Social protection of patients with severe diabetes. Disability due to diabetes - what determines the receipt of a group and the procedure for registration

The question is how to get disability when diabetes mellitus Type 2 is very ambiguous. Thanks to the development of treatments and means of controlling blood sugar levels, diabetes today, in most cases with proper treatment, is not as life-threatening as it was just a few decades ago.

But in any case, purchasing medications for different types of diabetes requires significant funds, which will be expensive not only for pensioners, but also for working citizens who are forced to additionally feed their families.

It is worth remembering that diabetes is primarily a chronic disease that requires constant monitoring. The causes of the disease often lie in other past illnesses. For example, diabetes is often caused by liver problems such as pancreatitis.

Diabetes also develops after viral diseases. It has been established that heredity also plays a significant role in the development of insulin resistance. The cause may be autoimmune diseases, including thyroiditis - inflammation of the thyroid gland.

For this reason, even with non-insulin-dependent diabetes, many patients highly expect to receive disability. A benefit from the state for treatment would make life much easier. But in practice, it turns out that it is not always possible to obtain disability due to diabetes, even if the treatment is already at a difficult stage.

Therefore, it is worth understanding whether disability is granted for diabetes and what influences the commission’s decision to make such a decision.

Modern conditions for obtaining disability

Currently, as already mentioned, disability for diabetes is not automatically assigned. The rules regarding assigning a group to a patient have become somewhat stricter in the last few years, and it has become much more difficult to obtain disability for group 2 diabetes mellitus.

In accordance with the order of the Ministry of Labor dated September 29, 2014, disability can be obtained by decision of the commission, which must be based on a number of grounds.

When making a decision, the medical commission takes into account not only and not so much the diagnosis itself, but the presence or absence of complications. These include physical or psychical deviations caused by the development of a disease that makes a person unable to work and also unable to self-care.

In addition, the decision whether a group is prescribed for diabetes can also be influenced by the nature of the disease, the degree of influence on the ability to manage usual image life.

If you look at the statistics, regardless of the country, on average 4-8% of residents are diagnosed with type 2 diabetes. Of these, 60% were given a disability.

But in general, you can not be considered disabled even if you have type 2 diabetes. This is possible provided that the recommendations are followed exactly: adhere to proper nutrition, accept medications and continuously monitor changes in blood sugar levels.

Types of pathological abnormalities

Sugar level

The patient is assigned different degrees of disability depending on the nature of the manifestations of the disease.

Each stage is assigned for certain complications of diabetes.

Depending on the complexity of the manifestations, several disability groups are assigned.

Disability group I for diabetes is prescribed for such serious pathologies accompanying the disease as:

1. Encephalopathy,
2. Ataxia,
3. Neuropathy,
4. Cardiomyopathy,
5. Nephropathy,
6. Frequently recurring hypoglycemic coma.

With such complications, a person loses the ability to lead normal life, cannot take care of himself, needs constant help from relatives.

The second group is placed in case of obvious violations of physical or mental health:

• neuropathy (stage II);
• encephalopathy
• deterioration of vision (stage I, II).

With such manifestations, the patient’s condition worsens, but this does not always lead to the impossibility of movement and self-care. If the symptoms are not pronounced and the person can take care of himself, then disability is not prescribed.

Group II - prescribed for manifestations of diabetes mellitus, mild or moderate pathologies.

Non-insulin dependent diabetes, unless otherwise observed related problems with health, is not an indication for prescribing to diabetics.

Situations in which disability and benefits are entitled

The commission's experts make a positive decision on assigning disability for group 2 diabetes in certain situations. First of all, this is age - children and adolescents are entitled to disability (without a group) regardless of the type of disease.

The group will be given in case of severe disturbances in the functioning of body systems caused by constant high level glucose. These include:

1. Neuropathy (stage II, in the presence of paresis),
2. Chronic form of renal failure,
3. Encephalopathy,
4. Significant decrease in visual acuity or complete.

If the patient is disabled and cannot care for himself, type 2 diabetes is assigned to group II disability.

Everyone who has been disabled due to diabetes has the right to free medications and insulin. In addition to medications, disabled people of group I are given free glucometers, test strips, and syringes. For disabled people of group II diabetes, the rules are slightly different. The number of test strips is 30 pieces (1 per day), if insulin therapy is not required. If insulin is given to the patient, then the number of test strips is increased to 90 per month. For insulin therapy for diabetes or poor vision in group II disabled people, a glucometer is provided.

Diabetic children are provided full social package. They receive the right to relax in a sanatorium once a year, while the trip to the institution and back is paid only by the state. Disabled children are paid not only for a place in a sanatorium, but also for travel and accommodation for an accompanying adult. In addition, it is possible to obtain all the medications necessary for treatment and a glucometer.

You can get funds and medications at any government-supported pharmacy with a prescription. If any of the medicines are needed urgently (usually the doctor puts a note next to such drugs), it can be obtained after the prescription is issued, but no later than 10 days later.

Non-urgent medications are received within a month, and medications with psychotropic effect- within 14 days from receipt of the prescription.

Documents for obtaining disability

If there are serious pathologies caused by diabetes, if a person needs constant help and regular insulin injections, he is entitled to the second group. Then it is useful to know how to apply for disability.

First of all, it is necessary to prepare documents giving the right to receive a group. First of all, a statement from the patient himself. For children under 18 years of age, legal representatives must also submit an application.

A copy of your passport must be attached to your application (for minor children, a birth certificate and a copy of the parent’s or guardian’s passport). In addition, to obtain disability due to diabetes, you need to take a referral or court order.

To confirm the presence of harm to health, the patient must provide the commission with all documentation confirming the medical history, as well as an outpatient card.

In addition, in order to obtain disability, you may need an education document. If the patient is just receiving education, it is necessary to obtain educational institution document – ​​characteristics of educational activities.

If the patient is officially employed, to register a group it is necessary to present a copy of the contract, as well as a copy work book, certified by an employee of the personnel department. This department must also prepare a document describing the nature and conditions of work.

During the re-examination, you additionally issue a certificate confirming your disability and a document describing the rehabilitation program, which should indicate the procedures already completed.

Conclusion of medical experts

A disability group for type I diabetes mellitus is assigned after the patient will pass a series of examinations carried out by specialists during the examination.

This measure allows us to determine not only the patient’s condition, but also to assess his ability to work, as well as the expected duration of treatment.

The conclusion after the examination is issued on the basis of the following types of research:

• examination of urine and blood for hemoglobin, acetone and sugar;
• renal biochemical test;
• liver test;
• electrocardiogram;
• ophthalmological examination;
• examination by a neurologist to check the extent of the disorder nervous system.

To be assigned type 2 diabetes mellitus, patients must be examined by a surgeon and undergo a series of procedures to identify diabetic foot and trophic ulcers.

Diabetes - serious illness endocrine system, caused by an absolute or relative lack of insulin, a hormone that ensures the passage of glucose through cell membranes. Diabetes is of the first and second types. In type 1 diabetes, beta cells, responsible for the production of insulin and located in the endocrine pancreas, various reasons die or fail to fulfill their responsibilities. As a result, the body experiences acute insulin dependence, which can only be compensated by introducing the hormone from the outside. In type 2 diabetes, insulin is synthesized in beta cells, but either the body receives less of it than it needs, or insulin resistance increases in organs and tissues and the biochemical mechanism stops working correctly. Diabetes of the second type is less acute, the disease develops over years and decades, but in the end no less severe diseases occur in the body. pathological changes than in type 1 diabetes. These changes lead to permanent loss of ability to work and often the patient is assigned one or another disability group. There is also gestational diabetes mellitus or pregnancy diabetes.

Like most system chronic diseases, diabetes mellitus is dangerous not in itself, but because of the complications that it causes. Persistent disorders of carbohydrate metabolism negatively affect all organs and tissues, but the most severely affected are:

• heart and peripheral blood vessels(macroangiopathy, diabetic myocardiopathy, diabetic foot, as a result - gangrene and amputation of the lower extremities);
• kidneys - microangiopathy and chronic renal failure varying degrees occur in 60% of patients with diabetes mellitus;
• nervous system – diabetic neuropathy, which leads to mental disorders, dementia, paresis and paralysis;
• eyes - diabetic retinopathy causes 10% of cases of blindness and 36% of cases of persistent decrease in visual acuity in the elderly.

With insulin-dependent diabetes mellitus type 1, everything is both worse and better. If the patient does not receive insulin injections or refuses them, he simply will not live to become blind or have diabetic foot. Just 100 years ago (before the invention of compensatory therapy), patients with T1D rarely even lived to be 30 years old, dying from ketoacidosis and diabetic coma.

If therapy is carried out as scheduled, then the prognosis for the course of the disease is even more favorable than with T2DM, the main thing is to regularly monitor blood sugar levels, adhere to a special diet and always have a supply of insulin for injections and “emergency” candy with you. It is important to monitor the correct dosage of the drug and adapt to the course of current events. An overdose of insulin or a combination of injection and excessive physical activity, stress, nervous tension is fraught backfire– the development of acute hypoglycemia and the same coma, only from a lack of sugar. In such emergency cases, the mentioned candy is just what you need.

Do you get disability if you have diabetes?

Almost all diabetics and people at risk (fasting sugar level 6-7 mmol per liter) are quite rightly interested in whether diabetes mellitus entails disability, what group is given for different types and on different stages development of the disease and what benefits you can expect.

Last in Russia normative act, regulating the procedure for sending patients with permanent or temporary disability for medical and social examination (MSE) is the order of the Ministry of Labor No. 1024n dated December 15, 2015. It came into force after approval by the Ministry of Justice on January 20, 2016 under No. 40560.

In accordance with this order, the severity of all functional disorders in the human body it is actually estimated on a ten-point scale - as a percentage, but in increments of 10%. There are four degrees of pathology:

1. Minor – the severity of violations ranges from 10-30%.
2. Moderate – 40-60%.
3. Persistent pronounced disorders – 70-80%.
4. Significant violations – 90-100%.

Doctors and researchers have justifiably criticized this system, since it practically does not make it possible to take into account combinations of several pathologies, but in general, the practice of socio-medical examination institutions has developed in recent months. Disability is given in the presence of at least one pathology classified as the second, third or fourth category of complexity or in the presence of two or more diseases, defects or injuries of the first category.

Disability in childhood diabetes

Disability in type 1 diabetes is certainly indicated for children under 14 years of age, and it does not matter whether the child is able to independently control his behavior, instrumentally check blood sugar levels and take insulin injections, or whether all this lies on the shoulders of the parents. Bodies of medical examination and social protection, as a rule, are in the position of parents and their sick children and give the third group of disability without any special questions. The second group can only be obtained if you have severe symptoms ketoacidosis, repeated diabetic comas, persistent disorders of the heart, central nervous system, kidneys, the need for hemodialysis and constant hospitalization, etc. The reason may be the difficulty of selecting compensatory therapy - when a child cannot be prescribed a clear insulin therapy plan and always needs support from adults, including medical workers.

Diabetes in young people

In youth and at a young age When assigning disability, what comes to the fore is not only the severity of the disease, the level of damage to organs and systems, but also the impact of the disease on the ability to learn, master a profession, and acquire skills labor activity. Young people with type 1 diabetes are given disability of the third group for the period of study in secondary, secondary specialized and higher educational institutions.

However, a diagnosis of diabetes often imposes restrictions on the right to engage in certain activities. This may be due to both the risk for the diabetic himself and the public danger that the disease causes. So, it is quite obvious that a patient with diabetes mellitus-1 cannot work as a taster. confectionery or a loader - in such work the patient risks seriously (if not fatally) harming himself. At the same time, a diabetic cannot be allowed to drive a bus or plane - an unexpected attack of hyper- or hypoglycemia can bring not only the patient himself, but also dozens of passengers for whom he is responsible, to the brink of death. Patients with insulin dependence should not work in hot shops, on assembly lines, or in control centers, where concentration is important and there is no time for strip tests and injections. The only solution may be to use an insulin pump, but this must also be discussed with your doctor in advance.

Type 2 diabetes

If disability in type 1 diabetes directly depends on the lability (severity) of the disease, the age of the patient and his ability to care for himself and carry out independent compensatory therapy, then disability in type 2 diabetes, due to the long course of the disease and vagueness of symptoms, in most cases is assigned already at late stages of the disease, when complications have entered a severe and even terminal stage.

It is no coincidence that type 2 diabetics are given the light third group quite rarely. The patient himself is in no hurry to undergo a medical and social examination, confident that the slight ailment will soon pass and retirement is still a long way off. Doctors also do not want to spoil the statistics and do not send the patient for medical examination, but only recommend that he give up heavy physical and significant mental stress, bad habits and change his diet.

A careless attitude towards one’s own health is superimposed on the psychological stereotype according to which in Russia disabled people are second-class people, and if a person “follows the group” for such an insignificant reason as excess blood sugar, then, on top of everything else, he is also a slacker trying to profit at the people's expense and receive undeserved benefits. Unfortunately, certain elements of our state’s social policy still do not make it possible to eliminate such a stereotype.

The truly pressing question of whether type 2 diabetes is a disability arises when the disease affects all target organs in the body.

Heart and coronary vessels affected by myocardiopathy.

On the part of the kidneys - severe chronic failure, the need for dialysis or urgent transplantation (and it is still unknown whether the donor kidney will take root in a weakened body or not).

As a result of neuropathy, paresis and paralysis affect the limbs, and dementia progresses. The vessels of the retina of the eyes are destroyed, the angle of vision steadily decreases until complete blindness occurs.

The vessels of the legs lose their ability to nourish the tissues, necrosis and gangrene occur. Moreover, even successful amputation does not guarantee the possibility of prosthetics - tissues eaten away by diabetes stubbornly refuse to accept an artificial leg, rejection, inflammation, and sepsis occur.

Are you asking if type 2 diabetes is disabled? Of course, it’s supposed to, but it’s better not to let it get to that point! Moreover, modern methods treatments are quite capable of coping with the negative course of the disease and preventing the development of formidable insurmountable complications.

How to get disability if you have diabetes?

If we're talking about about an adult patient, then to pass medical and social examination it is necessary to obtain a referral from the attending physician or local therapist for passing the ITU. After this, the patient undergoes the following tests and examinations:

1. General blood test, glucose levels on an empty stomach and after meals, levels of 3-lipoproteins, cholesterol, urea, creatinine, hemoglobin.
2. Urine analysis for sugar, acetone and ketone bodies.
3. Electrocardiogram.
4. Examination by an ophthalmologist (symptoms of reitnopathy and diabetic cataracts),
5. Examination by a neurologist - diagnoses damage to the central and peripheral nervous system, checks the sensitivity of the skin).
6. Examination by a surgeon (diagnosis of the condition of the lower extremities).
7. Special studies for severe lesions of specific organs and systems. For renal failure - the Zimnitsky-Rehberg test and determination of daily microalbuminuria, for neuropathy - an encephalogram, for diabetic foot syndrome - Dopplerography of the lower extremities. In some cases, more complex studies are prescribed, for example, MRI of the foot, heart or CT scan of the brain.

Attached are the results of daily monitoring blood pressure and cardiac activity performed at home or in a hospital.

The decision to assign a disability group is made based on studying the entire clinical picture, including the results of tests and interviews with the patient. The most severe disability group I is assigned when the patient is in critical condition, when he is practically unable to move independently and take care of himself. The most typical sad example is the amputation of one or both legs above the knee with the impossibility of prosthetics.

Even severe disability of the first group can be corrected if the patient’s condition improves, for example, after a successful kidney transplant for diabetic nephropathy. Unfortunately, as we noted, most often the conversation about disability comes too late.

Diabetes mellitus cannot be completely cured, but it can be managed active life, work, have a family, engage in creativity and sports. The main thing is to believe in yourself and remember that you must help yourself first of all.

Medical and social examination and disability in diabetes mellitus

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

Epidemiology. Diabetes mellitus affects 6% of the population in developed countries. By
In the incidence of disability and mortality, diabetes mellitus ranks third after
cardiovascular diseases and oncopathology. Mortality among patients
diabetes mellitus is 2 times higher, acute heart attack myocardium against its background - in 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 who are
on hemodialysis and suffer from diabetes. More than 60% of patients with diabetes
diabetes - disabled people of groups I and II. Life expectancy of patients in
childhood is about 40 years old.

Etiology and natogenesis. Type 1 diabetes causes death
(pancreatic b-cells and the development of absolute insufficiency
insulin. This type is divided into 2 subtypes.

Ia - a decrease in antiviral immunity is noted: typical acute onset
illness after viral infection(rubella, chicken pox, epidemic
mumps, Coxsackie B4); A2 and DR4 genotypes are detected; combination with
autoimmune diseases absent.

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

In type 2 diabetes mellitus, genetic defects. Noted
decreased sensitivity of b-cells to glucose and peripheral tissues - to
insulin. Among the risk factors, obesity is of particular importance,
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
excessive accumulation of advanced glycation end products and lipoxyphyllation
proteins in tissues, which leads to damage to the kidneys, nervous and cardiovascular
systems, lower extremities and organ of vision.

Clinic. Main symptoms: thirst, polyuria, weight loss and weakness. on their
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;
detect dry skin and mucous membranes, muscle hypotonia and eyeballs, smell
acetone, dehydration, tachycardia, Kussmaul respiration (at pH 7.2 and below);
There may be 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 mellitus
type for severe infections, myocardial infarction, stroke, overdose
diuretics. There is marked polyuria, thirst,
blood hyperosmolarity, cellular dehydration; often find focal
neurological symptoms. Blood glucose level 45-110 mmol/l,
osmolarity - more than 330 mOsm/l.

Hypoglycemic coma develops when there is an overdose of insulin, improper
nutrition, physical overload while taking sulfonylureas.

Lactic acid coma develops with hypoxia accompanying severe
heartfelt and respiratory failure, sepsis, myocardial infarction,
biguanide poisoning. Blood lactate exceeds 6 mmol/l.

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

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

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

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

1 tbsp. - hyperfunction of the nocturna, 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 kidney tissue is characterized
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 1
hypertension.

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

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

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

I Art. - non-proliferative: dilation, unevenness of veins,
microaneurysms of retinal vessels, pinpoint hemorrhages; visual function
the retina is not affected.

II Art. - preproliferative: dilation, unevenness of veins,
microaneurysms, large retinal hemorrhages, metamorphopsia,
preretinal hemorrhages, hemorrhages in rear camera eyes. Decline
vision, if the hemorrhage is localized in the macular area; Start
cataract formation.

III Art. - proliferative: to the picture of Art. II. join
neoplasms of blood vessels and retinal fibrosis, there may be retinal detachment, its
rupture, glaucoma, decreased visual acuity, even blindness.
In atherosclerosis of the vessels of the lower extremities, 4 stages of development are distinguished
(preclinical, initial, ischemic and necrotic). Marked
vague leg pain, paresthesia, fatigue. Then they join
attacks of intermittent claudication. The pulsation of the arteries of the feet is weakened, pegs
cold, pale, sometimes cyanotic. Impaired blood supply and decreased
immunity in combination with injury and infection groans 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. Diabetes mellitus type 2 (from predominant resistance to
insulin from relative insulin deficiency to predominant
secretory disorders with or without insulin resistance).

3. Other specific types of diabetes:

A - genetically determined dysfunction (pancreatic b-cells
glands;
B - genetically determined disorders in the action of insulin;
B - diseases of the endocrine pancreas;
G - endocrinopathies;
D - diabetes induced by drugs or chemicals;
E - infections;
F - unusual forms of immune-mediated diabetes;
3 - others genetic syndromes, sometimes combined with diabetes.

4. Gestational diabetes mellitus.

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

Mild degree: no ketosis, compensated by diet alone, glycemia
on an empty stomach - 7.5 mmol/l, daily glucosuria no more than 110 mmol/l; possible
initial manifestations angiopathy, transient neuropathy and stage I nephropathy.
Functional impairments are assessed as minor and do not lead to acute respiratory distress; V
In some cases, restrictions on the ability to work may be determined
activities I Art.

Moderate severity: ketosis is observed without precoma and coma, glycemia
on an empty stomach does not exceed 14 mmol/l, daily glucosuria does not exceed 220 mmol/l,
There is retinopathy grade I-II, nephropathy stage II-IIT, peripheral
neuropathy without obvious pain syndrome and trophic ulcers. Available
moderate impairment endocrine function and moderate multiple organ disorders
(nervous system, kidneys, visual apparatus). OZD is revealed in the form
decrease in the ability to work 1st degree, less often the ability to
movement of the 1st degree, other categories of vital activity are not impaired.

Severe course: ketosis often occurs, severe complications develop
regardless of the level of glycemia and the nature of treatment; there is a tendency to
comatose states. Hyperglycemia exceeds 14 mmol/l, glucosuria -
absent or above 220 mmol/l, grade II-III retinopathy, nephropathy are detected
Stage IV-V, gangrene of the lower extremities, neuropathy, encephalopathy.
Severe dysfunctions of the endocrine, central and
peripheral nervous system, kidneys, vision, immune, muscle and
musculoskeletal system, leading to limited ability to work
activity II-III degree, independent movement - II degree,
self-service - II degree. etc. An extremely severe course is characterized
irreversible damage to the cardiovascular (CH IV NYHA) and nervous system
(grade III encephalopathy, paralysis), kidney (terminal chronic renal failure), severe
dystrophic changes muscles, when a complete inability to
self-care and mobility, other categories are also significantly affected
life 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. Increase in ketone bodies in the blood and urine.
4. Positive glucose tolerance test. Indications for
definition: presence of risk factors for diabetes mellitus, persistent furunculosis,
repeated erysipelas, skin itching, periodontal disease, cataracts in youth
age with fasting blood glucose levels not exceeding 5.8 mmol/l and within
day - 7.2 mmol/l (if the glucose level is higher than the indicated figures, the sample is not
held).
5. Increase in glycated hemoglobin - (normal - 4-6%).
6. Increase in immunoreactive insulin in blood plasma (norm 3-20
µU/"l).
7. Decrease in the content of C-peptide, reflecting the actual synthesis of insulin.
In individuals with normal glucose tolerance, the level of C-peptide in the blood
is 0.12-1.25 nmol/l.
8. Absolute criteria for diagnosing diabetes (WHO, 1996): fasting blood glucose 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. To determine dysfunctions of other organs and systems
Appropriate research methods are used.

Treatment. Diet therapy involves providing adequate energy
dietary values, caloric intake, qualitative composition of poverty, nutritional rhythm,
interchangeability of products. Oral hypoglycemic agents are prescribed
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 mellitus
Type 2 (fasting glycemia more than 20 mmol/l). for diabetes mellitus type 1
type, with ketoacidotic and hyperosmolar coma. Treatment of chronic
complications of diabetes include achieving normoglycemia, vascular agents,
normalization of blood pressure, prescription of hypolyidemic and
normalizing metabolic processes drugs. If necessary - promptly
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 mellitus 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. Determined by the stability of normoglycemia, the onset and rate of development
diabetic triopathy. With the addition of constant proteinuria, chronic renal failure progresses. Timely initiation of dialysis (serum creatinine
about 0.40 mmol/l) and successful nephrotransplantation can prolong life
patients up to 2-5 years of age.

able-bodied are patients with mild diabetes mellitus and moderate severity
course without complications, pronounced lesions organs and systems accompanying
pathology and in the absence of contraindicated types and working conditions.

VUT criteria: decompensation of carbohydrate metabolism, acute complications,
exacerbations of chronic, intercurrent diseases, operations, onset
dialysis. VUT terms: at mild flow DM - 8-10 days, moderate severity - 25-30
days, for severe cases - 30-45 days; in diabetic comas for at least 30-45 days;
in hypoglycemic conditions are determined by their consequences; for acute
complications of diabetic triopathy are determined by their nature.
Intercurrent diseases in diabetes mellitus tend to
protracted flow, which lengthens the time of VUT.

Indications for referral to the ITU Bureau.
1) severe form of diabetes mellitus, pronounced manifestations microangiopathies
with significant impairment 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 reduction in qualifications or
reducing the amount of work performed.

Minimum required examination: clinical analysis blood, blood glucose
on an empty stomach and during the day, (3-lipoproteins, cholesterol, urea, creatinine,
serum electrolytes, glycated hemoglobin; general analysis urine, sugar
and acetone; ECG; examination by an ophthalmologist, neurologist (condition of the central and
peripheral nervous system), surgeon ( purulent complications, trophic
ulcers). For nephropathy - Zimnitsky and Reberg test, determination of daily
nroteinuria and microalbuminuria, CBS; with angiopathy of the lower extremities -
Dopplerography and rheovasography, for encephalopathy - EEG and REG; in case of defeat
cardiovascular system - echocardiography, daily ECG monitoring And
blood pressure.

Contraindicated types and working conditions.

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

Moderate severity of diabetes mellitus: 1) for patients who do not receive
insulin - moderate physical work and mental work are contraindicated
with high neuropsychic stress; 2) for most patients,
receiving insulin, with labile diabetes mellitus is contraindicated
Job, sudden cessation which is dangerous due to the possibility of an accident
accident or breakdown production process(work on a conveyor belt,
moving mechanisms, at heights, in hot shops, driving vehicles,
work as a dispatcher at the control panel, etc.). Easy physical available,
administrative, economic, intellectual work, in some cases - with
reduction in volume production activities. In case of vascular damage
of the lower extremities, work associated with prolonged standing is contraindicated,
walking, vibration. If the retinal vessels are damaged, work is contraindicated.
associated with prolonged eye strain.

Disability criteria.

I disability group is established in patients with severe diabetes when
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 mental disorders;
diabetic cardiomyopathy (HF stage III); severe angiopathy of the lower
limbs (gangrene, diabetic foot); terminal chronic renal failure; with frequent
hypoglycemia and diabetic comas. Limitations in the ability to
labor activities III Art. self-service III degree, movement III
Art., orientation II-III Art. Patients need constant outside help
and care.

II disability group determined by patients with severe diabetes mellitus
diabetes with severe dysfunction of the affected systems and organs: with
retinopathy stage II-III, nephrotic syndrome, initial chronic renal failure, terminal
CRF with adequate dialysis or successful nephrotransplantation, neuropathy II
Art. (severe paresis), encephalopathy with persistent mental changes,
which lead to limited ability to work II-III
Art., ability to move and self-care II Art. Sometimes pronounced
ACD is present in patients with moderate impairments functions of organs and systems during
labile course, when it is not possible to achieve stable stabilization of glycemia.

III group disability determined by patients with mild to moderate
severity of diabetes mellitus or its labile course with moderate
dysfunctions of organs and systems that lead to limitation
ability for self-service, work activity, class I, if in work
the patient has contraindicated factors in his main profession, and
rational employment leads to a decrease in qualifications or significant
reduction in the volume of production activities. To the faces of the young age III
the disability group is established for the period of training, acquisition of a new
professions of light physical or mental labor with moderate
neuropsychic stress.

Rehabilitation. Early detection of diabetes mellitus, diet, adequate
treatment and regular observation by an endocrinologist, prevention of complications,
leading to OJ. Shown Spa treatment, training for disabled people
rational lifestyle (school for diabetics). In young age
career guidance, retraining, rational employment and timely
referral to the ITU office; drawing up individual rehabilitation programs.

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

Diabetes mellitus is a common disease, and every year more and more children and adults suffer from it. Serious consequences this disease is a disability. But the disease itself cannot serve as a basis for confirming the disability group. It doesn’t matter what degree of diabetes a patient has, it all depends on the severity of the disease and the presence of certain complications that entail profound disruption of the vital functions of the human body.

Disability criteria

Let's take a closer look at how disability is determined when different groups diabetes

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

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

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

Second disability group prescribed to those diabetics whose disease occurs with the following severe complications:

1. Encephalopathy with mental disorders.
2. Less severe 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: impairment of labor function - limitation of the second or third degree, impairment of the ability to fully care for oneself and move - limitation of the second degree, the person needs periodic care - in this case a disability of the second group is assigned.

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

Medication examination for diabetics

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

Patients are referred to MTU if there are the following indications:

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

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

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

Despite the fact that medicine is constantly moving forward, diabetes mellitus still cannot be completely cured.

People with this diagnosis constantly have to maintain the condition of the body, take medications along with following a diet. This is also very expensive.

Therefore, the relevant question is whether and how to obtain disability for type 1 and type 2 diabetes mellitus in order to at least have additional benefits. This will be discussed further.

Having received a diagnosis of diabetes mellitus, a person will need to adhere to a special diet for the rest of his life, as well as follow the established regime.

This allows you to control blood sugar levels and prevent deviations from permissible norm. In addition, many of these patients are insulin dependent. Therefore, they require timely injection.

Such circumstances worsen the quality of life and complicate it. Therefore, the question of how to obtain disability for type 2 and type 1 diabetes mellitus is extremely important for the patient and his relatives. In addition, due to the disease, a person partially loses his ability to work, and often suffers from other diseases due to negative influence diabetes on the body as a whole.

What influences getting a group?

Before moving on to the question of how to register disability for type 2 and type 1 diabetes mellitus, it is necessary to consider the points that affect obtaining a group. The mere presence of such a disease does not provide the right to disability for diabetes mellitus.

This requires other arguments on the basis of which the commission can make an appropriate decision. Moreover, the absence of severe complications, even with the development of chronic diseases, does not become a factor allowing the assignment of disability.

When assigning a disability group, the following is taken into account:

• Is there any dependence on insulin?
• congenital or acquired type of diabetes;
• restriction of normal life activities;
• Is it possible to compensate for blood glucose levels?
• the occurrence of other diseases;
• acquisition of complications due to the disease.

The form of the disease also plays a role in obtaining disability. It happens:

• light- more often early stage when the diet allows glucose levels to be kept normal, there are no complications;
• average– more than 10 mmol/l is a blood sugar indicator, the patient has eye lesions that contribute to vision deterioration and development, weak general state, others appear accompanying illnesses, including damage to the endocrine system, kidney dysfunction, and gangrene. A patient with diabetes mellitus also has limitations in self-care and work activity;
• heavy– glucose levels are significantly higher normal indicators, drugs and diet have little effectiveness, complications appear a large number of, including other diseases, gangrene spreads, and complete incapacity is noted.

To obtain disability, circumstances such as the severity of the disease, its type, and concomitant diseases are taken into account.

Group assignment

How is disability granted for diabetes?

The disability group is determined based on the stage of the disease, loss of ability to work, and the presence of complications that interfere with normal life activities.

To do this, you must undergo a medical examination.

First of all, you need to see an ophthalmologist and a neurologist. The first will be able to determine the likelihood of blindness, and the second will reveal the degree of damage to the nervous system.

For diabetes mellitus, which group is given? The most serious is the 3rd disability group, when blindness has occurred or is expected, heart failure, paralysis and even coma are possible. In this case, the commission is obligatory, and the decision is made collectively based on the results of observations.

Assignment of the second disability group for diabetes mellitus is carried out when the nervous system is affected and work is disrupted internal organs.

However, independent care is maintained. In addition, partial vision loss and brain damage are most often observed.

The third group is given to people who have slight changes in the functioning of the nervous system and internal organs. It is given in cases where it is not possible to combine current work with diabetes. The action ends after finding a new job.

How to get a disability group for diabetes?

To obtain a disability group if you have type 1 or 2 diabetes, you must go through the following steps:

• contact the doctor with whom you are registered;
• get a referral for tests and undergo an examination;
• contact the doctor again, who will record all the results obtained, make an extract from the medical history, and refer you to the head physician for certification of the form;
• pass the necessary commission, presenting the necessary documents;
• Based on a personal conversation with the patient and studying the presented test results, the commission will decide on assigning a disability group.

It is important to provide a complete package of documents and pass all tests on time.

Doctors, tests, examination

The main decision is made by medical and social examination staff based on doctors’ opinions, examinations and test results. The first priority is to contact a general practitioner, who gives a referral to an ophthalmologist, surgeon, neurologist, cardiologist and other specialists.

The check will be carried out in the following areas:

• urine for acetone and sugar;
• Clinical urine and blood analysis;
• glycohemoglobin;
• brain function;
• vision;
• nervous system disorder;
• the presence of pustules and ulcers;
• glucose loading test;
• glucose level determined on an empty stomach, as well as during the day;
• Zimnitsky test, CBS, urine according to the Child - for kidney disorders;
• electrocardiography to check the condition of the heart.

What documents will you need?

When passing the commission you will need to present the following documents:

• passport or birth certificate;
• a statement expressing a desire to obtain disability;
• referral to ITU, which must be completed in the form;
• patient card from the outpatient clinic;
• extract of the examination from the place where it was carried out in the hospital;
• examination results;
• conclusions of specialists examined by the patient;
• a reference from a teacher from the place of study, if the patient is still studying;
• work record book and characteristics of the manager from the place of work;
• an accident report, if there was one, together with the conclusion of a medical commission and examination;
• rehabilitation program and document on disability, if the application is repeated.

If you disagree with the assigned disability group, you have the opportunity to challenge it. To do this, a corresponding application with an ITU conclusion is submitted. A trial is also possible, after which it will no longer be possible to appeal the decision.

Privileges

So, not everyone has the opportunity to become disabled due to diabetes.

In order to have the right to government assistance, evidence is required that its effect on the body is pronounced, that it is extremely difficult or even impossible to lead a normal life on one’s own. After assigning a disability group, the patient can receive not only financial assistance, but also other benefits.

First of all, diabetics with disabilities receive free glucometers, insulin, syringes, medicinal preparations, sugar-reducing test strips that allow you to control sugar levels.

You can get them at government pharmacies. For children, an additional vacation is provided once a year in sanatoriums. In addition, diabetics are referred to rehabilitation to improve their general condition.

Video on the topic

Features of passing a medical and social examination (MSE) to obtain disability for diabetes:

Thus, if you have diabetes, it is quite possible to receive a disability group and provide yourself with support from the state. However, for this it is necessary to provide compelling arguments, as well as documentary confirmation. Only after this will the ITU be able to make a positive decision. If you disagree with this commission, you always have the opportunity to challenge their decision.