Clinical examination of patients with diabetes mellitus, dispensary observation. Why is it necessary and how is the medical examination for diabetes mellitus carried out? Benefits for children with diabetes

With diabetes of any type, endocrinologist patients need expensive medications and various medical procedures. Given the sharp increase in morbidity, the state is taking various measures to support patients. Benefits for diabetics allow you to receive the necessary medicines, as well as undergo free treatment in a dispensary. Not every patient is informed about the possibility of receiving social security.

Are all diabetics eligible for benefits? Is it necessary to apply for a disability to receive them? Let's talk about this further.

What are the benefits of diabetes patients

Disability benefits

Diabetes patients who receive a disability are entitled to general benefits for all persons with disabilities, regardless of the reasons for their status.

What support measures does the state provide:

1. Health restoration activities.
2. Help from qualified specialists.
3. Information support.
4. Creation of conditions for social adaptation, provision of education and work.
5. Discounts for housing and communal services.
6. Additional cash payments.

Benefits for children with diabetes

A special category of patients is allocated to children diagnosed with diabetes. The disease affects a small body especially strongly, and with an insulin-dependent type of diabetes, a child is diagnosed with disability. It is important for parents to be informed about the benefits from the state, allowing them to reduce the cost of treatment and rehabilitation of a sick child.

Children with disabilities are granted the following privileges:

1. Free voucher to a sanatorium or a health camp with payment of travel to the place for both the child and his accompanying person.
2. Disability pension.
3. Special conditions for passing the exam, assistance with admission to an educational institution.
4. The right to undergo diagnostics and treatment in a foreign clinic.
5. Exemption from military service.
6. Cancellation of taxes.

Parents of a sick child under the age of 14 receive cash payments in the amount of average earnings.

Parents or guardians of the child are entitled to work shorter hours and extra days off. The old-age pension for these persons is provided ahead of schedule.

How to get benefits

Benefits for diabetics are provided by executive bodies upon presentation of a special document to patients. A document allowing to receive support from the state is issued to the patient of an endocrinologist or his representative at the center of diabetology at the place of actual residence.

How to get medicines

Waiver of benefits

It is assumed that if they refuse full social security, diabetics are entitled to financial support from the state. In particular, we are talking about material compensation for unused vouchers to sanatoriums.

In practice, the amount of payments does not go in comparison with the cost of rest, therefore, it is worth giving up benefits only in exceptional cases. For example, when the trip is not possible.

Diabetes mellitus is the most famous chronic ailment. To date, the therapeutic possibilities for this disease can save the lives of patients. But ensuring a long working life depends mainly on the level of organization of the patient dispensary observation.

Monitoring and prevention

Patients with diabetes mellitus are often monitored by endocrinologists. During the initial examination, patients are consulted by a number of doctors: a neuropathologist, an ophthalmologist, a therapist, a gynecologist is required for women. If necessary, the inspection is carried out by other specialists. Also, patients are required to perform a general analysis of blood and urine, plus a chest X-ray. Necessary measures will also include: determination of fasting blood glucose; study of the content of cholesterol and bilirubin in the blood, acetone and sugar in the urine (daily); measurement of body weight and height, blood pressure; conducting an electrocardiographic study.

Repeated examinations of patients with diabetes mellitus must be carried out at least once every 3 months. With a latent form, with proper treatment, the patient is removed from dispensary observation.

However, during the initial examination of a patient with a severe form of diabetes mellitus, it is carried out only in a hospital. Here, in addition to all of the above, you will have to undergo examinations by a surgeon and an otolaryngologist, and additionally determine the content of creatinine in the blood, ketone bodies and residual nitrogen. There are peculiarities of outpatient monitoring: the patient must undergo dispensary observation every 12-40 days, and with special indications, even more often.

Clinical examination as a necessary measure

is a whole complex of prevention and treatment, with the help of which it is possible to identify the disease at an early stage, to prevent its progression. Clinical examination is also a systematic treatment of a patient, maintaining a stable spiritual and physical condition, maintaining full working capacity and preventing all kinds of complications, as well as concomitant diseases.

All patients with diabetes mellitus are registered at the place of residence and in the diabetes center. This is necessary in order to monitor the treatment.

If the patient is registered, then he can be prescribed preferential drugs and an annual examination. Usually, for such a clinical examination, hospitalization in a hospital is not needed. But sometimes the polyclinic at the place of residence does not have the necessary diagnostic base, the patient is sent to the central hospital for years.

Patients with diabetes mellitus are monitored by endocrinologists. If there is no such specialist in the area, then the clinical examination is carried out by a therapist or general practitioner.

Unfortunately, the therapist does not always have time to organize the correct clinical examination of patients with diabetes mellitus. In such a situation, it is advisable for the patient to make an appointment himself and undergo all the necessary examinations.

What examinations are needed annually

Absolutely all patients are prescribed tests and instrumental studies. This examination is considered preventive. It helps to identify complications of diabetes in the early stages.

• clinical blood test;
• blood chemistry;
• general urine analysis (4 times a year);
• study of daily urine for microalbuminuria;
• fluorography (FLG);
• electrocardiography (ECG).

In a clinical blood test, the doctor evaluates the level of hemoglobin, erythrocytes, leukocytes, platelets, etc. The patient may have anemia and other pathological conditions.

In the biochemical analysis of blood for diabetic patients, the following parameters are especially important:

• calcium;
• potassium;
• sodium;
• bilirubin direct and general;
• transaminases (ALT and AST);
• creatinine;
• urea;
• total cholesterol;
• triglycerides;
• cholesterol fractions (HDL, LDL, VLDL), etc.

According to these indicators, an endocrinologist can suspect and confirm: fatty hepatosis, chronic renal failure (diabetic nephropathy), a violation of the lipid spectrum (high risk of atherosclerosis), etc.

In the general analysis of urine, the presence of glucose, acetone, bacteria, leukocytes, erythrocytes is analyzed. This analysis can be used to judge the state of carbohydrate metabolism and the state of the urinary system.

A 24-hour urine protein test (microalbuminuria) detects diabetic nephropathy at an early stage.

FLH is used to detect pulmonary tuberculosis. This infectious disease often occurs with a decrease in immunity. All patients with diabetes mellitus are at risk for tuberculosis.

An ECG is prescribed to detect gross violations in the work of the heart. Cardiogram may show heart rhythm disturbances, overload of the atria or ventricles, signs of myocardial ischemia.

If, according to the results of the analyzes, the patient has violations, then he is recommended to consult specialists: a cardiologist, nephrologist, gastroenterologist, phthisiatrician, etc.

Visiting doctors

Even if there are no violations in the analyzes, ECG and FLG, the patient still needs to visit specialists.

Every year, all patients need a consultation:

• neurologist;
• ophthalmologist;
• gynecologist (for women).

A neurologist evaluates the condition of the nervous tissue. The doctor checks sensitivity, muscle strength, reflexes. In addition, the neurologist evaluates memory, intelligence, and emotional responses. This specialist most often diagnoses peripheral sensorimotor neuropathy and encephalopathy in diabetic patients.

The optometrist detects eye diseases.

At the reception the following is necessarily assessed:

• visual acuity;
• the state of the vessels of the fundus;
• transparency of the eye environment (vitreous body, lens);
• intraocular pressure.

Examination can reveal complications of diabetes:

• diabetic retinopathy;
• diabetic glaucoma;
• diabetic cataract.

According to the results, treatment can be prescribed: active observation, drops, other medicines, surgery.

An annual examination by a gynecologist of women with diabetes is needed to identify infectious and oncological processes, and other gynecological diseases.

In addition, the doctor advises on contraception and pregnancy planning.

Where to be observed

Clinical examination is carried out in the district polyclinic at the place of residence. To register and begin to be monitored, you need to come to the doctor's appointment with documents (passport, policy, SNILS card, extracts).

If it is inconvenient for you to be monitored at the place of registration, then choose a more suitable medical institution. Registration may require permission from the head of the polyclinic and a certificate from the medical institution at the place of registration.

Specialized care for patients is also provided at the Diabetes Centers. These departments can be organized in the central district hospital, city or regional hospital.

Diabetes centers usually have a fairly good diagnostic base, consultations of doctors of various specialties (podiatrist, vascular surgeon, andrologist, etc.) are organized.

Also, the Diabetes Centers hold regular classes for patients. These educational programs are called the "Diabetes School". It is advisable to attend such classes every year. The educational program is regularly updated and expanded.

The patient himself should be able to determine the sugar content in urine at home using the glucotest indicator strips, and if they are absent using the Althausen, Trommer or Nielander reactions, determine the acetone content in urine using acetone express determination kits, blood glucose using indicator strips such as dextranal or glucosamtest. The patient should be educated to be careful ...

Clinical examination of patients with diabetes is a system of preventive and therapeutic measures aimed at early detection of the disease, prevention of its progression, systematic treatment of all patients, maintaining their good physical and mental condition, maintaining their ability to work and preventing complications and concomitant diseases. Well-organized dispensary observation of patients should ensure that they eliminate the clinical symptoms of diabetes - thirst, polyuria, general ...

Medical examination of the population for diabetes mellitus includes the following activities. Active identification of patients with diabetes mellitus and persons with impaired glucose tolerance The need for active detection is determined by the ability to prevent or delay the development of diabetes mellitus. It should be carried out by doctors of various specialties using preventive departments in polyclinics. Ideally, it is necessary to cover the entire population of the area served by the polyclinic with prevention ...

Teaching diabetes patients in self-control methods, medical education for their families and medical workers.This is the basis for maintaining stable compensation for diabetes mellitus, preventing complications and maintaining the ability to work, an integral part of clinical examination and is aimed at preventing both diabetes and its complications. Well-organized education enhances the health and lives of the sick, providing consistent social and economic benefits to the community….

There are 5 interrelated groups for education: people with diabetes, their families, medical personnel, people with risk factors for diabetes mellitus and health organizers planning the development of care for patients with diabetes and diabetes prevention. Education should be aimed at specific groups of patients according to age, type of diabetes, complications. Immediately after establishing the diagnosis, it is necessary to carry out treatment and ...

Registration of patients with diabetes mellitus Registration of patients with diabetes mellitus is carried out by an endocrinologist. This is important for the diagnosis of emergency conditions accompanied by loss of consciousness. It is desirable for a diabetic patient to have a diary in which he enters data on the dose of insulin, oral hypoglycemic drugs, diet, the results of the study of glycemia, glucosuria and acetonuria, changes in well-being. Diabetes outpatient records should be labeled. It is advisable to divide the patient cards ...

Dynamic observation of patients with diabetes The frequency of observation of patients depends on the course and severity of diabetes. Ophthalmologist, neuropathologist, therapist remain permanent consultants. The rest of the specialists are involved as needed. During pregnancy, the patient is observed together with an obstetrician-gynecologist. Persons with impaired glucose tolerance are examined by a therapist 1-2 times a year, an endocrinologist upon request, and other specialists, if necessary. Try…

For patients with severe diabetes, an endocrinologist is examined once a month, and more often if necessary. Glycemia is determined on an empty stomach and 2 hours after eating, and, if necessary, at other hours, it is better to examine the daily glycemic profile. Daily and portioned glucosuria are checked once a week, on other days of the week the patient, using a glucotest, conducts a glucosuria study ...

System of self-monitoring of patients with diabetes mellitus as part of dispensary observation. Like every chronic non-communicable disease, diabetes mellitus requires systematic monitoring. This control is carried out in the course of dispensary observation. However, diabetes mellitus has features associated with maintaining a stable compensation. Dispensary observation cannot fully ensure its achievement if there is not sufficient cooperation between the doctor and the patient. In each case ...

The medico-social importance of diabetes mellitus requires preventive measures to reduce morbidity, maintain working capacity and increase the life expectancy of patients. Modern information on the etiology and pathogenesis of diabetes mellitus, epidemiological studies that allow obtaining data on the prevalence of not only diabetes mellitus, but also its vascular complications, risk factors and natural evolution of the disease are becoming the scientific basis for preventive measures. The prevention strategy is based ...

In the prevention of IDDM, you can use primary prevention in genetically predisposed to diabetes mellitus relatives of the 1st degree of relationship (including healthy identical twins) and very early introduction of strict control over compensation for newly diagnosed diabetes mellitus. Primary prevention in relatives of IDDM patients is based on HLA typing, which makes it possible to determine which of them is predisposed to the disease. For relatives with ...

The second way used in the prevention of IDDM is early intervention in immunopathogenesis in newly diagnosed patients. Currently, various methods are available for early intervention in the processes of immunopathogenesis of IDDM. Glucocorticoids, plasmapheresis, anti-lymphocyte serum, cyclosporin A, interferon and antimetabolites (cyclophosphamide, azathioprine, etc.) are used. In the experiment, such interventions brought some success. However, their use in clinical practice ...

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Chapter 7
DISPENSARY SUPERVISION OF CHILDREN WITH DIABETES.
METHODS OF EXPRESS DIAGNOSTICS, INFORMATION

Dispensary observation

Active and systematic dispensary supervision of children with diabetes mellitus is now firmly established in life. In the USSR, a wide network of anti-goat dispensaries has been created, and the number of specialized offices in children's polyclinics, staffed by trained pediatric endocrinologists, has increased. The work of a pediatric endocrinologist should be based on the principle of active clinical examination and be carried out in a comprehensive manner, in close contact with doctors of other related specialties.
It is necessary to strive for full coverage of all children with diabetes mellitus with medical examination. The doctor's duties include carrying out medical measures at the modern level of scientific knowledge, organizing health-improving (preventive) hospitalization, analyzing the effectiveness of dispensary observation, identifying and registering persons with impaired glucose tolerance and with the greatest risk of illness, sanitary and educational work.
For each patient with diabetes mellitus, who is under dispensary observation, a dispensary card (form No. 30) is drawn up, which records the data of laboratory tests, the dose of insulin or other hypoglycemic drugs, the sugar value of food, the ratio of food ingredients. Indicate the severity of the disease, its complications, concomitant diseases. This card cannot replace the history of the disease and is an auxiliary document in checking the regularity of observation of the patient and the course of his treatment, and also serves to study and control the effectiveness of clinical examination.

A child with diabetes mellitus should be examined by an endocrinologist at least once a month, and more often if indicated. When examining a child, it is necessary to have data on the portioned glucosuric profile and on the blood sugar level (on an empty stomach or selectively during the day). With different types of insulin, the pediatric endocrinologist is able to find the most effective treatment options in accordance with the profile indicators. In a planned manner, 2 times a year, the child should be examined by an ophthalmologist and a neurologist, and, if indicated, by other specialists. For a comprehensive clinical and laboratory research, determining the need for insulin, establishing an appropriate diet and conducting complex drug therapy, hospitalization of the child is desirable.
Apparently, the widespread introduction of a single book of a patient with diabetes mellitus is advisable. It should be issued to every patient taken for dispensary observation. In the book, in addition to the passport data, the visit to the sick doctor, the main appointments and their implementation are noted. This is especially important for children living far from specialized care. With the sudden development of a coma in a patient, the book will help determine urgent therapeutic measures.
Patients with diabetes mellitus must be provided with the possibility of staged treatment: inpatient treatment, regular dispensary observation in a polyclinic and sanatorium treatment. The creation of specialized sanatoriums, pioneer camps for children with diabetes mellitus is certainly advisable. The correct organization of the rest of children during the holidays in specialized sanatorium groups of pioneer camps helps to consolidate the results of treatment. In 1984, the staff of the pediatric clinic of the Institute of Ethnology and the Chemistry of the USSR Academy of Medical Sciences developed guidelines for the clinical examination of children with endocrine diseases, which will help the pediatrician / endocrinologist, school doctor to properly organize dispensary observation of children with diabetes mellitus (see Appendix).