Do they give disability with hypoglycemia. Who is given the group? Benefits provided by law

The person who is ill diabetes 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, 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- small 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 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 cardio-vascular 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 last stage kidney 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 the sick sugar disease with the same serious violations, 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. Direction from medical institution at the place of residence 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 a 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 at the moment according to its 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, after a certain time, are re-examined, and a second 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 of the 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 need to contact a higher authority - the main thing ITU bureau. 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.

Diabetes mellitus is very serious illness, which, despite the rapid development of medicine, is not treatable. The danger of this disease lies also in the fact that it is often the cause of dangerous complications and also affects important internal organs human body. How to get a disability for diabetes mellitus, how to properly apply for a disability for diabetes, read further in the article.

Why is a person eligible for diabetes disability?

A person who has been diagnosed with this diagnosis must strictly adhere to special diet, as well as a certain regimen, which together allow you to effectively control the level of sugar, and maintain it at acceptable level. Often, diabetes mellitus makes the patient dependent on insulin, and, consequently, the person suffering from given by disease should be able to receive the necessary injection at a certain time. Naturally, the above facts have a rather negative effect on the quality of life, and also somewhat complicate it. That is why the question of how to get disability for diabetes is of great concern not only to patients, but also to their relatives.

A person who has been diagnosed with diabetes mellitus partially loses his ability to work, has a tendency to many diseases, due to the complications that this disease has on the body. In the event that the diagnosis was made at an age when it is still quite far from retirement, you need to think about how to apply for disability for yourself.

Basic conditions how to get a disability for diabetes mellitus?

You can apply for disability subject to the availability of extracts on treatment, as well as certificates that confirm the presence of the disease. At the same time, it should be borne in mind that disability will be issued only if a person, as a result of an illness, has completely or partially lost his ability to work due to persistent health disorders.

In legislation Russian Federation it is clearly stated that a person who has lost his ability to work as a result of diabetes mellitus has the right to apply for disability. Depending on the degree of disruption internal organs caused by diabetes mellitus or its complications, medical board can assign the first, second or third group of disability. In the event that diabetes mellitus requires constant use of insulin injections, disability is assigned on an indefinite basis, which eliminates the need for annual re-examination of the disease.

How to apply for diabetes disability?

The first step on the way to how to apply for a disability for diabetes is to contact a local doctor, who must write out a referral for a series of examinations to the patient. After an ECG examination has been completed, tests have been taken, and an extract from the medical history has been made, it will be necessary to undergo medical and social commission.

Having received a special extract from the head physician of the clinic you applied to, you must contact the medical and social commission of your district. In order to pass this examination, you must provide all available medical documents as well as a passport. The last step is to complete an application for certification. Based on the documents and certificates you have, the members of the commission will make a decision and assign you one of the disability groups. In cases where the commission, or the doctors of the polyclinic, decided that in your case there are no grounds for registering a disability, it is possible to seek help from the courts, and you can also apply for consideration of your issue in the regional medical and social commission.

It is important to remember that you must fight for your rights and use all available means for this, since disability implies state support.

Diabetes is a very serious disease. If you do not properly control your blood sugar levels, your vital functions may be impaired. important organs, which leads to partial or complete loss of human performance. Obtaining a disability requires contacting a local doctor.

Reasons for applying for diabetes disability

Disability (disability) in case of diabetes mellitus can be issued in view of the presence of serious reasons. To establish a disability group, one disease is not enough; for this, only the presence of complications that were obtained during the course of the disease is mandatory. They include dysfunction a separate body or the entire system of the human body. This state of affairs already suggests that the type of diabetes in a patient does not matter in the slightest. Violation of the normal functioning of the patient is the main reason for his application for disability registration.

Who gets disability for diabetes?

The assignment of disability to a child with diabetes mellitus (insulin-dependent) is possible only if he has not reached the age of majority. Then the registration of disability occurs without assigning a group. For all other patients, it is usually assigned, guided by the severity of the course of the disease, the nature of the complications that have appeared and the level of disability of the patient.

Only patients with such complications of the disease have the right to apply for disability (disability) in diabetes:

• Diabetic foot (common in diabetics). It occurs due to a violation of the blood circulation of the lower extremities, which leads to suppuration and necrosis, and subsequently to the amputation of the foot or part of it.
• All kinds of paralysis that occurs when nerve fibers are damaged and innervation is disturbed.
• Unstable functioning of the urinary system.
• Visual impairment - from a decrease in acuity up to blindness.

How to draw up a disability for diabetes and a list of documents?

To figure out how to properly apply for disability for diabetes, first of all, study the list required documents, and then follow the instructions below.

• an extract from your medical history with the conclusion of examinations;
• direction;
• the passport;
• medical policy;
• pension insurance certificate;
• statement.

Step-by-step instructions: how to get a disability for diabetes

First of all, in order to correctly issue a disability for diabetes, consult a doctor. If your illness is already quite long, then your attending physician is aware of this, which means that you have all the marks on the treatment completed in your card. Diabetes is an area that endocrinologists are in charge of, however, a referral to an expert medical and social commission should be written by a district therapist.

You will receive a referral for general tests, blood sugar tests, urine tests (with exercise, without exercise), ECG, examination of organs affected by an excess of sugar.

To correctly issue a disability for diabetes, after the examination, go back to the therapist. The doctor will record the results on a card that you later present to the commission and make an extract from the medical history with brief description diseases and courses of treatment. With a new direction. With a new direction, you must get an appointment with the head physician, and certify the form with the necessary seals at the registry.

Since the tests are only valid for 14 days, during this time you must have time to pass the commission in order to avoid re-taking the tests.

For the commission, you provide an application, a passport, a medical policy, an insurance pension certificate, a referral and an extract from the medical history.

After reviewing the results of the examinations and personally talking with you, the commission will determine the disability group provided to you, and it depends on the degree of organ damage and the level of disability.

Diabetes requires a person to spend money: strips, drugs, diet food, regular examinations. Let's try to figure out whether the state can compensate them, whether they give disability in diabetes mellitus, how it can be obtained, and what benefits the disabled and patients without a group have.

Of course, I want to shift part of my health care to the state. Who, if not it, should protect the interests of its citizens? Unfortunately, the number of diabetics in Russia exceeds 10 million people, and the funds of the Pension Fund are not unlimited, so not every patient receives a disability. Special criteria have been developed by which the health status of the applicant for the group is assessed.

Disability groups

The fact of disability is established by a special commission that conducts a medical and social examination, abbreviated as ITU. The result of the work of this commission is the assignment of a disability to a diabetic patient or refusal if it is established that the degree of loss of health is insignificant.

Disability is divided into 3 groups:

1. I - a diabetic patient with any type of disease is not able to serve himself and move independently, needs constant help. People with group I disability either cannot work due to a significant impairment of body functions, or work is contraindicated for them. Often people with disabilities of group I cannot exist normally in society, learn, realize the danger of their condition.
2. II - patients can serve themselves, including with the help of additional means (for example, walkers for patients with diabetic feet), but need regular help to perform some tasks. They either cannot work or are forced to work with more light conditions or with a workplace converted to your needs. Those receiving education need a special program or home schooling.
3. III - in patients with diabetes, the ability to self-service remains, normal communication in a team is possible. They can work and study in places where it is possible to observe the daily regimen of a diabetic. At the same time, constant health problems are observed, part of the body's functions are lost. The patient needs social protection.

Disability for diabetics with type 1 disease under the age of 18 does not have a division into groups, all children receive the category "disabled child". Disability can be established in any type of diabetes, including non-insulin dependent.

Grounds for establishing disability

The medical commission determines the degree of loss of health and the disability group according to the list of criteria adopted by law (order of the Ministry of Labor of the Russian Federation 1024n of 12/17/15). The loss of functions is estimated in tens of percent. Depending on the range of health loss, the order establishes which disability group is given:

Assessment of health loss

Scroll possible causes disability in diabetes mellitus and the corresponding percentage of health loss:

If several reasons for disability have accumulated in diabetes mellitus, only the most severe of them is taken into account. The percentage of health loss can be increased taking into account other diseases, but not more than 10 points.

Disability is given to children with diabetes without fail until the age of 14. After reaching this age, disability depends on the presence of concomitant diseases, the independence of the child and the risk of acute complications without supervision from one of the parents.

How to get a group

As can be seen from the table above, only a part of the criteria for establishing disability has an objective basis. For example, the presence of organs, residual vision, or the degree of kidney damage. The remaining criteria are subjective, the determination of the percentage of loss of functions according to them remains at the discretion of the commission. To prove the presence of a serious loss of health, a diabetic patient must submit a maximum of documents indicating all the complications and concomitant diseases.

Examination for diabetes mellitus can be obtained from polyclinic doctors or specialized medical centers. In some cases, to confirm complications have to go to hospital for treatment.

You should be prepared that the registration of disability, including going through all the procedures and collecting paperwork, can take a long time. You may have to defend your rights more than once. Advice on disability determination can be obtained from a lawyer familiar with medical law or hotline Federal Bureau ITU.

Doctors' conclusions

A referral to the ITU can be obtained from the attending physician of a polyclinic or hospital. At the same time, a form is issued in the form N 088 / y-06. Also, a patient with diabetes mellitus is given a list of specialists, the conclusion of which must be obtained.

Without fail, you will have to visit an endocrinologist, surgeon, ophthalmologist and neurologist. In the presence of concomitant diseases of diabetes, this list can be expanded.

The task of the patient is to quickly bypass the doctors, acquaint them with all the symptoms, pay attention to the existing complications and their severity. It is also worth checking that in the certificates and extracts there are references to the fact that the health disorder is persistent, and no significant changes are expected in the course of treatment. The conclusions of narrow specialists are valid for 2 months.

Test results

For ITU with diabetes you will need:

• general analysis urine with the determination of glucose, ketones and acidity in it;
• clinical blood test;
• fasting blood glucose;

Additional research:

• to assess the work of the heart, you will have to do a cardiogram and ultrasound;
• in a patient with diabetes, they are sent to electroencephalography (EEG) to detect changes in the cortex and rheoencephalography (REG) to study cerebral vessels;
• to establish disability in the presence of diabetic nephropathy, a Rehberg test is needed to determine GFR with daily urine sampling and venous blood and the Zimnitsky test to determine the ability of the kidneys to concentrate urine;
• to confirm angiopathy, angiography and ultrasound of the vessels of the legs will be required.

Required Documents

The package of medical reports is prepared by the attending physician. The applicant for disability will need originals and copies of the following documents:

1. Application for an examination.
2. Passport, under 14 years old birth certificate.
3. If a legal representative is present at the ITU, documents are required confirming his authority as a parent or guardian. For representatives of capable citizens, a notarized power of attorney will be required.
4. Passport of the legal representative.
5. Consent that the personal data of a person with diabetes will be processed by ITU staff.
6. For employees - a copy of the labor from the personnel department and production characteristic, which will indicate the working conditions, load, workplace equipment, the possibility of facilitated working conditions.
7. For the unemployed - a work book.
8. For pupils and students - pedagogical characteristics.
9. When extending disability - a certificate of its presence, an individual rehabilitation program.

If disability is not given

If a patient with diabetes was denied a disability, or was given a group that did not correspond to the severity of the condition, the decision of the commission can be appealed within a month. To do this, you must fill out an application for appeal and transfer it to the place of initial examination. Within 3 days, the application will be transferred to a higher authority, and a new examination will be carried out a month later. For re-consideration, you can submit the results of examinations from other medical institutions.

If a refusal is received again, or some documents were unlawfully not attached, a diabetic patient can defend his right to disability and rehabilitation in court.

Benefits for diabetics

By Government Decree 890 dated 07/30/94, diabetes mellitus was classified as a disease in which the patient is provided free of charge medicines and other medical means.

In case of diabetes, according to a doctor's prescription, diagnostic tools should be issued - a glucometer and strips for them, even in the absence of a disability group. With type 2 diabetes - drugs that reduce sugar from the list of vital ones (established annually by the Government of the Russian Federation). Patients with an insulin-dependent form of the disease - insulin, syringes, syringe pens and consumables for them. Purchases of preferential drugs for patients without disabilities are engaged in regional bodies. They also establish specific names of medicines (in federal list only active ingredients), which are available for free. The right amount drugs and consumables are determined by the attending physician.

Disabled people are provided at the expense of the federal budget, in an increased volume. I and II non-working groups can receive the means of rehabilitation indicated in the program, and dressings. They are also entitled to free travel on public transport, an abbreviated working week, spa treatment, free prosthetics, orthopedic shoes. Patients with all disability groups are paid a pension.

People who are sick with diabetes know that this disease is not treated, and thanks to complex treatment, it is only possible to alleviate the symptoms of the disease. This disease has several degrees, but after its acquisition, a person is not assigned a disability. In order to receive it, complications must occur against the background of this disease. Type 1 diabetes mellitus, which disability group should be assigned to the patient - about this will be discussed in this article.

In the event that a doctor limits the performance of his patient, this does not mean that he has been assigned a disability group. Type 1 diabetes can be of two types: autoimmune and idiopathic.

Disability group and type 1 diabetes

Any person, even who does not have a disability, knows that there are several degrees. The medical commission can assign the first degree to patients with the following complaints:

• heart failure of the third degree;
• blindness in both eyes;
• hypoglycemic coma;
• kidney failure;
• neuropathy;
• paralysis.

Important! Disability of the first degree is assigned to patients who cannot do without outside help, this is the most serious degree that relies on people with complex complications. Although patients are allowed to perform household chores, communicate with others and move independently.

The second group is assigned to patients with the following complaints:

• chronic renal failure;
• change in the psyche;
• ritinopathy, which is manifested by less pronounced symptoms than with the first degree of disability;
• neuropathy of the second degree.

This group of disability can be called moderate. Patients should be supervised, but not always. Some patients can easily move around, do light work and take care of themselves.

As a rule, the most common disability groups are the first and second. The third group is assigned to people with the development of a labile course of the disease, with simple disorders.

Fact! Often, such a disability group is assigned to young people during internship or mastering a new profession in order to reduce mental and physical activity.

How to get a group?

Many people want to get a disability group just to get free medicines and social benefits. Indeed, for most patients, it is not affordable to be treated for diabetes, since the cost of drugs is very high. And as it shows medical practice, most often, diabetes mellitus of the first type makes out disability. The decision on whether or not to assign a disability group to a patient is decided by a medical and social examination, which accepts it based on the available data.

To qualify for a disability group, a patient must meet the following conditions:

• the ability to take care of oneself, navigate in space and move around has been completely or partially lost;
• the patient needs rehabilitation and social assistance;
• the patient has not only complaints, but also failures in the operation of many systems;
• the patient cannot communicate with others;
• the person cannot work.

In order to get a disability, you will have to collect a lot of documents and wait for the decision of the medical commission. First of all, you need to contact a therapist so that he writes out a referral for tests. In some cases, the doctor will also give directions to narrow specialists.

Important! If the medical commission does not assign you a disability, and your disease has acquired the character of complications, you need to go to court to appeal the decision. In medical practice, such and unreasonable refusals are often encountered.

To get a group for type 1 diabetes, you need to collect and provide the following documents:

• statement;
• outpatient card;
• referral or certificate for the assignment of disability;
• the passport;
• open sick leave;
• characteristics from the place of work or study;
• education data;
• a copy of the work book - for working citizens;
• certificate of disability and certificate of rehabilitation - upon re-applying.

But it is worth noting that, once having received a group, you will have to regularly confirm your position. So, for example, for the first degree of disability, it is necessary to collect certificates and undergo an examination every two years, for the second group every year.

As statistics show, recently this disease has been developing in children, and it is precisely the first degree.

Important! Children under 18 years of age, when type 1 diabetes mellitus is diagnosed, are immediately assigned a disability that does not have a group. But if complications appear, then the child can be assigned a group number and then the range of benefits and benefits will be larger.

Privileges

The benefits that a person with a diagnosis of diabetes mellitus can count on when assigning a disability group to him are as follows:

• free medicine;
• issuance of syringes;
• free test strips, counting 3 strips for one day;
• delivery of insulin;
• issuance of a glucometer.

Many of the benefits on this list should be available to patients, whether or not they have a disability. But, unfortunately, many people do not know this, and therefore spend money on treatment out of their own pocket.

For children with disabilities with diabetes, the number of benefits is wider, they can claim free rest in a sanatorium once a year, receive a pension and take advantage of preferential places when entering universities. If the child is sent for sanatorium-and-spa treatment, then in addition to the cost of the voucher, the state pays for the two-way trip and the cost of living for the parent or accompanying child.

If the disease develops in pregnant women, then another 16 days must be added to the parental leave. If diabetes is hereditary disease, a newborn child is also entitled to free meals. In addition, you can receive the following benefits:

• discount on travel in suburban transport;
• discount on payment of tax for real estate;
• exemption from payment of state duty for the services of a notary and a lawyer;
• service out of turn in different institutions;
• 50% subsidy for utility bills;
• exemption from paying land tax;
• receiving a social apartment in the order of the general queue.

If a disabled child is brought up in the family, then the state must pay a monthly allowance for his maintenance, in addition to the benefits described above.

Important! Diabetics of the first insulin type are completely disabled.

To answer the question: what group of disability is assigned for type 1 diabetes, it will definitely not work. Since in the first place it depends on how the disease proceeds. As medical practice shows, with type 1 diabetes, all applicants are often assigned a degree of disability due to serious condition sick person. Also, people have the right to receive disability in this disease due to the fact that it is chronic.

Medical and social expertise and disability in diabetes mellitus

Diabetes mellitus is a disease characterized by hyperglycemia on an empty stomach and in
during the day, glucosuria, impaired carbohydrate, protein, fat metabolism
due to absolute or relative lack of insulin.

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

Etiology and natogenesis. Death occurs in type 1 diabetes
(b-cells of the pancreas and the development of absolute insufficiency
insulin. This type is divided into 2 subtypes.

Ia - a decrease in antiviral immunity was noted: an acute onset is characteristic
diseases after viral infection(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
combined with others autoimmune diseases. B8, DR3 genotypes are characteristic.

In type 2 diabetes, genetic defects are detected. Noted
decreased sensitivity of b-cells to glucose and peripheral tissues - to
insulin. Obesity is one of the most important risk factors,
hereditary burden for diabetes mellitus, dyslipoproteinemia and
concomitant arterial hypertension.

Absolute or relative insulin deficiency affects
almost all types of metabolism and leads to dysfunctions 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 organ of vision.

Clinic. The main symptoms are thirst, polyuria, weight loss and weakness. On them
acute and progressive chronic complications may occur.

Acute complications.

diabetic ketoacidosis; it is based on undiagnosed sugar
type 1 diabetes, 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;
reveal dry skin and mucous membranes, muscle hypotension and eyeballs, smell
acetone, dehydration, tachycardia, Kussmaul breathing (at pH 7.2 and below);
may have abdominal pain. If left untreated, stupor and coma develop;
blood glucose 14-25 mmol / l (sometimes up to 45 mmol / l), blood pH 7.3 - 7.0 and
below.

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

Hypoglycemic coma develops with an overdose of insulin, improper
nutrition, physical overload while taking sulfonylurea drugs.

Lactacidemic coma develops with hypoxia associated with severe
cordial 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
most often represented by diabetic triopathy (polyneuropathy, angiopathy
and nephropathy).

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

Damage to the cardiovascular system is manifested by micro- and
macroangiopathic disorders involving the heart muscle in the process
(diabetic cardiomyopathy) and blood vessels, which leads to the development and
progression of IHD.

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

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

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

III Art. - incipient nephropathy is characterized by moderate
microalbuminuria (up to 300 mg/day), combined with unstable arterial 1
hypertension.

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

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

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

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

II Art. - preproliferative: expansion, uneven veins,
microaneurysms, large retinal hemorrhages, metamorphopsias,
preretinal hemorrhages, hemorrhages in the posterior chamber of the eye. decline
vision, if the hemorrhage is localized in the macular region; Start
cataract formation.

III Art. - proliferative: to the picture II Art. are joining
vascular neoplasms and retinal fibrosis, there may be retinal detachment, its
rupture, glaucoma, decreased visual acuity, up to blindness.
With atherosclerosis of the vessels of the lower extremities, 4 stages of development are distinguished
(preclinical, initial, ischemic and necrotic). Are celebrated
vague pain in the legs, paresthesia, fatigue. Then join
bouts of intermittent claudication. The pulsation of the arteries of the feet is weakened, pegs
cold, pale, sometimes cyanotic. circulatory disorders and decreased
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 resistance to
insulin with relative insulin deficiency to predominant
secretory disorders with or without insulin resistance).

3. Other specific types of diabetes:

A - genetically determined dysfunction (b-cells of the pancreas
glands;
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 - others genetic syndromes sometimes associated with diabetes.

4. Gestational diabetes.

The severity of diabetes mellitus is assessed taking into account the clinic, condition
compensation, the presence of acute and chronic complications. Diabetes mellitus 1st
type usually proceeds more severely.

Mild: no ketosis, compensated by diet alone, glycemia
on an empty stomach - 7.5 mmol / l, daily glucosuria not 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
in some cases, restrictions on the ability to work can be determined
activities I Art.

Moderate severity: observed ketosis without precoma and coma, glycemia
on an empty stomach 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 marked pain syndrome and trophic ulcers. Available
moderate violations endocrine function and moderate multiple organ dysfunction
(nervous system, kidneys, visual apparatus). OZD are revealed in the form
reduced ability to labor activity 1 tbsp., less often the ability to
movement I st., other categories of life are not violated.

Severe course: ketosis often occurs, severe complications
regardless of the level of glycemia and the nature of the treatment; has a tendency to
coma states. Hyperglycemia exceeds 14 mmol / l, glycosuria -
absent or above 220 mmol / l, retinopathy II-III stage is detected, nephropathy
IV-V stage, 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
activities II-III Art., independent movement - II Art.,
self-service - II Art. etc. The extremely severe course is characterized by
irreversible damage to the cardiovascular (CH IV NYHA) and nervous system
(encephalopathy stage III, paralysis), kidneys (terminal CRF), severe
dystrophic changes muscles, when a complete inability to
self-service and mobility, other categories also suffer significantly
vital activity.

Diagnostics. Based on clinical picture and laboratory results
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
definition: the presence of risk factors for diabetes mellitus, persistent furunculosis,
repeated erysipelas, pruritus, paradontosis, cataract in young
age at a fasting blood glucose level not higher than 5.8 mmol / l and during
days - 7.2 mmol / l (if the glucose level is above the indicated figures, the sample is not
held).
5. Increase in glycated hemoglobin - (normal - 4-6%).
6. Increase in immunoreactive insulin of blood plasma (norm 3-20
μED / "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 - 7.5 mmol / l, 2 hours after
glucose load - 11.1 mmol/l and above.
9. To determine violations of the functions of other organs and systems
appropriate research methods are used.

Treatment. Diet therapy provides for the provision of proper energy
dietary values, calories, qualitative composition poverty, the rhythm of nutrition,
product interchangeability. Prescribe oral hypoglycemic agents
drugs: sulfonylurea derivatives (with normal weight body),
biguanide derivatives (for obesity). Insulin therapy is indicated for
no effect from oral medications in patients with diabetes
Type 2 (fasting glycemia more than 20 mmol/l). with type 1 diabetes
type, with ketoacidotic and hyperosmolar coma. Treatment of chronic
complications of diabetes include the achievement of normoglycemia, vascular agents,
normalization blood pressure, administration of hypolipidemic and
normalizing metabolic processes drugs. Operational if needed
treatment, dialysis, nephrotransplantation.

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

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

able-bodied are patients with mild to moderate diabetes mellitus
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, onset
dialysis. Terms of VUT: at easy course SD - 8-10 days, moderate - 25-30
days, with severe - 30-45 days; at diabetic coma at least 30-45 days;
in hypoglycemic conditions are determined by their consequences; with 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 Bureau.
1) severe form of diabetes, pronounced manifestations microangiopathy
with a significant violation of the functions of organs and systems; 2) labile course
(frequent hypoglycemic conditions, ketoacidosis) or difficult to compensate
moderate diabetes mellitus; 3) mild to moderate diabetes with
the need for rational employment with a decrease in qualifications or
reduction in the amount of work performed.

Required minimum examination Key words: clinical blood test, blood glucose
on an empty stomach and during the day, (3-lipoproteins, cholesterol, urea, creatinine,
serum electrolytes, glycated hemoglobin; urinalysis, for sugar
and acetone; ECG; examination by an ophthalmologist, neurologist (condition of the central and
peripheral nervous system), surgeon ( purulent complications, trophic
ulcers). With nephropathy - a test of Zimnitsky and Rehberg, determination of the daily
nroteinuria and microalbuminuria, KOS; with angiopathy of the lower extremities -
dopplerography and rheovasography, with encephalopathy - EEG and REG; in defeat
cardiovascular system - EchoCG, 24-hour ECG monitoring and
blood pressure.

Contraindicated types and working conditions.

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

The average severity of diabetes: 1) for patients not receiving
insulin, - moderate physical labor and mental labor are contraindicated
with high neuropsychic stress; 2) for most patients,
receiving insulin, with a labile course of diabetes mellitus is contraindicated
work, the sudden cessation of which is dangerous due to the possibility of an accident
case or disruption of the production process (work on the conveyor, at
moving machinery, at height, in hot shops, driving,
work as a dispatcher on the control panel, etc.). Available light physical,
administrative, economic, intellectual work, in some cases - with
decrease in the volume of production activity. With vascular damage
of the lower extremities, work associated with prolonged standing is contraindicated,
walking, vibration With damage to the retinal vessels, work is contraindicated,
associated with prolonged eye strain.

disability criteria.

I disability group established in patients with severe DM
the presence of significantly pronounced dysfunctions of the endocrine and other
systems: retinopathy (blindness in both eyes), neuropathy (persistent paralysis,
ataxia), diabetic encephalopathy with severe violations psyche;
diabetic cardiomyopathy (CH III stage); severe angiopathy of the lower
extremities (gangrene, diabetic foot); terminal chronic renal failure; with frequent
hypoglycemia and diabetic coma. The limitations of the ability to
labor activity III Art. self-service class III, mobility III
Art., orientations II-III Art. Patients need constant help
and leaving.

II group of disability determined by patients with severe diabetes
diabetes with severe dysfunctions of the affected systems and organs:
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,
that lead to limited ability to work II-III
Art., the ability to move and self-service II Art. Sometimes pronounced
OZD is present in patients with moderate dysfunctions of organs and systems with
labile course, when it is not possible to achieve stable stabilization of glycemia.

III group disability determined by patients with mild and medium degree
severity of diabetes mellitus or its labile course with moderate
violations of the functions of organs and systems, which lead to the restriction
ability to self-service, labor activity I st., if in work
the patient in the main profession has contraindicated factors, and
rational employment leads to a decrease in qualifications or a significant
decrease in the volume of production activity. Young people III
disability group is established for the period of study, acquisition of a new
professions of light physical or mental labor with moderate
neuropsychic stress.

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