hemodialysis suffer from diabetes mellitus. More than 60% of diabetic patients are invalids of groups I and II. The life expectancy of patients in childhood is about 40 years.

Etiology and natogenesis

In type 1 diabetes mellitus, there is death (of pancreatic b-cells and the development of absolute insulin deficiency. This type is divided into 2 subtypes.

Ia - a decrease in antiviral immunity was noted: an acute onset of the disease after a viral infection is characteristic (rubella, chicken pox, epidemic
parotitis, Coxsackie B4); A2 and DR4 genotypes are detected; combination with autoimmune diseases missing.

Ib - autoimmune disorders that precede its development are detected, which are combined with other autoimmune diseases. B8, DR3 genotypes are characteristic.

In type 2 diabetes, genetic defects are detected. A decrease in the sensitivity of b-cells to glucose and peripheral tissues - to insulin was noted. Among the risk factors, significant importance is attached to obesity, hereditary burden of diabetes mellitus, dyslipoproteinemia and concomitant arterial hypertension.

Absolute or relative insulin deficiency affects almost all types of metabolism and leads to dysfunction of many organs and systems. Micro- and macroangiopathic disorders are characteristic, as well as excess accumulation end products of glycation and lipoxyphylation
proteins in tissues, which leads to damage to the kidneys, nervous and cardiovascular systems, lower extremities and the organ of vision.

Clinic

The main symptoms are thirst, polyuria, weight loss and weakness. Against their background, acute and progressive chronic complications may occur.

Acute complications

diabetic ketoacidosis; it is based on undiagnosed type 1 diabetes mellitus, discontinuation of insulin treatment, severe emotional stress, infection, burns, severe injuries, stroke, acute diseases. Characterized by an increase in weakness, thirst, polyuria, anorexia, nausea and vomiting, dry skin and mucous membranes, muscle hypotension and eyeballs, the smell of acetone, dehydration, tachycardia, Kussmaul breathing (at pH 7.2 and below) may be abdominal pain. If untreated, stupor and coma develop, blood glucose is 14-25 mmol/l (sometimes up to 45 mmol/l), blood pH is 7.3-7.0 and lower.

Hyperosmolar coma develops in older people with type 2 diabetes mellitus with severe infections, myocardial infarction, stroke, and diuretic overdose. There is marked polyuria, thirst, blood hyperosmolarity, cellular dehydration; often find focal neurological symptoms. The content of glucose in the blood is 45-110 mmol / l, the osmolarity is more than 330 mosm / l.

Hypoglycemic coma develops with an overdose of insulin, malnutrition, physical overload while taking sulfonylurea drugs.
Lactacidemic coma develops with hypoxia, concomitant severe cardiac and respiratory failure, sepsis, myocardial infarction, biguanide poisoning. Blood lactate exceeds 6 mmol/L.

Chronic complications in proper treatment develop after 15-20 years and are most often represented by diabetic triopathy (polyneuropathy, angiopathy and nephropathy).

Diabetic neuropathy begins with minor disturbances and ends with paresis and paralysis. They find central (encephalopathy) and peripheral disorders of the sensitive, motor and autonomic spheres. For early diagnosis examine tendon reflexes, temperature and vibration sensitivity.

Defeat of cardio-vascular system manifested by micro- and macroangiopathic disorders involving the heart muscle (diabetic cardiomyopathy) and blood vessels, which leads to the development and progression of coronary artery disease.

Diabetic nephropathy occurs in 35-60% of patients and includes 5 stages of development (according to C. Mogensen).

1 st. - hyperfunction of the nights, characterized by an increase in glomerular filtration of more than 140 ml / min, a thickening of the basement membrane of artsriol glomeruli, normoalbuminuria.

II Art. - initial structural changes in the kidney tissue are characterized by microalbuminuria (up to 30 mg/day), expansion of the mesangium.

III Art. - incipient nephropathy is characterized by moderate microalbuminuria (up to 300 mg/day), combined with unstable arterial hypertension.

IV Art. - severe nephropathy is characterized by proteinuria, hypoproteinemia, hypercholesterolemia and massive edema; declining glomerular filtration.

V Art. - uremic is characterized by a decrease in the glomerular filtration rate of less than 10 ml / min, azotemia and terminal stage HPN. Against the background of massive proteinuria, high hypertension and exacerbations of concomitant pyelonephritis, CRF often progresses rapidly.

Diabetic retinopathy is detected in 85% of patients ( severe forms- in 10-18% of patients). There are 3 stages of its development.

I st. - non-proliferative: expansion, irregularity of veins, microaneurysms of retinal vessels, petechial hemorrhages; visual function the retina is not affected.

II Art. - preproliferative: dilation, uneven veins, microaneurysms, large retinal hemorrhages, metamorphopsias, preretinal hemorrhages, hemorrhages in rear camera eyes. Reduced vision if the hemorrhage is localized in the macular region of cataract formation.

III Art. - proliferative: to the picture II Art. vascular neoplasms and retinal fibrosis join, there may be retinal detachment, its rupture, glaucoma, decreased visual acuity, up to blindness.

In atherosclerosis of the vessels of the lower extremities, 4 stages of development are distinguished (preclinical, initial, ischemic and necrotic). Indefinite pain in the legs, paresthesia, fatigue are noted. Then attacks of intermittent lameness join. The pulsation of the arteries of the feet is weakened, the pegs are cold, pale, sometimes cyanotic. Violation of the blood supply and a decrease in immunity, combined with injury and infection of the groan, lead to massive purulent-necrotic lesions (diabetic foot), requiring special surgical treatment.

Classifications. Etiological classification of glycemic disorders (WHO, 1999)

1. Type 1 diabetes mellitus (cell destruction usually leads to absolute insulin deficiency):

A - autoimmune;

B - idiopathic.

2. Type 2 diabetes mellitus (from predominant insulin resistance with relative insulin deficiency to predominantly impaired secretion with or without insulin resistance).

3. Other specific types of diabetes:

A - genetically determined dysfunction (b-cells of the pancreas;
B - genetically determined disorders in the action of insulin;
B - diseases of the endocrine part of the pancreas;
G - endocrinopathy;
D - diabetes induced by medicinal or chemical substances;
E - infections;
G - unusual forms of immune-mediated diabetes;
3 - other genetic syndromes, sometimes combined with diabetes.

4. Gestational diabetes.

The severity of diabetes mellitus is assessed taking into account the clinic, the state of compensation, the presence of acute and chronic complications. Type 1 diabetes is usually more severe.

Light degree: no ketosis, compensated by one diet, fasting glycemia - 7.5 mmol / l, daily glucosuria no more than 110 mmol / l; possible initial manifestations angiopathy, transient neuropathy and nephropathy I stage.
Functional disturbances are assessed as minor, and do not lead to AO; in some cases, restrictions on the ability to work can be determined
activities I Art.

Moderate severity: ketosis is observed without precoma and coma, fasting glycemia does not exceed 14 mmol/l, daily glucosuria is not more than 220 mmol/l,
there is retinopathy I-II st., nephropathy II-IIT st., peripheral neuropathy without expressed pain syndrome and trophic ulcers. There are moderate impairments endocrine function and moderate multi-organ dysfunction ( nervous system, kidneys, visual apparatus). OZhD are detected in the form of a decrease in the ability to work 1 st., less often the ability to move 1st st., other categories of life are not violated.

Severe course: ketosis often occurs, severe complications are formed regardless of the level of glycemia and the nature of the treatment; there is a tendency to coma. Hyperglycemia exceeds 14 mmol / l, glucosuria - absent or above 220 mmol / l, retinopathy II-III stage, nephropathy stage IV-V, gangrene of the lower extremities, neuropathy, encephalopathy.

Severe dysfunctions of the endocrine, central and peripheral nervous system, kidneys, organ of vision, immune, muscular and
musculoskeletal system, leading to limited ability to work II-III Art., independent movement - II Art., self-service - II Art. etc. An extremely severe course is characterized by irreversible damage to the cardiovascular (CH IV NYHA) and nervous system (grade III encephalopathy, paralysis), kidneys (terminal CRF), severe dystrophic changes muscles, when a complete inability to self-service and movement is revealed, other categories of life activity also suffer significantly.

Diagnostics

Based on the clinical picture and the results of laboratory data.

1. Increased blood glucose on an empty stomach and during the day.
2. Glucosuria.
3. Raise ketone bodies in blood and urine.
4. Positive test for glucose tolerance. Indications for determination: the presence of risk factors for diabetes mellitus, persistent furunculosis, repeated erysipelas, pruritus, periodontitis, cataracts at a young age with a fasting blood glucose level of not more than 5.8 mmol/l and during the day - 7.2 mmol/l (if the glucose level is higher than the indicated figures, the test is not performed).
5. Increase in glycated hemoglobin - (normal - 4-6%).
6. Increase in immunoreactive insulin of blood plasma (norm 3-20 μU / "l).
7. Decrease in the content of C-peptide, reflecting the actual synthesis of insulin. In persons with normal glucose tolerance, the content of C-peptide in the blood is 0.12-1.25 nmol / l.
8. Absolute criteria for diagnosing diabetes (WHO, 1996): fasting glycemia in capillary blood - 6.1 mmol/l, in venous blood - 7.5 mmol/l, 2 hours after glucose load - 11.1 mmol/l and above.
9. Appropriate research methods are used to determine the dysfunctions of other organs and systems.

Treatment

Diet therapy provides for proper energy value diet, calories, qualitative composition poverty, the rhythm of nutrition, the interchangeability of products. Oral hypoglycemic drugs are prescribed: sulfonylurea derivatives (with normal weight body), biguanide derivatives (for obesity). Insulin therapy is indicated in the absence of effect from oral medications in patients with type 2 diabetes mellitus (fasting glycemia more than 20 mmol / l). with type 1 diabetes mellitus, with ketoacidotic and hyperosmolar coma. Treatment of chronic complications of DM includes the achievement of normoglycemia, vascular agents, normalization of blood pressure, the appointment of hypolipidemic and normalizing drugs. metabolic processes drugs. If necessary - surgical treatment, dialysis, nephrotransplantation.

DM Compensation Criteria

Ideal: normoglycemia at any time of the day and aglucosuria with a normal level of glycated hemoglobin. Less strict: fasting glucose less than 6.1 mmol / l for type 2 diabetes mellitus and less than 7.5 mmol / l for type 1 diabetes mellitus, during the day - no more than 10 mmol / l, aglucosuria - the level of glycated hemoglobin less than 6.5-7.5%.

Forecast

It is determined by the stability of normoglycemia, the onset and pace of development of diabetic triopathy. With the addition of constant proteinuria, chronic renal failure progresses. Timely start of dialysis (when serum creatinine is about 0.40 mmol/l) and successful nephrotransplantation can prolong the life of patients up to 2-5 years.

Able-bodied are patients with diabetes mellitus mild and moderate course without complications, severe lesions of organs and systems, concomitant
pathology and in the absence of contraindicated types and working conditions.

Criteria for VUT: decompensation carbohydrate metabolism, acute complications, exacerbations of chronic, intercurrent diseases, operations, beginning of dialysis. Terms of VUT: at easy course DM - 8-10 days, moderate - 25-30 days, with severe - 30-45 days; with diabetic coma for at least 30-45 days; in hypoglycemic conditions are determined by their consequences; in acute complications of diabetic triopathy are determined by their nature.
Intercurrent diseases in diabetes mellitus tend to lingering current, which lengthens the time of VUT.

Indications for referral to the ITU office for diabetes mellitus

2) labile course (frequent hypoglycemic conditions, ketoacidosis) or moderately difficult to compensate diabetes mellitus;

3) diabetes of mild and moderate severity in the need for rational employment with a decrease in qualifications or a decrease in the amount of work performed.

Required minimum examinations:

• clinical blood test, fasting blood glucose and during the day, (3-lipoproteins, cholesterol, urea, creatinine,
• serum electrolytes, glycated hemoglobin;
• general analysis urine, sugar and acetone;
• examination by an ophthalmologist, a neurologist (the state of the central and peripheral nervous system), a surgeon (purulent complications, trophic
• ulcers). With nephropathy - Zimnitsky and Reberg's test, determination of daily roteinuria and microalbuminuria, KOS;
• with angiopathy of the lower extremities - dopplerography and rheovasography, with encephalopathy - EEG and REG;
• with damage to the cardiovascular system - echocardiography, daily monitoring ECG and blood pressure.

mild diabetes mellitus: hard physical labor, work associated with exposure to industrial poisons, traveling, business trips, overtime,
night shifts, irregular working hours; in adverse microclimatic conditions.

The average severity of diabetes:

1) for patients who do not receive insulin, moderate physical labor and mental labor with high neuropsychic stress are contraindicated;

2) for the majority of patients receiving insulin, with a labile course of diabetes mellitus, work is contraindicated, the sudden termination of which is dangerous due to the possibility of an accident or disruption of the production process (work on a conveyor, near moving mechanisms, at height, in hot shops, driving, work as a dispatcher on the control panel, etc.). Easy physical, administrative, economic, intellectual work is available, in some cases - with
decrease in the volume of production activity. With damage to the vessels of the lower extremities, work associated with prolonged standing is contraindicated,
walking, vibration With damage to the retinal vessels, work associated with prolonged visual strain is contraindicated.

Criteria for disability in diabetes mellitus

I disability group

• retinopathy (blindness in both eyes), neuropathy (persistent paralysis, ataxia), diabetic encephalopathy with severe mental disorders;
• diabetic cardiomyopathy (CH III stage);
• severe angiopathy of the lower extremities (gangrene, diabetic foot);
• terminal chronic renal failure;
• with frequent hypoglycemia and diabetic coma. Restrictions on the ability to work III Art. self-service III st., movement III st., orientation II-III st. Patients need constant outside help and care.

II group of disability

With retinopathy II-III stage, nephrotic syndrome, initial CRF, terminal CRF with adequate dialysis or successful nephrotransplantation, neuropathy II
Art. (pronounced paresis), encephalopathy with persistent changes in the psyche, which lead to a limitation of the ability to work II-III st., the ability to move and self-service II st. Sometimes pronounced AR is present in patients with moderate dysfunctions of organs and systems with a labile course, when it is not possible to achieve stable stabilization of glycemia.

III disability group

Persons young age III group disability is established for the period of study, acquisition of a new profession of light physical or mental labor with moderate neuropsychic stress.

Rehabilitation
Early detection of diabetes mellitus, diet, adequate treatment and regular monitoring by an endocrinologist, prevention of complications leading to OJ. shown Spa treatment, training for the disabled rational image life (school of diabetics). At a young age, career guidance, retraining, rational employment and timely referral to ITU bureau; drawing up individual rehabilitation programs.

Diabetes - endocrine disease, in which the production of the hormone insulin suffers or the sensitivity of peripheral target organs to its effects is impaired. With this pathology, all types of metabolism suffer: proteins, fats and carbohydrates. Damage to organs and systems develops with a gradual decrease in the quality of life, sudden life-threatening conditions may occur.

With diabetes, the patient should regularly take medications, measure sugar and other indicators of blood, urine, clearly understand which foods and physical exercise admissible, be attentive to the planning of pregnancy. But even with a reasonable approach to treatment, not all patients manage to avoid deterioration.

In some cases, diabetes leads to disability, in children - to the need to control treatment with refusal to work for the parent, exacerbates the course of other diseases in a pensioner. Then the patient asks the question: do they give disability in case of diabetes, are there any features of paperwork and what benefits can be claimed.

Follow-up of patients with diabetes

There are two main types of this endocrine pathology. Type 1 diabetes is a condition in which a person's insulin production is affected. This disease debuts in children and young people. The lack of its own hormone in sufficient quantities makes it necessary to administer it in the form of injections. That is why type 1 is called insulin-dependent or insulin-requiring.

Such patients regularly visit the endocrinologist and prescribe insulin, test strips, lancets for the glucometer. The amount of preferential coverage can be clarified with the attending physician: it varies in different regions. Type 2 diabetes develops in people over 35 years of age. It is associated with a decrease in the sensitivity of cells to insulin, the production of the hormone is not primarily impaired. Such patients live freer lives than those with type 1 diabetes.

The basis of treatment is nutritional control and the intake of hypoglycemic drugs. The patient may receive periodic outpatient or stationary conditions. If a person is sick himself and continues to work or cares for a child with diabetes, he is issued a temporary disability sheet.

The very fact of observation by an endocrinologist and constant treatment with medicines does not mean that a person will be given a disability.

Grounds for issuance sick leave can be:

• states of decompensation in diabetes;
• diabetic coma;
• carrying out hemodialysis;
• acute disorders or exacerbation of chronic diseases;
• the need for operations.

Approximate periods of temporary disability are indicated in the recommendations of the Social Insurance Fund.

Diabetes and disability

If the course of the disease is accompanied by a deterioration in the quality of life, damage to other organs, a gradual loss of ability to work and self-service skills, they speak of disability. Even with treatment, the patient's condition may worsen. There are 3 degrees of diabetes:

• Lightweight. The condition is compensated only by the correction of the diet, the level of glycemia on an empty stomach is not higher than 7.4 mmol/l. Possible damage to the vessels, kidneys or nervous system of the 1st degree. There is no impairment of bodily functions. These patients are not given a disability group. The patient may be recognized as disabled in the main profession, but may work elsewhere.
• Medium . The patient needs daily therapy, it is possible to increase fasting sugar to 13.8 mmol / l, damage to the retina, peripheral nervous system, kidneys up to 2 degrees develops. No history of coma or precoma. Such patients have some limitations of life and ability to work, it is possible to receive disability.
• Heavy. In patients with diabetes, a sugar rise above 14.1 mmol/l is recorded, the condition may spontaneously worsen even against the background of selected therapy, there are severe complications. The severity of pathological changes in target organs can be stably severe, this also includes terminal conditions (for example, chronic kidney failure). They no longer talk about the possibility of working, patients cannot serve themselves. They are on disability for diabetes.

Children deserve special attention. Identification of the disease means the need for continuous treatment and control of glycemic levels. The child receives medicines from diabetes through regional budget in a certain amount. After the appointment of disability, he claims other benefits. AT federal law"On State Pension Provision in the Russian Federation" regulates the issuance of a pension to a person caring for such a child.

How is disability processed?

The patient or his representative addresses an adult or pediatric endocrinologist at the place of residence. The grounds for referral to the ITU (medical and sanitary expert commission) are:

• decompensation of diabetes with the ineffectiveness of rehabilitation measures;
• severe course of the disease;
• episodes of hypoglycemia, ketoacidotic coma;
• the appearance of violations of the functions of internal organs;
• the need to obtain labor recommendations to change the conditions and nature of work.

The doctor will tell you what steps you need to take to complete the documents. Typically, diabetics undergo the following examinations:

• general blood analysis;
• measuring blood sugar levels in the morning and throughout the day;
• biochemical studies indicating the degree of compensation: glycosylated hemoglobin, creatinine and urea in the blood;
• measurement of cholesterol levels;
• general urine analysis;
• determination in the urine of sugar, protein, acetone;
• urine according to Zimnitsky (in case of impaired renal function);
• electrocardiography, 24-hour ECG study, blood pressure to assess the work of the heart;
• EEG, the study of cerebral vessels in the development of diabetic encephalopathy.

A full examination will help the commission make the right decision.

The patient is examined by doctors of related specialties: ophthalmologist, neurologist, surgeon, urologist. Significant disorders of cognitive functions, behavior are an indication of an experimental psychological study and a psychiatrist's consultation. After passing the examinations, the patient undergoes an internal medical commission in the medical institution in which he is observed.

If signs of disability or the need to create an individual rehabilitation program are found, the attending physician enters all information about the patient in form 088 / y-06 and sends it to the ITU. In addition to referral to the commission, the patient or his relatives collect other documents. Their list varies depending on the status of the diabetic. The ITU analyzes the documentation, conducts an examination and decides whether or not to give a disability group.

Design criteria

Experts evaluate the severity of violations and assign a certain disability group. The third group is issued to patients with mild or moderate disease. Disability is given in case of impossibility to fulfill their production duties in the existing profession, and transfer to simpler work will lead to significant losses in wages.

The list of production restrictions is specified in Order No. 302-n of the Ministry of Health of Russia. The third group is also issued to young patients undergoing training. The second group of disability is issued with a severe form of the course of the disease. Among the criteria:

• damage to the retina of the 2nd or 3rd degree;
• initial signs of renal failure;
• terminal renal failure on dialysis;
• neuropathy of the 2nd degree;
• encephalopathy up to 3 degrees;
• violation of movement up to 2 degrees;
• violation of self-service up to 2 degrees.

This group is also given to diabetics with moderate manifestations of the disease, but with the inability to stabilize the condition against the background of regular therapy. A person is recognized as a disabled person of the 1st group if self-service is impossible. This happens in case of severe target organ damage in diabetes:

• blindness in both eyes;
• development of paralysis and loss of the ability to move;
• gross violations of mental functions;
• development of heart failure of the 3rd degree;
• diabetic foot or gangrene of the lower extremities;
• terminal stage of renal failure;
• frequent coma and hypoglycemic conditions.

Registration of disability for a child is carried out through the children's ITU. These children need regular insulin injections and glycemic control. The parent or guardian of the child provides care and medical manipulations. In this case, the disability group is given up to 14 years. Upon reaching this age, the child is examined again. It is believed that a patient with diabetes from the age of 14 can independently inject and control blood sugar, therefore, does not need adult supervision. If such viability is proved, the disability is removed.

The frequency of re-examination of patients

After an examination at the ITU, the patient receives a conclusion on recognition as a disabled person or a refusal with recommendations. When assigning a pension, a diabetic is informed for how long he is recognized as disabled. Usually, the initial exit to disability of 2 or 3 groups means re-examination after 1 year from the date of registration of the new status.

The appointment of disability group 1 for diabetes is associated with the need to confirm it after 2 years, in the presence of severe complications in the terminal stage, a pension can be immediately issued indefinitely. When examining a pensioner, disability is more often issued indefinitely. In case of deterioration of the condition (for example, progression of encephalopathy, development of blindness), the attending physician may refer him for re-examination to increase the group.

When examining children, disability can be given for different term A: 1 year, 2 years or up to 14 years.

Individual rehabilitation and habilitation program

Together with a certificate of disability, a patient with diabetes receives an individual program in his hands. It is developed on the basis of personal needs in one form or another of medical and social assistance. The program includes:

• Recommended frequency of planned hospitalizations per year. Responsible for this government agency health care in which the patient is observed. With the development of renal failure, recommendations for referral to dialysis are indicated.
• The need for the design of technical and hygienic means of rehabilitation. This includes all positions that are recommended when preparing documents for ITU.
• The need for high-tech treatment, according to the quota (prosthetics, operations on the organs of vision, kidney).
• Recommendations for social and legal assistance.
• Recommendations on training and the nature of work (list of professions, form of training, conditions and nature of work).

This is what an individual rehabilitation program for a disabled person looks like

Important! When implementing the measures recommended to the patient, medical and other organizations put a mark on the implementation with their seal in the IPRA. If the patient refuses rehabilitation: planned hospitalization, does not visit a doctor, does not take medication, but insists on being recognized as a disabled person for diabetes indefinitely or increasing the group, the ITU may decide the issue not in his favor.

Benefits for the disabled

Patients with diabetes spend a lot of money on their purchase of drugs and consumables for glycemic control (glucometers, lancets, test strips). Disabled people are entitled not only to free drug therapy, but also the opportunity to apply for the installation of an insulin pump as part of the provision of high-tech medical care through OMS.

Technical and hygiene products rehabilitation is done on an individual basis. You should familiarize yourself with the list of recommended positions before submitting documents for disability in the office of a specialized specialist. In addition, the patient receives support: disability pension, home care social worker, registration of subsidies for utility bills, free spa treatment.

To resolve the issue of providing sanatorium-and-spa treatment, one should clarify with the local Social Insurance Fund which groups of disabled people they can offer vouchers for. Usually, a free referral to a sanatorium is given for groups 2 and 3 of disability. Patients with group 1 need the presence of an accompanying person, who will not be given a free ticket.

Assistance to children with disabilities and their families includes:

• payment social pension to kid;
• Compensation for a carer who is forced not to work;
• inclusion of care time in seniority;
• possibility of choosing a shorter working week;
• possibility of free travel various types transport;
• income tax incentives;
• creating conditions for learning at school, passing the exam and OGE;
• preferential admission to the university.
• land for individual housing construction, if the family is recognized as in need of better housing conditions.

The insulin pump will provide the patient with insulin without interruption

Primary disability in old age is more often associated with type 2 diabetes. Such patients are interested in whether any special benefits will be provided to them. The basic support measures are no different from those for able-bodied patients who have received a disability. In addition, pensioners receive additional payments, the amount of which depends on the length of service and disability group.

Also old man can remain able to work, having the right to a reduced working day, the provision of annual leave from 30 days and the opportunity to take leave without pay for 2 months. Registration of disability for diabetes mellitus is recommended for people with a severe course of the disease, no compensation during therapy, if it is impossible to continue working in the same conditions, as well as children under 14 years of age due to the need to control treatment. Disabled people get the opportunity to enjoy benefits and qualify for expensive high-tech treatment.

A person with diabetes is forced to put up with this disease until the end of his days. Each patient experiences this disease differently. Someone lives their whole life as completely healthy man by adhering to certain rules. And someone endures serious complications up to and including loss of employment. Is it possible to get a disability with diabetes - we will analyze in the article.

For what violations give a disability group. What group can you get

Despite the fact that diabetes mellitus is not treated, this is not a basis for disability registration. It all depends on how difficult the disease is - what disorders in the body accompany it. At the same time, there is no difference what type of sugar disease belongs to - to the first or second.

Disability according to the law can be assigned to any patient if he cannot go to work to provide for himself financially. In some cases, the patient is completely incapacitated and cannot do without outside help. Here the question of assigning disability is not discussed at all.

Unfortunately, nowadays children with early age also suffer from diabetes mellitus, often insulin-dependent. In such cases, the child is assigned the status disabled child without assigning one or another group. Let's consider everything in order.

Doctors have adopted four degrees of functional disorders in the patient's body:

• 1 degree- minor but persistent functional disorders in the patient's body associated with past injuries, diseases, small defects in the range from 10 to 30%.
• 2 degree– moderately stable violations according to similar indicators from 40 to 60%, respectively.
• 3 degree- persistently expressed functional disorders according to similar indicators from 70 to 80%, respectively.
• 4 degree- stable and significantly pronounced dysfunctions according to similar indicators from 90 to 100%, respectively.

The basis for issuing a conclusion-certificate on disability the patient is considered complications in the body, starting with the second degree. A patient whose body functions are impaired, resulting in a restriction of activities in life, may qualify for second or third group disability.

Patients in whom functional disorders in the body are associated with total loss ability to work and the need to care for a diabetic from the outside, assign first group disability.

In this way , disability group 1 received by patients suffering from sweet sickness”, which proceeds with special complications and consequences. Installed some medical indicators which the patient can rely on when applying for disability:

• diabetic retinopathy when the patient is blind in both eyes.
• Diabetic neuropathy when the patient's motor skills, coordination of movements are disturbed, paralysis occurs.
• Diabetic cardiomyopathy- diseases of the cardiovascular system.
• Diabetic encephalopathy when the patient's psyche is disturbed, dementia occurs.
• Frequent coma in a patient due to delayed administration of insulin.
• diabetic nephropathy- this is the last stage of renal failure, the kidneys completely lose their functions.

With such indicators, the patient becomes socially maladaptive. Such patients cannot take care of themselves, stop communicating, do not move without help, sometimes completely disconnected from the world, that is, dementia sets in.

Disability 2 groups give to patients with diabetes with the same serious disorders, but less pronounced:

• Blindness sick, but not so pronounced.
• After a kidney transplant, the patient is constantly on dialysis, that is, on a constant artificial cleaning of the body.
• Diabetic neuropathy grade 2- the patient has impaired coordination, there are paresis, but the patient can move independently.
• Diabetic encephalopathy to the same extent.

Patients with such indicators have limitations vital functions but they don't need outside help.

Disability of the third group can be prescribed for the same diseases that have a sluggish process. As a rule, these are patients whose disease is classified as to the first degree according to medical criteria. Diabetics are fully able-bodied, but for some reason the patient is contraindicated to work by profession.

Young people most often insist on the third group with the possibility of retraining. Patients are allowed mental work and light work.

Thus, when assigning disability, type 1 and type 2 diabetics are not separated. It all depends on concomitant diseases how hard they run. The degrees and criteria for the two types are the same.

When are children given a disability?

Diabetic children from birth until the age of eighteen receive disability automatically. In this case, the group is not assigned. A child or young person is considered disabled childhood.

To obtain an appropriate conclusion, you must submit the following documents:

1. Application for a disability certificate from the patient or his parent.
2. Referral from a medical institution at the place of registration, where the patient is registered for diabetes.
3. Identity card depending on the age of the patient: passport or birth certificate.
4. Medical card and related applications to it: pictures, certificates, extracts.
5. If the patient is studying or working, submit a document on education or a work book.
6. Characteristics from the place of work or study.
7. When re-passing the examination, present data on the previously passed examination and a certificate of disability received.

How to get disability with diabetes

If diabetes mellitus occurs with serious complications for the patient, he has the right to apply to Medical and Sanitary Expertise (ITU) for disability. This is a fairly lengthy process and needs to be done in stages.

First you need to contact the therapist who is watching you for the issuance of the appropriate certificate.

There are times when the doctor refuses to do this. He has no such rights!

The therapist initially issues a referral for the passage medical examination. You will be examined by such specialists as an ophthalmologist, cardiologist, endocrinologist, gynecologist, nephrologist, urologist. Each of them issues its opinion on the state of your health on this moment according to your profile. A prerequisite is the delivery of general urine and blood tests, as well as blood for sugar.

Depending on how difficult the disease is, you may be asked to stay in a hospital for a while under the supervision of specialists.

After the examination, having collected all the results and conclusions, the therapist fills referral form 088/y-06 with which you are traveling to ITU. Based on this document, the ITU appoints you a date for an examination of your disease. By the appointed time, experts study the materials and decide whether to assign you a disability of a certain group or refuse it.

If the attending physician refuses to issue a referral to the commission, you have the right to apply to the ITU yourself.

In addition to sending for an examination, additional documents must be submitted to the ITU:

• an application from a patient for an examination for the purpose of disability;
• the passport;
• a certified copy of the work book, if the patient is currently working;
• documents on education, if the patient has them;
• documents from the medical institution in which the patient is registered due to illness, confirming the patient's condition at the moment.

If the commission makes a positive decision, you will be issued a certificate, on the basis of which you will receive a certificate of a disabled person of a certain group. The social service will give you a monthly allowance.

Patients who received the first group of disability, re-survey not required. Patients who were in the second and third groups of disability, through certain time re-examined, and a re-examination is carried out, despite the fact that diabetes- incurable disease.

When applying again to the ITU, in addition to the above documents, it is necessary to submit to the commission:

• certificate of disability;

YPRES- this is Individual Rehabilitation Program disabled person. This is a document confirming that a set of measures was taken to eliminate the complications of the course of the disease, that is, medical, psychological, pedagogical and social measures were taken. Program designed to "put the disabled on their feet". The main task of rehabilitation- independence and social adaptation patient.

If the expert commission issued you a certificate of refusal to assign a disability group, and you do not agree with this, then you must contact a higher authority - the main bureau of the ITU. If the issue is not resolved in your favor, feel free to go to court. As practice shows, in the last resort the issue is resolved faster.

Unfortunately, doctors have not found such a medicine that would completely get rid of diabetes. modern medicine helps to make life easier for diabetics, but does not completely cure this disease.

Diabetes is a common disease, and every year more and more children and adults suffer from it. severe consequence this disease is a disability. But the disease itself cannot serve as a basis for confirming a disability group. It does not matter what degree of diabetes the patient has, it all depends on the severity of the disease and the presence of certain complications that entail profound violations of the vital important functions human body.

Disability Criteria

Let's take a closer look at how disability is determined in case of different groups diabetes.

Disability of the first group is prescribed when the following severe complications are detected:

1. Chronic renal failure ( final stages).
2. Blindness in both eyes or.
3. Paralysis.
4. Stage III cardiomyopathy caused by diabetes.
5. Hypoglycemic coma.
6. Gangrene of the feet.
7. Encephalopathy with mental disorders.

If all these complications affect the fact that a person is not able to serve himself and fully move around, communicate, there are third-degree restrictions - he is assigned a disability of the first group.

The second group of disability prescribed to those diabetics whose disease occurs with such severe complications:

1. Encephalopathy with mental disorders.
2. Less pronounced retinopathy than in the first group.
3. Diabetic neuropathy of the second degree (presence of paresis).
4. Chronic renal failure.

In the presence of these complications, the following is also taken into account: violation of labor function - restriction of the second or third degree, violation of the ability to fully serve oneself and move around - restriction of the second degree, a person needs periodic care - in this case, disability of the second group is assigned.

The third disability group is assigned to patients suffering from moderate and mild diabetes. If there are minor disturbances in the functioning of the organs and systems of the body that cause difficulties in performing any work and self-service - a restriction of the first degree, then such a patient is assigned a third disability group.

Medical examination of diabetics

Disability is assigned after the examination of the patient by a special commission. The commission not only determines the disability group, but also determines the degree of loss of professional activity, its timing and time for the necessary rehabilitation.

Patients are referred to the ITU in the presence of such indications:

1. Frequent hypoglycemic coma or states of ketoacidosis, which characterizes the unstable course of the disease.
2. A severe form of type I or II diabetes, in which there is a pronounced disruption of the work of all organs and systems.
3. Difficult-to-compensate type 1 or type 2 diabetes of moderate severity;
4. Diabetes mellitus of mild or moderate severity (regardless of type), if the patient needs employment with a decrease in the amount of work and qualifications.

The commission will also need certificates with the results of the patient's tests, a passport, a referral from the attending physician, a statement from the patient, outpatient card, extracts from hospitals, a copy of the work book (duly certified), a diploma of education, a description of working conditions. And at the secondary examination - an individual rehabilitation program and a certificate of disability.

You should know that the appointment of a disability to a patient determines not only the social protection of a diabetic. This is rehabilitation, which includes comfortable living and working conditions, a convenient work schedule, compliance with special diet, constant monitoring by an endocrinologist, adequate and regular treatment and proper adherence to the recommendations of a specialist. Early detection of complications initial stage development of diabetes slows the progression of the disease and prolongs the patient's life.

Unfortunately, doctors have not yet learned how to cure diabetes completely. Modern methods therapy can prolong the life of diabetics and significantly improve its quality. However, sometimes disability in diabetes mellitus is an inevitable consequence of this serious disease.

By itself, diabetes mellitus is not a basis for establishing a disability group. A diabetic can receive a group only if there are certain complications of diabetes that entail severe violations vital functions of the body.

Disability in different types of diabetes

It doesn’t matter if a person suffers from type 1 or type 2 diabetes, it is only taken into account how severe its complications are and how they interfere with the patient’s normal life and work. The disability group is necessarily given taking into account the degree of disability of the diabetic in connection with this disease. This is the basis for the difference between the first, second and third groups.

Children under 18 with diabetes (mostly insulin-dependent) receive the status of disabled children, without reference to a particular group.

Disability groups and their causes

Consider separately the groups of disability, as well as their causes: the presence of complications, the degree of limitation of functions and the need for outside care.

Group 1 disability is given to patients with severe diabetes if the following parameters are present:

Severe disorders of body functions associated with severe diabetes mellitus:

• blindness in both eyes - diabetic retinopathy;
• diabetic neuropathy - ataxia, paralysis;
• diabetic cardiomyopathy - heart failure of the 3rd degree;
• diabetic encephalopathy - mental disorders, dementia;
• repeated hypoglycemic coma;
• diabetic nephropathy - the last stages of chronic renal failure;

The presence of restrictions of the 3rd degree to movement, self-service, communication, orientation;

These patients need outside care and constant help.

Disability 2 groups are given under the following conditions:

A severe form of diabetes mellitus, which caused pronounced disorders in the functioning of organs and systems:

• less pronounced retinopathy than in group 1;
• chronic renal failure in the terminal stage with a successful kidney transplant or adequate dialysis;
• diabetic neuropathy of the 2nd degree (presence of paresis);
• diabetic encephalopathy.

Limited abilities of the 2nd degree for movement, self-service, labor activity.

Such diabetics to help strangers, but permanent care(as in group 1) they do not need.

Group 3 disability is given to diabetics with:

Moderate disturbances in the functioning of organs and systems:

• labile course of the disease;
• mild or moderate diabetes.

These violations cause 1 degree of limitation of the ability to self-service and labor activity. Provided that the work of a diabetic by profession is contraindicated, rational employment will lead to a significant decrease in qualifications and productivity.

Young people are assigned group 3 for the period of acquisition new job associated with mental or mild physical labor activity and without mental stress.

From the foregoing, we can conclude that the presence of compensated diabetes without severe complications cannot be a reason for assigning a disability. You should consult a doctor if there are complications that lead to disability to timely determine the degree of disability.

Diabetes Compensation Criteria

Ideally compensated diabetes is one in which, under the condition of treatment, a normal level of glucose in the blood is observed at any time of the day. As well as the absence of sugar in the urine and a normal level of glycated hemoglobin. Such compensation is the goal of treating any stage and form of diabetes.

Satisfactory compensation or subcompensation fasting blood sugar - 6.2-7.8 mmol / l, after meals - up to 10 mmol / l, glycosylated hemoglobin - 6.5-7.5%, sugar in urine up to 0.5%.

If the data is higher than with satisfactory compensation, then diabetes mellitus is called decompensated. This course of the disease leads to frequent complications and is taken into account when predicting and establishing a disability group.

Medical and social examination of diabetics

Disability is assigned after examination of the patient by a special commission. An examination is carried out not only to establish a disability group, but also to determine the degree of loss of professional ability to work, its timing, and the necessary rehabilitation.

Indications for referral to ITU:

• a severe form of type 1 or type 2 diabetes with a pronounced disruption of the functioning of organs and systems;
• unstable course of diabetes - frequent hypoglycemic coma or states of ketoacidosis;
• difficult to compensate for type 1 or type 2 diabetes of moderate severity;
• mild or moderate diabetes mellitus (regardless of type 1 or 2), if the patient needs rational employment with a decrease in qualifications and workload.

Necessary examinations: a general blood and urine test, a blood test for sugar on an empty stomach and after eating during the day, glycosylated hemoglobin, a urine test for sugar and acetone, a lipogram, kidney and liver biochemical tests, an electrocardiogram.

Examination by an ophthalmologist - to detect retinopathy of the eye. Examination by a neurologist, EEG, REG - to determine the state of the nervous system and its damage. Surgeon's examination, dopplerography, rheovasography at diabetic foot, gangrene, trophic ulcers. Inspection of the therapist, echocardiography, daily monitoring of pressure and ECG with symptoms of diabetic cardiomyopathy. Zimnitsky and Reberg's test for the detection of diabetic nephropathy.

Documents for applying to ITU:

• patient statement;
• the passport;
• referral from the attending physician;
• extracts from hospitals, tests, outpatient card and extract from it;
• diploma of education;
• a certified copy of the work book;
• characteristics of working or study conditions (for a child);
• at re-survey certificate of disability, completed individual rehabilitation program.

Contraindicated working conditions

Patients with a mild form of diabetes should not engage in any severe physical labor, work at enterprises associated with the use of industrial poisons or located in adverse microclimatic conditions. Night shifts, business trips, irregular working hours are contraindicated for such diabetics.

Patients with medium degree severity of type 2 diabetes, one should not engage in moderate physical labor, as well as mental labor with frequent neuropsychic unrest. Type 1 diabetics (who are on insulin) are contraindicated in all types of dangerous work and where needed increased attention and fast response. For example, work at moving mechanisms or on a conveyor, in hot shops, at height, all types of dispatching work, etc.

Such patients are allowed light physical or intellectual work, administrative work, sometimes with a decrease in its volume. With diabetic eye damage, work that leads to prolonged visual strain is contraindicated. And if the lower extremities are affected, you will have to give up work associated with vibration, long walking or standing.

In severe diabetes, patients are given 1 disability group, which indicates a persistent and complete disability.

Disability is not only social protection diabetics, but also the rehabilitation of all types of this disease. It consists in following a diet, proper treatment, observation of the attending doctor, as well as in the prevention and early detection complications. Patients with type 1 and 2 diabetes need sanatorium treatment, education in schools for diabetics about the rules of life with diabetes and caring for their bodies. All this leads to a slowdown in the progression of the disease, and hence the degree of disability.

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