Diabetes mellitus is a chronic disease, the basis of which is a metabolic disorder in the human body due to the lack of production of its own insulin and the resulting high level of glucose in the blood. The main manifestations of diabetes mellitus are considered to be strong thirst, increased urination, high appetite, weakness, dizziness, and so on.
Diabetes mellitus is a chronic pathology that is constantly progressing. This disease provokes such complications as strokes, liver failure, myocardial infarction, gangrene, blindness. Also, fluctuations in blood glucose levels can provoke hypoglycemic or hyperglycemic coma.
The heterogeneity of the nature of diabetes mellitus is explained by the fact that it is not one, but a whole complex of metabolic diseases that are very different in etiology, clinic and pathogenesis.
However, all cases of diabetes mellitus have such a manifestation as hyperglycemia, which, in the absence of therapy, constantly develops and, unlike a situationally caused disease, does not return a person's sugar level to the normal range.
Classification of diabetes
Based on the heterogeneity of the disease, the classification of diabetes mellitus is very important in medicine, for which doctors all over the world try to apply a unified approach based on the classification of the World Health Organization. In 1980 and 1985, WHO offered other methods for the classification of pathology, but today they have completely lost their relevance.
Modern medicine uses the etiological classification of diabetes mellitus, which was developed in the American Diabetes Association and has been used in WHO since 1999. According to this classification, diabetes mellitus can be of 1 or 2 types, specific or gestational. Type 1 diabetes is considered to be a disease that has arisen due to the disruption of the structure of most of the beta-cells of the body, which has led to a sharp insulin deficiency. Type 2 diabetes is characterized by insulin resistance and some relative insulin deficiency or impaired insulin secretion with or without insulin resistance. Other specific forms of diabetes that are fully studied in medical science include pathologies of the exocrine nature of the pancreas, genetic defects in the functioning of β-cells, endocrinopathy, genetic pathologies of insulin exposure, drug or chemical diabetes, infectious pathology, and some types of immune mediated diabetes. Gestational diabetes mellitus includes a pathological state of lack of tolerance towards glucose in the body, which is detected for the first time during pregnancy.
Types of diabetes
Type I pathology
The basis of type I diabetes is pathogenetic insufficiency of secretion and synthesis of endocrine cells of the insulin pancreas (so-called β-cells). Such deficiency is caused by the destruction of β-cells due to viral infections, autoimmune aggression, stressful conditions and other factors.
The prevalence of this type of diabetes in the population reaches 10-15% of all registered cases of this pathology. This type of disease is characterized by the manifestation of the main symptoms in adolescence or even childhood, the rapid progression of complications due to decompensation of carbohydrate metabolism. The first type of diabetes mellitus is treated with insulin injections, which allow to normalize metabolic processes. Insulin is injected subcutaneously with a special pump-dispenser, insulin syringe, pen syringe. This type of diabetes must be constantly treated, because without therapy it develops very quickly, progresses, causing all sorts of complications such as ketoacidosis or diabetic coma.
Type II diabetes
The basis of the pathogenesis of type II diabetes is a decrease in the sensitivity of insulin-dependent tissues to its effects, that is, the formation of insulin resistance. At the start of the disease, insulin can be synthesized in the required or even overestimated amount. Losing weight and diet at the initial stage of the disease helps to normalize the carbohydrate metabolism, restores insulin sensitivity of the tissues, reduces hepatic glucose synthesis. But if the pathology starts to progress, the β-cells of the pancreas reduce insulin synthesis, which leads to the need for insulin replacement hormone therapy.
The second type of diabetes occurs in 85-90% of all persons suffering from this pathology in adulthood. The manifestation most often occurs after the age of 40 and is usually accompanied by obesity. The development of this pathology is slow, it proceeds quite easily. The clinical picture is usually accompanied by concomitant symptoms, rarely ketoacidosis develops. The stability of hyperglycemia over time provokes various angiopathies, nephropathy, neuropathy, retinopathy and other complications.
The gestational form of diabetes occurs in women during the childbearing, and after giving birth, it either disappears completely or is greatly relieved. The mechanism for the development of gestational diabetes is similar to that of the second type of pathology.
Among pregnant women, gestational diabetes can occur with a frequency of up to 5% of cases. In the course of carrying a child, this pathology brings a lot of harm to both the woman and the fetus. Also, women who have had gestational diabetes have many chances in the future to detect type II diabetes.
The effect of the gestational type of the disease on the child is most often expressed in its excessive body weight at birth (macrosomia), congenital deformities and malformations. All these symptoms are described in medical sources in the form of diabetic fetopathy.
MODY diabetes as a form of the disease
MODY diabetes is a heterogeneous group of autosomal dominant pathologies that are caused by genetic defects that contribute to the deterioration of the secretory function of pancreatic β-cells.
This type of disease can occur in 5% of all patients with pathology. A feature of MODY diabetes is the start of its development at an early age. Such patients have insulin needs, however, unlike patients with the first type of diabetes, it is rather low and is quite successfully compensable. Ketoacidosis in this type of disease is not observed, and the C-peptide indices are within the normal range.
MODY diabetes is conditionally considered an intermediate type of the disease between the first and the second, because it possesses features of one and the other disease.
The indefinite type of diabetes is a relatively new concept in medicine. In recent years, cases have increasingly begun to occur where it is impossible to determine the type of disease studied in a patient. Experts of the World Health Organization proposed to introduce a new category in the classification of diabetes mellitus with an indicator of "unspecified type" in order to speed up the development of an effective method of treating such a disease.
A distinctive feature of an indefinite type of diabetes mellitus is a set of clinical manifestations of the pathology that may be present in all previously studied types of diabetes mellitus taken together.
Pathology of the first type is most often manifested in patients under the age of 30 years. Insulin synthesis is impaired due to autoimmune lesions of the pancreas and, as a result, due to the destruction of insulin-producing β-cells. In many people, the disease begins to develop after suffering viral infections such as parotitis, hepatitis, rubella, or from the toxic effects of pesticides, nitrosamines, certain drugs, the immune response to which leads to the death of pancreatic cells. With the defeat of 80% of cells producing insulin, diabetes mellitus of the first type develops. With its autoimmune nature, this form of diabetes is often combined with other pathologies of an autoimmune nature - diffuse toxic goiter, thyrotoxicosis, and others.
In the second type of diabetes mellitus, tissue insulin resistance develops, that is, the process of losing their sensitivity to insulin produced in the body, which at the time of development of the pathology in the cells is sufficient or even an excess amount, begins.
Diabetes mellitus of the second type, as already mentioned above, is the predominant form of this disease among all patients. In obesity, insulin resistance arises due to the blocking of insulin sensitivity by the cells of adipose tissue in the body. This type of disease is more susceptible to the elderly with age-related loss of glucose tolerance.
The onset of type II diabetes can be affected by factors such as:
- genetics, which in 3-9% of cases predetermines the occurrence of pathology in a person, if his close relatives suffered from it;
- obesity, which leads to the fact that adipose tissue significantly reduces the sensitivity of healthy cells to the effects of insulin;
- improper diet based on carbohydrates and lack of fiber;
- cardiovascular pathologies leading to loss of insulin resistance;
- chronic stresses that increase the concentration of catecholamines and glucocorticoids that provoke diabetes;
- drugs with diabetic properties, for example, glucocorticoids, antihypertensive drugs, diuretics, cytostatics and others;
- chronic insufficiency of the adrenal cortex.
When the formation of insulin resistance or insufficiency of glucose in the cells enters significantly less, which increases its concentration in the blood. The body begins to look for alternative ways to utilize glucose, leading to accumulation of sorbitol, glycosaminoglycans, glycated hemoglobin in tissues. Increasing the concentration of sorbitol can lead to cataracts, neuropathy and various microangiopathies, and glycosaminoglycans provoke processes of joint damage. In order to obtain the proper level of energy, the body provokes the processes of the breakdown of protein tissue, which leads to dystrophy, skeletal weakness and weakness of the heart muscle. Fat oxidation processes are activated in the body and toxic exchange products, ketone bodies, begin to accumulate.
Hyperglycemia in diabetes mellitus provokes increased urination to help remove excess sugar, but in addition to glucose, a large amount of fluid is also excreted by the kidneys, which can cause dehydration. With the loss of glucose, the energy reserves in the body are lost, so that patients with this type of pathology lose weight drastically and severely.
Elevated glucose, dehydration and accumulated ketone bodies can cause diabetic ketoacidosis. With the progression of the disease due to high glycemic indices, the nerves, kidneys, eyes, brain, and heart of the patient are damaged.
Symptoms of the disease
Diabetes mellitus of the first type is developing very rapidly, and the second - gradually. Very often, this pathology is asymptomatic (hidden). The disease is detected randomly in studies of various pathologies, for example, the fundus of the eye or by analyzing the level of sugar in the urine or blood. And although the clinic in diabetes types I and II is different, many of the symptoms of these pathologies are the same and it can be concluded from them that the disease is present:
- dry mouth, extreme thirst, leading to polydipsia (increase fluid intake to 8-10 liters per day);
- frequent and abundant urination (polyuria);
- increased appetite (polyphagia);
- itching and dryness of mucous membranes and skin, pustular infections;
- loss of strength and performance, weakness, interruptions in sleep;
- calf cramps;
- visual impairment.
Symptoms of the first type of diabetes are always manifested by nausea, thirst, weakness, increased urination, hunger, weight loss, irritability. In children, this type of pathology is expressed by the occurrence of enuresis, which has never happened before. Very often, such diabetes causes hyperglycemic and hypoglycemic conditions, when blood sugar levels are either critically high or very low. In this case, patients urgently need to carry out rehabilitation emergency measures.
The clinical picture of type 2 diabetes is expressed by thirst, pruritus, visual impairment, fatigue, drowsiness, slow healing of wounds, infections of the skin, numbness of the legs, paresthesia. Also, patients with this disease are very often obese.
It happens that with diabetes on the face, hair growth increases, and on the legs they begin to actively fall out. Also, xanthomas (small yellow growths) may appear on the body, men develop balanoposthitis, and women develop vulvovaginitis. With the development of the disease, the human immunity decreases sharply, which leads to a deterioration in resistance to infections. With a long treatment, bone damage in the form of osteoporosis is possible. There are pains in the lower back, joints, bones, there is a high probability of dislocations and subluxations, deformations of bones, fractures that can provoke a patient’s disability.
Degrees of severity
The first degree or form of diabetes is the easiest. It is characterized by a low level of glycemia (not higher than 8 mmol per liter in the fasting state), the absence of marked fluctuations in blood sugar levels during the day, and a small glucosuria. Compensation of pathology can be easily maintained by diet therapy. At the same time, even in mild form, patients may suffer from angioneuropathy of the functional or preclinical stage.
On the second or moderate severity of glycemia, diabetes mellitus increases on an empty stomach to 14 mmol per liter, daily fluctuations in glycemia are observed, and glucosuria is not very large during the day, rarely may keto or ketoacidosis develop. The compensated form at the second stage is possible with the correct diet, which is supplemented by taking oral glucose-lowering drugs or subcutaneous insulin in a dosage of up to 40 OD per day. Patients with the second stage of diabetes mellitus may experience angioneuropathy of various stages and localization.
The third, the most severe degree of diabetes, is manifested by high levels of glycemia, exceeding 14 mmol per liter in the fasting state, pronounced fluctuations in blood glucose levels during the day, high glucosuria. Patients need constant insulin therapy, which in dosage is equal to or exceeds the rate of 60 OD. The list of diabetic angioneuropathies detected in this case is very extensive.
Stages of the disease
Under the stages of diabetes mellitus refers to successive stages of the disease. The chronic nature of the pathology implies a progression of symptoms over time.The peculiarity of the disease is the fact that with diabetes diagnosed once, the patient will never be able to recover from the disease completely, his diagnosis will remain on a lifelong basis.
As a rule, even in the early stages of the disease, hyperglycemia can affect the functionality of many organs and systems at once. Symptoms of the initial stage of diabetes mellitus can be expressed:
- increased urination;
- constant fatigue and headaches;
- decreased visual acuity;
- numbness of the limbs;
- the long process of healing wounds;
- the appearance of various skin rashes.
Most patients with diabetes suffer from reduced immunity, which leads to a high risk of developing various infections with a long and complicated course.
Under the hidden means such a stage of diabetes mellitus, in which clinical manifestations of the disease is not yet, but if you go through the examination, then its results will be a violation of tolerance towards glucose. At the same time, the level of sugar on an empty stomach can remain normal or close to the upper limit of the norm, and a couple of hours after administration of glucose, this figure will rise to the range of 7.8-11.1 mmol per liter. At the latent stage of the disease, it is urgent to begin taking preventive measures that will help prevent the development of the disease. In the absence of timely treatment, the latent stage of diabetes mellitus manifests soon in a clear.
At the last stage of the disease, all clinical manifestations of the pathology are present, and the level of sugar in the blood is significantly exceeded. Patients experience thirst, frequent visits to the toilet, dry mouth, weakness, in type 1 diabetes, the patient is losing weight rapidly, and in type 2 pathology, obesity may occur.
This stage of the disease requires an urgent request for medical help from an endocrinologist who can select an effective individual treatment. In the first two stages of diabetes, treatment can lead to stable compensation, but with the identification of the last stage, it is almost impossible to achieve this effect.
Complications and consequences
Among all possible complications due to diabetes mellitus, multiorgan disorders such as diabetic retinopathy are the most difficult to treat. Diabetic retinopathy is understood as the process of destruction of human capillaries, veins and retina, reduction in visual acuity, which can lead to retinal detachment and complete blindness. In the case of type 1 pathology, this complication may occur 10–15 years after the onset of the manifestation, and with type 2, much earlier. Moreover, such a complication occurs in 90% of cases of all diagnosed pathologies.
The conclusion about the occurrence of a similar pathology in a patient is given by an optometrist after conducting an indirect or direct ophthalmoscopy of the fundus. In this case, this complication has 3 stages. The first stage is diabetic non-proliferative retinopathy, the second is proliferative, and the third is terminal retinopathy. The non-proliferative and proliferative stage of the disease is treated by compensating for the patient’s diabetes itself.
Under diabetic encephalopathy is understood the process of diffuse degenerative damage to the human brain, which is caused by diabetes. The main signs of the patient’s occurrence of this complication are memory impairment, a decrease in the intellectual level, all sorts of neurosis-like changes, asthenia, dysfunctions of the vegetative-vascular system, and other symptoms.
The diagnosis of diabetic encephalopathy is set by the doctor during a neurological examination of the patient, during an analytical review of the results of REG, EEG, cerebral MRI. It is necessary to treat this complication only with parallel antidiabetic therapy with various vascular, metabolic, antioxidant, vitamin, psychotropic and anti-sclerotic drugs.
A severe condition in diabetes, which is triggered by a lack of insulin in the body, is called a diabetic coma. With an insufficient amount of insulin in the blood, the concentration of glucose and the "hunger" of peripheral tissues, which are dependent on insulin intake and are not capable of utilizing glucose without its participation, increase. The answer to this process is the start of gluconeogenesis in the liver (glucose synthesis) and the development of ketosis (the synthesis of ketone bodies from acetyl CoA). If the body also develops a lack of utilization of ketone bodies, ketoacidosis occurs. When accumulations of metabolic oxidized products (lactate, for example), lactic acidosis is provoked. With gross metabolic disorders, hyperosmolar coma may also develop.
The duration of a diabetic coma can last for years. In the practice of doctors, there is a known case when a patient’s diabetic coma lasted for more than 40 years.
Capillary damage to the renal glomeruli, which leads to glomerulosclerosis, is called diabetic nephropathy. At its terminal stage, the excretory functionality of the kidneys is disturbed, and a chronic type of renal failure occurs.
Today, such stages of diabetic nephropathy are known as:
- microalbuminuria is a preclinical stage without severe symptoms, with a possible transient increase in pressure, which can sometimes be triggered by other factors;
- proteinuria - a stage with persistent arterial hypertension, severe renal edema, an increased amount of protein in the urine, including a general analysis;
- Uremia is a severe stage in which, due to severe edema and complex hypertension, intoxication symptoms occur on the basis of poisoning by metabolic products.
Diabetic angiopathy, polyneuropathy, and diabetic foot should be called among other polyorgan disorders that may complicate the course of diabetes mellitus.
In diabetic angiopathy, there is an increase in vascular permeability, vascular fragility, thrombosis, atherosclerosis, coronary heart disease, intermittent claudication, diabetic encephalopathy develops. Polyneuropathy is a lesion of the peripheral nerves in a large percentage of patients with diabetes, because of which sensitivity is disturbed, swelling and chilliness occur in the extremities, burning, goosebumps and so on. There is a similar pathology many years after the manifestation of diabetes mellitus, most often its first type. Under the diabetic foot in medicine, it is commonly understood as a violation of the blood circulation process in the lower limbs, which leads to pain of the gastrocnemius muscles, trophic ulcers, destruction of the bone and joints in the feet.
To prevent all sorts of complications in identifying the disease, it is necessary to constantly treat and control the amount of sugar in the patient's blood.
Diagnosis of diabetes
When diagnosing the first and second types of diabetes, it is easy for the doctor to make a diagnosis, relying on the pronounced specific symptoms of the disease - polyphagia, polyuria, a sharp loss of body weight. However, the main diagnostic method is to identify the concentration of glucose in the patient’s blood. The glucose tolerance test is used to determine the degree of decompensation of carbohydrate metabolism.
The diagnosis requires that the clinical picture coincides with signs such as fasting blood sugar concentration of more than 6.1 mmol per liter, and 2 hours after eating and during glucose tolerance testing, more than 11.1 mmol per liter, glycated hemoglobin exceeded in terms of the level of 5.9%, sugar and acetone were detected in the urine.
EEG of the brain, ultrasound of the kidneys, rheoencephalography, rheovasography of the lower extremities are also used to diagnose the disease and its complications.
What tests do
So, for the diagnosis of diabetes, you must pass a series of laboratory tests. For this, doctors necessarily refer patients for blood donation from a finger, in which it is necessary to track glucose levels, urinalysis, which reveals ketone bodies and sugar, the determination of glycated hemoglobin (with pathology much higher than normal), insulin, C-peptide and to conduct load test demonstrating glucose tolerance. All the abovementioned analyzes have their own limits of normal indicators, therefore it is practically impossible to make a mistake when making a diagnosis, having the results of laboratory tests.
To slow the progression of the pathology and prevent the development of complications, patients need to follow all the recommendations of a diabetologist on a lifelong basis. Any treatment for diabetes is aimed at reducing the glycemic index, normalizing metabolic processes in the body, preventing complications.
The main thing in the treatment of this pathology is an individually selected diet, which provides for taking into account the age, sex, weight of the patient and those physical activities that he regularly performs. Patients are trained to count the caloric content of their own diet and take into account the amount of proteins, carbohydrates, fats, vitamin-mineral composition.
In the case of an insulin-dependent type of diabetes, the patient is advised to use carbohydrates always at exactly the same hours of the day in order to make it easier to correct the glucose in the blood with insulin injected. When the pathology of the first type is required to limit the consumption of fatty foods, since this leads to ketoacidosis. If the patient has an insulin-independent type of disease, then any type of sugar should be excluded from the diet, and the total caloric content of food per day should be reduced.
Nutrition in diabetes should be fractional, while it is necessary to distribute the daily intake of carbohydrates in order to stabilize glucose and support the main metabolic processes. It is important to use sweeteners, which are in many diabetic foods, instead of regular sugar. With a mild pathology, diet correction is sufficient to maintain the disease in a compensated form.
Drug treatment is always selected based on the type of specific pathology. Thus, in the first type of disease, insulin therapy is prescribed to patients, and in the second, hypoglycemic agents in combination with diet, and insulin can only be indicated if the tablets are ineffective, ketoacidosis, precomatosis, tuberculosis, renal or hepatic insufficiency, pyelonephritis.
Insulin intake should be carried out with systematic monitoring of glucose in urine and blood. At the same time, insulins themselves can be prolonged, intermediate and short duration of action. Prolonged insulin is introduced into the body once a day and its introduction does not depend on the meal. Sometimes prolonged insulin is prescribed to patients along with intermediate and short injections in order to approximate the compensation of diabetes.
However, the use of insulin can lead to a sharp decrease in sugar levels and a state of hypoglycemia or coma. Therefore, it is constantly required to control and change the dosage of drugs, depending on physical activity, changes in sugar level throughout the day, caloric content of the daily menu, frequency of nutrition, tolerance of the drug and other factors. When insulin therapy often occurs general and local allergic reactions, this treatment can also be complicated by lipodystrophy - the occurrence of fatty tissue dips in the places where insulin is administered.
In case of an insulin-independent type of the disease, tablets are prescribed with a hypoglycemic effect in combination with a diet. Such drugs according to the mechanism of action are divided into sulfonylurea preparations, biguanides, meglitinides, alpha-glucosidase inhibitors, thiazolidinediones.
Sulfonylurea preparations, which include glibenclamide, glycidone, carbutamide, chlorpropamide, help stimulate the production of insulin by ß-cells of the pancreas, promote better penetration of glucose into tissues. With the optimal selection of the dosage of these funds, the glucose level will be in the range of up to 8 mmol per liter., And overdose may cause hypoglycemic coma.
Biguanides are considered to include drugs that reduce the absorption of glucose in the intestine and promote the saturation of peripheral tissues with it, such as buformin, metformin, and others. Biguanides contribute to the increase of uric acid in the body, lead to severe lactic acidosis in patients after 60 years and those who suffer from renal or hepatic insufficiency or chronic infectious processes. Drugs in this group are prescribed for an insulin-independent type of pathology and concurrent obesity in young patients.
Meglitinides, such as Repaglinide or Nateglinide, help lower sugar levels and stimulate the pancreas to produce insulin. This group of agents always acts, depending on the blood sugar level at the time of administration, therefore it does not cause hypoglycemia.
Acarbose, miglitol and other alpha-glucosidase inhibitors inhibit the process of increasing sugar, blocking the enzymes that are involved in the absorption of starch. This group of remedies often leads to diarrhea and flatulence as a side effect.
Thiazolidinediones have contraindications for severe heart failure in patients. They lower blood sugar and increase insulin susceptibility of fat cells in the body.
The complex of diabetes therapy also includes teaching patients and their relatives the skills to control the level of sugar, the patient's well-being, and measures for providing first emergency aid in case of a premacomatous condition. Beneficial for the course of the disease affects the reduction of overweight and exercise moderate physical exertion. Muscular efforts in physical education increase the oxidation of glucose, reducing its concentration in the blood. You can not engage in sports when the level of sugar is more than 15 mmol per liter, in this case it is required to wait for its decrease under the influence of drugs. It is also important that physical exertion in the case of the disease under consideration be redistributed evenly to all muscle groups.
How not to get sick
Preventive measures regarding diabetes mellitus of the I group are reduced to the fact that a person takes all measures to increase the resistance of his own organism to various infectious processes and to exclude the toxic effect of harmful agents on the pancreas.
To prevent the onset of diabetes mellitus type II, it is necessary to carefully monitor your own body weight, prevent obesity, and adjust nutrition. Especially it is important to keep track of these parameters if a person has diabetes in the hereditary history.
In order to prevent decompensation or complications of the disease, it is necessary to treat the pathology in a timely manner, to comply with all the requirements of doctors and to monitor their lifestyle.
Diabetic life expectancy
Type 1 diabetes is insulin-dependent, so the patient must use insulin on a daily basis to ensure a full life for themselves. In this case, the life expectancy of such patients directly depends on how well and responsibly a person approaches their diet, physical exertion, and medications that alleviate the disease. Usually, after the pathology is diagnosed, patients live for at least 30 years, during which people have other serious chronic pathologies that shorten the life span. Typically, the first type of diabetes manifests at an early age (up to 30 years), so with a competent lifestyle, you can live with it for at least 60 years. In recent years, according to statistics, the life expectancy of patients with the considered diagnosis has increased on average to 70 years. All people who could live with diabetes of the first type longer than the standard period had a correct lifestyle, they timely controlled the level of glucose in their blood, went in for sports and took all the necessary preparations.
When considering statistical data on the life expectancy of diabetics depending on gender, we can conclude that, on average, with this disease, life expectancy is reduced in women by 20, and in men by 12 years. However, each case of the disease is individual, the body has its own protective mechanisms, therefore, these statistics in private can be significantly different from reality.
In diabetes mellitus type II, which is much more widespread than the insulin-dependent type, the manifestation of pathology occurs more often in people over the age of 50 years. Death in this case can arise not only from the diabetes itself, but also from complications of the heart, kidneys, which it causes. However, according to statistics, people with the second type of the disease live much longer than the first, and their life expectancy is reduced by only 5 years compared with healthy peers. But in the second type of diabetes, disability occurs more often, since the progression of the pathology is usually quite fast, causing complications.
Is the disability put
Disability in diabetes relies in the event that the pathology has led to significant complications in various organs and systems.
Diabetes alone is not a cause of disability assignment.
Functional impairments due to diabetes of any type are the basis for a patient’s disability. The severity of complications determines the type of disability that can be assigned to a patient who has decreased working ability due to illness. Children who have diabetes from an early age are given lifelong disability without being tied to a specific group.
With the most severe forms of diabetes and pronounced functional complications to which it leads, patients are assigned the first group of disabilities. The easy course of pathology can be the basis for the appointment of the third group, and the second is assigned to those patients who partially lose their performance from complications, but are still able to independently provide for a normal life.