Sanatoriums for the treatment of type 2 diabetes. Diabetes
The first information about the treatment of patients diabetes in the resort of Luhacovice (Czech Republic), the alkaline waters of the Aloiska spring date back to the beginning of the 19th century. In the 1860s The Czech resort of Karlovy Vary became popular among diabetic patients, it was even called the "hospital for diabetics". The effect of Karlovy Vary waters was considered especially favorable in case of complications of diabetes mellitus with liver diseases, chronic gastric catarrh (gastritis), nervous disorders, gout (which was understood as diseases of the joints against the background of metabolic disorders). The waters of the French Vichy resort were considered equally effective in diabetes mellitus, since, according to many doctors, they regulated and increased metabolism. In the initial forms of diabetes mellitus, especially in neurotic syndromes, manifested by irritability, bad mood, insomnia, treatment in Baden-Baden was recommended, and the effect was explained by the presence of arsenic in Baden waters. However, one of the main factors in diabetes mellitus was considered the dietary regime, against which all other resort factors favorably acted: climate, change of scenery, drinking treatment with healing waters, baths.
Scientific clinical and experimental work on the use of drinking treatment for diabetes with the waters of the Essentuki resort began in the first half of the 20th century. Resort endocrinology has developed especially rapidly since the 60s, when it became possible to determine the hormonal status in diabetes mellitus. Studies have shown that of all the mineral springs of the resort cities of the Caucasian Mineral Waters, the Essentuki mineral waters have the most pronounced positive effect on the state of carbohydrate metabolism and its hormonal regulation, and therefore the Essentuki resort is currently the leading resort in Russia, where they can get a full-fledged and qualified medical care patients with diabetes mellitus.
Relevance of the problem:
Diabetes mellitus, which ranks third as a cause of death after cardiovascular and oncological diseases, was recognized by WHO experts as a non-communicable epidemic of the 20th century. According to various sources in the world, there are from 120 to 180 million patients with diabetes mellitus, which is 2-3% of the total population of the planet. The number of patients with diabetes mellitus continues to increase steadily, according to forecasts, a twofold increase in the number of patients is expected every 15 years. The existing modern conditions put before the resort medicine the solution of the problems of improving the methods of treatment of diseases that are socially significant for the country. One such disease is diabetes mellitus.
*Decree of the Government of the Russian Federation of December 1, 2004 No. 715 “On approval of the list of socially significant diseases and a list of diseases that pose a danger to others” (With amendments and additions from: July 13, 2012) [Appendix. P. 7. E 10 - E 14 diabetes mellitus]
Improve the quality of life of patients with diabetes mellitus, increase their life expectancy allowed the success of insulin therapy and the use of glucose-lowering tablets. However, under these new conditions, chronic, so-called late complications of diabetes mellitus from various organs and systems, primarily vascular and neurological, have moved to the fore, which lead to long-term disability, early disability and determine the prognosis of patients with diabetes mellitus.
The following figures speak of how severe and dangerous the complications of diabetes mellitus are: in type II diabetes mellitus, 40% of patients die from myocardial infarction and 20% from stroke; in type I diabetes, the most common cause death is chronic kidney failure. The following data are even more illustrative: every 4th blind person, every 5th person dying from uremia, every 2nd patient with non-traumatic amputation are patients with diabetes mellitus
The problem of diabetes is acute all over the world. Therefore, the world community, at the initiative of the International Diabetes Federation and the WHO Regional Office in Europe, in 1989 adopted the Saint Vincent Declaration, emphasizing the importance of measures to reduce mortality and disability in patients with diabetes mellitus.
World Diabetes Day has been celebrated around the world every year on November 14* since 1991.
*date chosen in recognition of the contributions of one of the discoverers of insulin, Frederick Banting, born November 14, 1891.
Treatment of diabetes mellitus and its complications is a difficult task, patients need constant monitoring of the state of metabolism, correction of existing disorders, treatment and prevention of complications. Therapeutic measures are carried out throughout the life of patients; they include a significant arsenal of drugs that require long-term complex administration, which often leads to polypharmacy, accompanied by side and allergic reactions. These circumstances lead to the search for various non-drug methods, among which a special place belongs to the use of natural and preformed physical factors.
Specialized resort treatment centers within the framework of the Federal Target Program "Diabetes Mellitus"
Within the framework of the Federal target subprogram "Diabetes mellitus" * in 2002 in Essentuki on the basis of the sanatorium named after M.I. Kalinin, where by that time more than 10 years of experience in treating patients with diabetes mellitus in a resort had been accumulated, the Federal Center for the Rehabilitation of Patients with Diabetes Mellitus by Natural Factors was established. Currently, the sanatorium is designed for accommodation and treatment of 360 people at the same time, there is a department "Mother and Child", where children with diabetes mellitus aged 4 years and over are admitted for treatment.
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* Federal target subprogram "Diabetes mellitus", approved by Decree of the Government of the Russian Federation of November 13, 2001 No. 790.
Currently, the Federal Target Program "Prevention and Control of Socially Significant Diseases (2007-2012)", which includes the subprogram "Diabetes Mellitus", is in operation, approved by a Government Decree Russian Federation dated May 10, 2007 No. 280
Within the framework of the Federal Program for the treatment of children with diabetes, a specialized department was created in the Malakhovka children's sanatorium (Moscow Region), and sanatorium treatment was organized in 28 regions of the country on the basis of local sanatoriums. The sanatoriums employ diabetologists who have specialized in the Department of Endocrinology of the Russian Medical Academy of Postgraduate Education in Moscow.
The main natural factors of spa treatment for patients with diabetes mellitus: climatotherapy (aerotherapy, heliotherapy), drinking treatment with mineral waters, balneotherapy, mud therapy, apparatus physiotherapy.
On the procedure for medical selection and referral of patients with diabetes mellitus to sanatorium-and-spa treatment
When choosing a resort, one should take into account the type of diabetes mellitus, the severity, the nature of the course and the state of diabetes compensation; the presence of complications and concomitant lesions of various organs and systems.
The list of mandatory diagnostic studies before resort treatment includes: clinical analysis of blood and urine, determination of glucose levels in blood and urine, ECG, x-ray examinations of the chest organs, According to indications, additional studies are carried out: glucose tolerance test (GTG), glycosylated hemoglobin (HbA1c); Ultrasound of the abdominal organs.
Indications and contraindications for spa treatment of adults and children with diabetes mellitus
Spa treatment is indicated persons with prediabetes, impaired glucose tolerance, patients with type I and II diabetes mellitus of mild and moderate severity in a state of stable compensation, without a tendency to severe acidosis, initial stages microangiopathies, as well as patients in whom diabetes mellitus is combined with diseases of the digestive system, liver and biliary tract, urinary system, and circulatory organs.
Extract from the Order of the Ministry of Health of Russia dated 05.05.2016 No. 281n “On approval of lists of medical indications and contraindications for sanatorium treatment”
Medical indications for spa treatment of adults (Appendix No. 1) and children (Appendix No. 2) with diseases of the endocrine system, eating disorders and metabolic disorders (class IV according to ICD-10)
Indications for spa treatment of adults
Type 1 diabetes mellitus within the target values of glycated hemoglobin, with a stable course, without a tendency to ketosis, after completion of inpatient treatment, including in the presence of polyneuropathiesSanatorium-resort organizations in the climatic zone of the patient's residence.
Balneological resorts with drinking mineral waters
With glycated hemoglobin values close to the target, with a stable course, without a tendency to ketosis, after completion of the stage of inpatient treatment, including in the presence of polyneuropathies
Balneological resorts with drinking mineral waters, as well as carbonic, sodium chloride and radon waters
Indications for spa treatment of children:
E10 Insulin-dependent diabetes mellitus
Sanatorium-resort organizations in the climatic zone of the patient's residence.
Resorts:
1) climatic;
E11 Non-insulin dependent diabetes mellitus
a) in a state of compensation and subcompensation;
b) burdened (in remission) chronic cholecystitis, cholangitis, biliary dyskinesia, intestinal dyskinesia, gastritis, peptic ulcer stomach and duodenum, angioretinopathy stage 1-2, polyneuritis
Sanatorium-resort organizations in the climatic zone of the patient's residence.
Resorts:
1) climatic;
2) balneological with drinking mineral waters
Spa treatment is contraindicated patients with severe diabetes mellitus, with malnutrition, severe acidosis, pre-coma; patients with diabetes in the phase of severe decompensation of metabolic processes with significant hyperglycemia and glucosuria, ketosis; in the presence of a labile form of diabetes; with the inability of patients to recognize the initial manifestations of hypoglycemia, as well as patients in whom hypoglycemic conditions are manifested by a rapid loss of consciousness.
General contraindications to spa treatment
Treatment of patients with diabetes mellitus in a resort is aimed at the prevention and treatment of metabolic disorders, complications and concomitant diseases; improving the general condition of patients, increasing their ability to work. Sanatorium-resort treatment with the use of resort factors is carried out against the background of insulin therapy, the use of oral sugar-lowering drugs (according to indications), which patients must be provided with at their place of residence.
Insulin and oral sugar-lowering drugs in the amount sufficient for the entire period of spa treatment should be obtained at the place of residence
Principles of spa therapy for diabetes
The basic principles of sanatorium treatment of diabetic patients include the appointment of a physiological diet, adequate insulin therapy or oral antidiabetic drugs, dosed physical activity and sanatorium rehabilitation. Prevention and treatment chronic complications, primarily angioneuropathy, is to achieve stable compensation for diabetes and the appointment of angioprotectors. A prerequisite for successful treatment is training and self-control.
Methods of spa therapy for patients with diabetes mellitus were mostly developed by scientists from the Pyatigorsk Research Institute of Balneology. In the clinics of the Research Institute of Balneology and sanatoriums of Russia, against the background of a sanatorium regimen, diet therapy, taking sugar-lowering drugs or insulin, a variety of therapeutic factors are used. These methods became the basis of the standards of health resort care for patients with diabetes mellitus in the stage of compensation, subcompensation with an uncomplicated course, approved by Order No. 220 of the Ministry of Health and Social Development of the Russian Federation dated November 22, 2004.
Drinking mineral water treatment for diabetes
The leading in the treatment of diabetic patients at the resort stage is drinking treatment with mineral waters: hydrocarbonate, hydrocarbonate-sulfate [Vichy, Essentuki, Karlovy Vary, Krasnousolsk, Lugacovice, Tovry]; sulfate [Dorohovo]; weakly radon [Narechensky baths]; magnesium-containing [Rogaska Slatina]) which can be prescribed for any severity of the disease *.
*The resorts mentioned in the article are given.
Drinking mineral waters in patients with diabetes mellitus have a positive effect on carbohydrate and lipid metabolism: they reduce hyperglycemia and glucosuria, while the effect of certain enzymes that promote the penetration of glucose into tissues increases, and the lipid spectrum of blood serum improves. At the same time, the processes of tissue metabolism of carbohydrates improve, the formation of adenosine triphosphoric acid (ATP) increases, during the decay of which a large amount of energy is released. In addition, mineral waters significantly increase the sensitivity of insulin receptors to insulin, and therefore, in almost diabetic patients, the need for exogenous insulin and hypoglycemic tablets is reduced.
Hydrocarbonate and sulfate waters affect carbohydrate metabolism, normalizing blood insulin activity, increasing the activity of the hexokinase enzyme, which promotes the penetration of glucose into tissues, which leads to a decrease in hyperglycemia and glycosuria.
Hydrocarbonate ion plays an important role, first of all, in maintaining the acid-base balance. With mild and moderate diabetes, as a result of the use of hydrocarbonate waters, carbohydrate metabolism improves, the sugar content in the blood and urine decreases. As a result of taking these waters, dyspeptic symptoms (heartburn, belching, feeling of heaviness in the epigastric region, etc.) are eliminated.
Magnesium mineral waters regulate intestinal motility, and also contribute to the formation and secretion of bile. A decrease in the concentration of magnesium ions in the blood by 10-12% in diabetes mellitus has been proven. Therefore, the additional intake of magnesium ions by internal intake mineral water allows you to effectively replenish the reserves of magnesium homeostasis and promote the activation of metabolic reactions.
Methods of drinking treatment for diabetes mellitus have been developed and clinically confirmed by studies at the leading resorts in Russia and Europe.
According to studies conducted at the Dorokhovo resort (Moscow region), the use of magnesium-calcium sulphate Dorokhovskaya mineral water in the treatment of patients with diabetes contributes to the creation of a reserve of substances in the body that determine insulin activity, and microelements contribute to the inactivation of the insulinase enzyme, thereby normalizing the level of glucose in the blood. In most cases, with diabetes, mineral water is prescribed 200 ml 3 times a day. The time of taking mineral water and its temperature are set depending on the concomitant pathology. gastrointestinal tract according to general indications.
Complex spa therapy with the use of drinking mineral waters of the Essentuki type has a positive effect on the functional state of the kidneys and the ophthalmoscopic picture of the fundus in patients with diabetes mellitus with microvascular complications (diabetic retino- and nephropathy), as evidenced by studies conducted at the clinic of the State Scientific Research Institute of Balneology in Pyatigorsk .
Similar studies were carried out by the Ternopil State Medical Academy in the Tovtry sanatorium, Khmelnytsky region (Ukraine). Clinical and immunological examination was carried out in 65 patients with type I and II diabetes mellitus who were on sanatorium treatment in the sanatorium "Tovtry" after a course of treatment with "Zbruchanska Naftusya" - a low-mineralized (M - 0.88 g / l) hydrocarbonate sodium-magnesium mineral water at a dose of 10 ml per kg of weight three times a day 45 minutes before meals. We observed a pronounced positive effect of mineral water on the clinical course of the disease, as well as laboratory parameters: bilirubin, cholesterol, blood serum and urine glucose. A nonspecific immunomodulatory effect of mineral water from the Zbruchany deposit was revealed, which was more pronounced in patients with type 2 diabetes mellitus.
The results of studies conducted by the Research Institute of Rehabilitation Medicine and Balneology of the Belarusian State Medical University in the sanatorium Krasnousolsk (Republic of Bashkiria) showed that mineral drinking water has a preventive effect on the progression of glucose intolerance disorders, thereby delaying the timing of the manifestation of diabetes. Treatment at the resort makes the course of diabetes mellitus more benign, helps to reduce clinical manifestations, and in some cases, preventing the occurrence of complications, reduces the manifestations of concomitant ailments.
A special place in the drinking treatment for diabetes mellitus is occupied by magnesium-containing mineral waters. Magnesium ions occupy a special position in the general range of macro- and microelements. Together with calcium ions, magnesium will determine the activity of more than 300 enzymes. The role of magnesium in maintaining the optimal functioning of cardiomyocytes is known, and its deficiency provokes the development various diseases hearts. In addition, magnesium, through various mechanisms, controls blood pressure. Finally, magnesium ions are necessary to ensure the processes of digestion, since, on the one hand, they regulate intestinal motility, and on the other hand, they contribute to the formation and secretion of bile. A decrease in the concentration of magnesium ions in the blood by 10-12% in diabetes mellitus has been proven. Therefore, the additional intake of magnesium ions through the internal intake of mineral water allows you to effectively replenish the reserves of magnesium homeostasis and promote the activation of metabolic reactions, which is vital in diabetes.
The results of clinical testing of therapeutic mineral water "Donat Mg" (Mg content 1014 mg / l) (Rogashka Slatina resort, Slovenia) on the basis of the endocrinological department of the ICD No. 11 and the diabetological sanatorium named after. Chkalov testify to the high efficiency of crenotherapy with magnesium water in the complex treatment of patients with diabetes mellitus.
Drinking treatment with bottled mineral waters, such as "Donat Mg", Essentuki No. 17, Essentuki No. 4, Yessentuki "New", it is advisable to include in the complex therapy of diabetes mellitus in the post-resort period. Mineral waters have an impact on the main links in the pathogenesis of diabetes mellitus and its manifestations. At the same time, there is an improvement in the islet apparatus of the pancreas, which manifests itself in optimizing the producing ability of beta cells by increasing the labile and basic pools of insulin, the effectiveness of its action in tissues. The disturbed interaction of insulin and glucagon is restored. Activated enteric-pancreatic and neuroendocrine relationships, secretion of gastrin, intestinal hormones that actively affect the function of the islet apparatus of the pancreas. Counter-insular effects are inhibited, which relieves intense stimulation of islet beta cells and leads to an increase in their functional reserves.
With concomitant diseases of the digestive system in patients with diabetes, other methods of internal use of mineral water are also prescribed: duodenal drainage, gastric lavage, microclysters, siphon intestinal lavages. Rectal methods of introducing mineral water in patients with diabetes contribute to the rapid elimination of ketoacidosis.
Comprehensive spa treatment for patients with diabetes mellitus
The best and longer effect of spa treatment (up to 10-14 months) for diabetes is achieved with a combination of drinking treatment and balneotherapy procedures.
Mineral baths have a normalizing effect on the neuroendocrine regulation of metabolism, the level of redox processes, the activity of internal organs and physiological systems. They contribute to the formation of biologically active substances, which leads to a change in the regulation of the activity of both individual internal organs and entire functional systems, including the endocrine system. When taking mineral baths in patients with diabetes mellitus, a favorable dynamics of indicators of all types of metabolism was noted, the functional state is activated nervous system, metabolism, while it has a positive effect on neuroregulatory mechanisms, contributing to the normalization and stabilization of hemodynamics. Mineral baths significantly enhance non-specific protective factors and improve specific immunity, improve carbohydrate and other types of metabolism, in addition, have a positive effect on the course of concomitant diseases of the cardiovascular and nervous systems, digestive organs, musculoskeletal system, skin, kidneys, sexual spheres, etc. The most significant effect is observed when using gas mineral baths: carbon dioxide, carbon dioxide-hydrogen sulfide, radon.
Carbonic baths increase the tone of the nervous system, have a beneficial effect on the cardiovascular system, improve metabolism. Under the influence of carbon dioxide baths, expansion occurs small arteries, capillaries, their number increases, capillary blood flow accelerates, which is especially important for patients with angiopathy.
Application "dry" carbonic baths in complex spa therapy plays an important role in the prevention and treatment of diabetic microangiopathies. Unlike aqueous carbon dioxide baths, they do not cause a significant redistribution of circulating blood and negative reactions from the heart.
radon water contribute to the improvement of microcirculation in tissues, normalization of pancreatic function, lower blood sugar levels, and are effective in the treatment of angiopathy and other complications of diabetes mellitus.
Sulfide (hydrogen sulfide) baths(Matsesta type) contribute to the intensification of carbohydrate metabolism, which leads to a decrease in hyperglycemia in patients with diabetes mellitus.
Mud therapy can be used only in 10-15% of all patients with diabetes mellitus (according to studies of the Essentuki resort and the Pyatigorsk Research Institute of Balneology), since this often increases the activity of the cortical and medulla of the adrenal glands, and according to some reports, excitability sympathetic department nervous system. In some cases, these mechanisms lead to a deterioration in the state of carbohydrate metabolism, especially in case of poor compensation and a severe course of the disease. In this regard, the use of mud therapy in people with diabetes is very limited, requires caution and special monitoring of the condition of patients.
Physiotherapy, unlike mud therapy, does not have a negative effect on impaired carbohydrate metabolism and is the method of choice in the treatment of patients with diabetes mellitus in a state of sub- and decompensation, with a severe or labile course of the disease.
Especially effective is the use of "dry" carbonic baths in complex spa therapy, which play an important role in the prevention and treatment of diabetic microangiopathies.
Phytotherapy, acupuncture, psychotherapy, physiotherapy exercises are also widely used in complex spa treatment.
Physiotherapy exercises in the complex spa therapy of patients with diabetes mellitus in the form of special kinesitherapy complexes, according to studies conducted in the endocrinology clinic "SKK Narechenski Bani" (Bulgaria), are pathogenetically substantiated and have a high therapeutic significance. Studies by many authors prove that systematic physical exercise, adequate to the patient's condition, reduce the need for hypoglycemic drugs. The adequacy of the load is determined by the exercise therapy doctor together with the endocrinologist by changing the level of hyperglycemia, glycosuria, and body weight.
Wide spectrum medical procedures, used in the spa therapy of patients with diabetes mellitus, allows you to choose an adequate treatment method for each patient, taking into account the severity of the underlying disease, its complications and concomitant pathology and ensure the maximum effect of the therapy. For example, complex treatment of patients with diabetes mellitus in the Bulgarian National rehabilitation center"SKK Narechensky Baths" included drug therapy, diet therapy, drinking treatment of low-mineralized (1.46 g/l) weakly radon, bicarbonate-sulfate sodium mineral water, physiotherapy, kinesitherapy, hypnotherapy. As a result of treatment, positive dynamics was revealed clinical symptoms, a statistically significant decrease in blood sugar (from 10.2 mmol / l to 5.85 mmol / l), a significant improvement in lipid metabolism.
With timely referral to spa treatment at an early stage of diabetes mellitus and with initial manifestations of complications, it is highly possible to achieve stabilization of the process, and in some cases regression of the disease, and prevention of complications.
Spa treatment should occupy a special place in the treatment of patients with diabetes in cases where diabetes mellitus occurs against the background of concomitant diseases of the gastrointestinal tract, liver, biliary tract, and obesity.
Currently, the treatment of patients with diabetes mellitus is organized in many specialized specialized sanatoriums for the treatment of patients with diseases of the digestive system. Meanwhile, this category of patients needs treatment for other diseases.
It is generally accepted that a rational diet plan and pharmacological hypoglycemic therapy are the basis for the treatment of patients with diabetes mellitus. Statistics show that 17% of all conflict situations regarding poor-quality organization of medical care in resorts are associated with diabetes mellitus, namely, the lack of proper catering for this category of patients in sanatoriums. According to Israeli doctors, the diet of a diabetic is the ideal diet for any healthy person. In all specialized sanatoriums, 6 meals a day are organized according to two diets: for patients receiving insulin and for patients with non-insulin-dependent diabetes mellitus.
In many sanatoriums, the "School of Diabetes Management" has been introduced into the treatment complex for patients with diabetes, which teaches the patient to manage his disease, control the course of diabetes and thereby actively participate in treatment. In the "School of Diabetes Management" patients are taught self-control, the principles of rational nutrition, methods of dosed physical activity, correction of insulin doses depending on the level of glycemia. AT comfortable conditions resort, surrounded by attentive and highly qualified staff, patients learn to live with their illness much faster, achieving at least a lasting improvement.
Recognizing the unconditional priority of preventive balneology, however, it should be noted that this type of medical care is needed by a category of patients with long-term, often recurrent diseases that are in the stage of subcompensation. This is primarily due to the desire of patients to be treated in more comfortable conditions that the resort can offer with the possibility of combining non-drug therapy with highly effective pharmaceuticals and modern medical technologies. Treatment of this category of patients is possible only if the principles of phasing of therapy and continuity between city health care facilities and health care facilities of resorts are observed. In the domestic and world practice of spa medicine, the circle of persons indicated for resort rehabilitation and the range of indications for the use of drinking water, mud, and balneotherapy are significantly expanding. The main principles of carrying out rehabilitation measures in long-term whitening patients with diabetes mellitus are the principle of a systematic analysis of the clinical status for the individualization of rehabilitation programs, the principle of specialization and integration.
Another important aspect of spa treatment for patients with diabetes is dialysis at the spa. Patients with diabetes mellitus with diabetic nephropathy can undergo complex treatment in Russia (Sestroretsky resort) and the Czech Republic (Marianske Lazne, Windsor clinic in the Pacific Astoria sanatorium).
Mineral waters, climatotherapy, landscape therapy, along with the methods of orthodox medicine, significantly increase the effectiveness complex treatment this category of patients. According to recent studies, the mental state of patients requiring permanent dialysis is regarded as an astheno-depressive syndrome. Symptoms of depression are often "masked" by a decrease in contacts, initiative, sleep disorders, and appetite. These patients need sanatorium-and-spa treatment, and simply high-quality rest, which was impossible until recently. The possibility of dialysis in a resort is a new direction in the treatment of this severe pathology, which can not only improve the patient's condition, but also significantly improve the quality of life.
Comprehensive spa treatment of patients with diabetes has a diverse effect on the body. Treatment at the resort helps to improve the general condition, increase or restore working capacity, favorably affects metabolic processes disturbed in diabetes, improves the function of the gastrointestinal tract, nervous and endocrine systems. Treatment at the resort makes the course of diabetes mellitus more benign, prevents the occurrence of complications, and reduces the manifestations of concomitant diseases.
The author has developed a resort selection system (table), which reflects the main natural healing factors. The resorts of Russia and Europe are systematized by regions and, consequently, by the climatic zone. This is especially important for people with chronic diseases and the elderly, as well as during short courses of spa therapy, since the processes of adaptation and re-adaptation that inevitably occur when changing climatic conditions can significantly reduce the effect of treatment and even worsen the course of the disease. The table shows the climatic characteristics of the resorts, the main types of mineral waters, therapeutic mud.
Given the fact that in Russia there is a unique resort and recreational potential focused on the provision of medical services, the resort search system allows you to choose a resort taking into account the main and concomitant (competing) diseases in any region of Russia. The system of listing resorts also includes resorts in Europe, available to the Russian consumer of spa services and represented on the market by leading travel companies.
The list of resorts in Russia and Europe indicated for diabetic patients includes resorts and sanatoriums operating under special programs for the treatment of diabetic patients, organizing "diabetes management schools", as well as sanatoriums accepting patients with concomitant and competing diseases that occur for treatment. on the background of diabetes.
Diabetes mellitus is an insidious disease that sometimes sneaks up unnoticed and gradually destroys human health. The best way to deal with the disease - healthy lifestyle life supportive therapy, spa treatment.
The choice of a sanatorium depends on a number of reasons. This is its location, and the medical base, and the cost of the ticket. Patients have many options. Let's talk about them in more detail.
Health resorts in Belarus
From the moment a person is diagnosed with diabetes, he must pay close attention to his health. Visiting sanatoriums and boarding houses in Belarus is good option rest and recovery. Of course, it is necessary to come to be treated not when serious complications of the disease appear. but during a relatively quiet period. The mild climate, coniferous forests, a high level of service, affordable prices - all this makes the resorts of Belarus very popular. For the treatment here are used such effective methods how:
- heliotherapy
- baths - ozone and oxygen
- physiotherapy
- magnetotherapy
In addition, patients drink mineral water, which has an immunostimulating effect. They are also prescribed walks and medical nutrition.
Sanatoriums Essentuki
Many people come to this well-known resort of Kavminvod precisely in order to treat diabetes. The basis of therapy is the intake of mineral water and healing baths. They help here to cope with the manifestations of the disease not only for adults, but also for children, starting from 4 years old. Parents and kids have the opportunity to live together and undergo treatment depending on their specific health disorders: after all, Essentuki is a multi-profile resort. Doctors begin their work with patients by teaching them to follow a certain diet. The list of procedures includes baths, mud, massage, physiotherapy. The use of currents of various frequencies is popular.
Pay attention here and the psychology of patients. Everyone knows how difficult it is for the sick not to lose heart, to maintain faith in the strength of the body. Every day there are physical therapy classes, which also give positive emotions. In Essentuki, several sanatoriums specialize in the treatment of diabetes, so you can choose both a more expensive and more economical option. And taking mineral waters "Essentuki" and "Essentuki Novaya" always justifies itself.
Sanatoriums of Crimea
In the sanatoriums of the Crimea, endocrinologists of the highest qualification category, even very difficult patients are accepted here. Doctors advise and prescribe complex treatment. It includes:
- baths
- mud
- aromatherapy
- massages
- physiotherapy
- medical nutrition
Sanatoriums of the Crimea are comfortable, equipped with everything necessary for the organization of treatment, pleasant leisure. Swimming pools with sea and fresh water, gyms, saunas, concert halls - all this is very popular among resort guests.
Sanatoriums of the Krasnodar Territory
The Krasnodar Territory is a forge of health. A large number of sunny days, the Black Sea coast, clean air, warm climate - all this contributes to the treatment of a variety of diseases, including diabetes. Many of the country's largest health resorts are located here. In sanatoriums, patients with diabetes mellitus are prescribed a special diet, drug treatment, physical therapy classes are held. Those for whom the disease has already become a way of life are taught self-control techniques, which allows minimizing complications. The use of mineral waters normalizes metabolism, activates immune system, leads to the fact that a person's need for insulin decreases. 1/5 of diabetic patients are shown treatment with mud, which also has a beneficial effect on the body. In the list of procedures that are offered in sanatoriums Krasnodar Territory- physiotherapy, phytotherapy, acupuncture, psychological work with the sick.
Sanatoriums in Kislovodsk
Kislovodsk has the best climate of all the cities of the Caucasian Mineral Waters. The cleanest air and the most sunny days a year. The oldest sanatoriums of the city, whose medical bases offer wide opportunities, accept patients with diabetes mellitus for treatment. Patients are prescribed various types of baths, taking Narzan mineral water, healing mud of the Tambukan Lake, ozone therapy, the use of herbal teas, physiotherapy and, of course, a diet.
Health resorts in city Marianske Lazne (Czech Republic)
If finances allow, sanatoriums located in the Czech city of Marianske Lazne are an excellent option for the treatment of diabetes. For several decades, a balneological institute has been operating here. During this time, doctors have achieved a lot. They manage to regulate metabolic processes in the human body, reduce the main danger of diabetes - the risk of vascular complications.
You can give advice: even if you have been treated for more than a year, and arrived in the Czech Republic with a “fresh” sanatorium card, you should get an appointment with one of the local professors and take additional tests. You may receive completely unexpected recommendations that will be of great benefit.
In sanatoriums, they are treated with mineral water and healing baths, including dry gas ones. Acupuncture and CO2 injections are performed. nutrition in many sanatoriums is organized according to the "Sokolinsky system", as a result of which the sensitivity of cells to insulin improves.
Sanatoriums Rogaška Slatina (Slovenia)
It is pleasant to visit this small country and you can immediately get very effective treatment. Good climate, several options for very effective procedures, moderate prices with enough high level service - all this contributes to the popularity of the resort, especially among couples. Sanatoriums in Slovenia are located near healing springs - thermal or mineral. During the treatment, hot mineral baths are used. Under their action, the capillaries expand, the level of secretion of the hormone insulin changes. Patients begin to feel much better. Such treatment is also suitable for the prevention of the development of severe ailments.
Sanatoriums in Jurmala (Latvia)
One of the most popular resorts in Latvia has become famous due to the mild climate, the combination of sea and pine air, the presence of thermal springs and therapeutic mud. The composition of the latter includes amino acids, vitamins and even natural antibiotics. It is also used in sanatoriums for physiotherapy, juice therapy, and an Ayurvedic center. Horseback riding is also popular for therapeutic purposes. And in Jurmala there is a center “Learn to Manage Diabetes”, where special programs have been developed for various categories of patients, taking into account their psychology and basic needs. Here they teach how to use medicines correctly, develop individual diets, cook dishes that are useful for diabetes, work out non-standard situations - and adapt to the conditions of ordinary life. There are programs for parents with children, for young people, for pregnant women, for those with type 2 diabetes, and for those who want to go into rehabilitation. In a word, from here you can return as a real expert.
Indications for the treatment of diabetes in sanatoriums
It is possible to be successfully treated in sanatoriums both for type 1 and type 2 diabetes, with a latent form of the disease. It should be emphasized that the patient's condition should not be severe, that is, the sugar level cannot exceed moderate values. It is very important for patients that in sanatoriums they treat not only diabetes directly, but also diseases associated with it. As well as those ailments that can significantly worsen the health of a diabetic. These are, first of all, diseases of the digestive system: gastritis, pancreatitis, colitis. Chronic cholecystitis outside the stage of exacerbation. The use of mineral waters, a special diet, daily routine, the help of psychologists - all this contributes to the rapid restoration of good health.
How and how diabetes is treated in sanatoriums
The main task that physicians set for themselves when taking a patient with diabetes mellitus for sanatorium treatment is to strengthen the body's strength, increase immunity, and return a person to working capacity. Medicine cannot completely cure diabetes mellitus, but almost 100% of those who punctually followed the doctor's prescriptions experience a steady remission. To a large extent, this is due to the fact that in each sanatorium, patients are taught to carefully control their condition: eat right, regularly measure blood sugar levels, take the necessary medications, monitor weight, give themselves physical activity. As treatment procedures, balneotherapy is used, a course of mineral water is prescribed, natural mud, apparatus physiotherapy, and herbal drinks are also used.
Mineral water as a result of taking - improves metabolism, sugar in the blood and urine decreases. Cholesterol is also lower. The load on the liver decreases, wounds begin to heal faster. Also, with the help of mineral water, the stomach and intestines are washed in the sanatorium, toxins and toxins leave the body, and the work of internal organs is normalized. Very popular in resorts and treatment with local healing mud. It has a beneficial effect on musculoskeletal system, digestive organs. In addition, each resort has its own characteristics associated with the location. For example, if the health resort is located on the sea, the patient will probably be prescribed procedures related to the use sea water, recommend swimming and sunbathing.
It has a good effect on the condition of diabetics and physiotherapy. It has fewer contraindications than mud treatment, and is suitable for almost everyone. However, the advantages of the sanatorium lie in the fact that an individual approach is applied to each patient. This applies to everything - diet, exercise, procedures. Therefore, with sanatorium treatment, it is possible to achieve the maximum effect.
Contraindications to spa treatment
As for diabetes itself, contraindications for treatment in a sanatorium are its pronounced decompensation, a tendency to hypoglycemia and fainting. With regard to other diseases, contraindications are oncology and tuberculosis in an active form, exacerbated chronic pathologies, life-threatening heart disease, periodic bleeding, and late pregnancy. A severe form of obesity, as well as severe disorders in the functioning of the thyroid gland, will also become an obstacle to referral to a sanatorium. They may refuse to provide you with sanatorium treatment even if you have recently undergone surgery, including on the organs of vision. And yet, in order to be treated in a sanatorium, you need to be able to serve yourself on your own. This also applies to people with disabilities.
Documents required for treatment in a sanatorium
In order to start the procedures without delay upon arrival at the place of treatment, you need to take with you:
- passport - a citizen of the Russian Federation, and if you are going to a foreign sanatorium, then a passport
- health resort card
- medical policy
It is best to issue a CCM in the clinic at the place of residence, and start this process a couple of weeks before the intended trip. It’s not worth it before - it’s desirable to have fresh results of analyzes and examinations on hand. The local therapist will refer you to a fluorography and an ECG, prescribe blood and urine tests. Women will need to visit a gynecologist. In addition, it is recommended to visit that narrow specialist - according to the profile of which you are going to be treated in a sanatorium. For diabetics, this is an endocrinologist. CCM can also be issued upon arrival at the resort, but here you will have to pay for consultations, examinations and tests. In addition, if you find contraindications to spa treatment, you will have to return home “not salty.” Another thing is that in a large resort town you can get advice from a medical "luminary" and continue to use his recommendations. Such opportunities should not be abandoned.
Diabetes mellitus - symptoms
Diabetes mellitus is the third most common disease in modern world. But at the same time, a quarter of people whose sugar is elevated do not pay attention to symptoms that are not yet too pronounced. Such neglect of one's health can end sadly: a heart attack, a heart attack and a stroke, irreversible disorders in the functioning of the kidneys and organs of vision.
Type 1 Diabetes Symptoms
Symptoms of type 1 diabetes increase rapidly in a person, to the point that the patient may fall into a coma. It:
- pronounced thirst: the patient drinks and cannot get drunk
- breath smells of acetone
- noticeable weight loss constant feeling hunger and increased appetite
- profuse urination
- itching, inflammation of the skin, wounds do not heal well.
Diabetes of this type can begin unexpectedly after an illness or a nervous shock.
Type 2 Diabetes Symptoms
Type 2 diabetes develops gradually and is not as pronounced, to the point that sometimes it is diagnosed by chance, during an examination for another reason. Some of the symptoms are similar to type 1:
- thirst
- frequent and profuse urination
- difficult wound healing
This is joined by: fatigue, decreased visual acuity, difficulty walking - pain and numbness in the legs, ulcers may appear on the skin. Over time, a person begins to noticeably lose weight. Unlike type 1 diabetes, which is common in young adults and even children, type 2 diabetes is more commonly diagnosed in middle-aged and older people who are overweight. Having noticed the above symptoms in yourself, you need not be too lazy and check your blood sugar levels. Neglecting your health can end tragically.
Particular attention is paid to children. Previously, young people mostly had type 1 diabetes, today type 2 is not uncommon. There are a lot of guys with metabolic disorders, overweight. Their symptoms appear in a rather erased form and, often, doctors attribute them to other diseases. Therefore, the level of sugar in the blood must be controlled. Sanatorium-and-spa treatment for diabetes gives a pronounced positive effect, and this should be used.
Boarding house for patients with diabetes - best option to ensure comfortable living and professional care for elderly relatives with a similar diagnosis. Our website offers a wide range of options. It is easy to sort offers by location, belonging to a certain network, price of accommodation, and other important parameters.
Features of caring for patients with diabetes mellitus
Diabetes is a chronic endocrine disease characterized by high blood sugar levels. It leads to various complications. Most often, the disease is accompanied by visual impairment, decreased sensitivity in the lower extremities. It can lead to the development of coronary heart disease or stroke, impaired kidney function, etc.
That is why people of respectable age with diabetes require high-quality professional care. It consists in:
- Daily monitoring of sugar levels and other important parameters;
- Compliance with the instructions of the attending physician;
- Proper skin care;
- Control over the menu of the elderly;
- Timely treatment of complications.
Why you should entrust the care of a loved one to professionals
The staff of specialized public and private boarding houses consists of qualified specialists. They know all the ins and outs of diabetic care different types. In such institutions, individual programs are developed to alleviate the condition of the guests.
The disease is often accompanied by overweight. To control and reduce it, physical activity is important. Medical staff of boarding houses will control the implementation of physical therapy exercises.
Particular attention is paid to proper nutrition, because without it it is impossible to control the metabolism of carbohydrates in the body. Only healthy foods are included in the diet. Diets are compiled taking into account the characteristics of the residents: weight, physical activity, etc.
In modern special institutions, all conditions for a comfortable stay are created. Typically, buildings are located in quiet, environmentally friendly places. This contributes to the full rest of the residents. Here, people of the golden age are in the circle of peers and are surrounded by care. They offer a variety of interesting activities. For them, festive and themed events are held.
By choosing a specialized boarding house for your loved one, you give him professional care, communication and comfortable living.
Today, resort medicine is faced with the task of improving the methods of restorative treatment of socially significant diseases, which, in particular, include diabetes mellitus (DM). The scale of the economic costs associated with the treatment of this pathology makes this area a priority in the work of many resorts.
DM, which ranks third as a cause of death after cardiovascular and oncological diseases, was recognized by WHO experts as a non-infectious epidemic of the 20th century. According to various sources, there are from 120 to 180 million people with diabetes in the world, which is 2-3% of the total population of the planet. The number of patients with diabetes continues to grow steadily and is expected to double every 15 years.
The successes of insulin therapy and the use of hypoglycemic tablets have significantly improved the condition of patients and increased their life expectancy. However, in these new conditions, chronic, so-called late complications of diabetes from various organs and systems (primarily vascular and neurological) have come to the fore, which lead to long-term disability, early disability and determine an unfavorable prognosis in patients with diabetes.
The problem of prevention and treatment of DM is acute all over the world. Therefore, WHO and the International Diabetes Federation in 1989 adopted the Saint Vincent Declaration, which emphasizes the importance of measures to reduce mortality and disability in patients with diabetes. By Decree of the Government of the Russian Federation of December 1, 2004 No. 715, diabetes mellitus is included in the list of socially significant diseases.
The federal target program "Diabetes mellitus", approved by the Decree of the Government of the Russian Federation of October 7, 1996 No. 1171, is aimed at reducing the incidence, disability and mortality of patients with diabetes in the Russian Federation. In addition, the program addresses issues of organization of prevention, early diagnosis and effective treatment diabetes and its complications, increasing the duration and improving the quality of life of patients. As part of this program in Essentuki on the basis of the sanatorium. M.I. Kalinin, where they have been treating diabetes for more than 10 years, a Center for the Rehabilitation of Patients with Diabetes with the Involvement of Natural Factors was established (Order of the Ministry of Health of the Russian Federation of September 14, 2001 No. 353), a specialized department was organized in the Malakhovka children's sanatorium. In 28 regions of the country, sanatorium treatment is organized on the basis of local sanatoriums, where diabetologists who have specialized at the Department of Endocrinology of the Russian Medical Academy of Postgraduate Education work.
Treatment of DM and its complications is a difficult task. It includes a significant arsenal of drugs that require long-term complex use, which often leads to polypharmacy, the development of side effects and allergic reactions. These circumstances necessitate the search for various non-drug methods of therapy, among which a special place belongs to the use of natural and preformed physical factors.
Studies have shown that of all the mineral springs of the resort cities of the Caucasus with mineral waters, Essentuki mineral waters have the most pronounced positive effect on the state of carbohydrate metabolism and its hormonal regulation. The Essentuki resort is currently the leading resort in Russia, where patients with diabetes can receive full and qualified medical care.
Indications for spa treatment
Class IV. Diseases of the endocrine system, eating disorders and metabolic disorders. Group of diseases: diabetes mellitus. ICD-10 code: E 10 Insulin-dependent diabetes mellitus; E 11 Non-insulin-dependent diabetes mellitus.
Diabetes:
- in a state of compensation ( normal performance ketone bodies in the blood, the absence of acetone in the urine, glycemia is not higher than 9-10 mmol / l, daily glucosuria is not more than 5% of the sugar value of food);
- burdened (in remission) with chronic cholecystitis, cholangitis, biliary dyskinesia, intestinal dyskinesia, gastritis, peptic ulcer of the stomach and duodenum, angioretonopathy of I-II degree, polyneuritis.
It should be remembered that patients with diabetic retinopathy of the 1st-2nd stage, nephropathy of the 1st stage without azotemia, patients with impaired peripheral circulation in the lower extremities without trophic ulcers and gangrene.
Contraindications: DM in the stage of decompensation; tendency to hypoglycemic states with rapid loss of consciousness.
Principles of resort therapy for patients with diabetes are reduced to the appointment of a physiological diet, dosed physical activity, adequate insulin therapy, oral hypoglycemic drugs in combination with spa rehabilitation. Prevention and treatment of chronic complications, primarily angioneuropathy, consists in achieving stable compensation for diabetes and prescribing angioprotectors. A prerequisite for successful treatment is patient education and self-control.
Many methods of spa therapy for patients with diabetes have been developed by scientists from the Pyatigorsk Research Institute of Balneology. These methods formed the basis of the standards of health resort care for diabetes in the stage of compensation, subcompensation with an uncomplicated course, approved by Order No. 220 of the Ministry of Health and Social Development of the Russian Federation of November 22, 2004.
The leading method of spa therapy for diabetes is crenotherapy - treatment with mineral spring waters. Mineral waters have a positive effect on carbohydrate and lipid metabolism: hyperglycemia and glucosuria decrease, the influence of certain enzymes that promote the penetration of glucose into tissues increases, and the lipid spectrum of blood serum improves. At the same time, the processes of tissue metabolism of carbohydrates improve, the formation of adenosine triphosphoric acid (ATP) increases, during the decay of which a large amount of energy is released. In addition, mineral waters significantly increase the sensitivity of insulin receptors to this hormone, and therefore, in almost all patients, the need for exogenous insulin and hypoglycemic tablets decreases.
The maximum and longest effect (up to 10-14 months) is achieved with a combination of crenotherapy and balneotherapy procedures. When taking mineral baths in patients with diabetes, there is a favorable dynamics of indicators of all types of metabolism, the functional state of the nervous system and metabolism are activated, while there is a positive effect on neuroregulatory mechanisms, contributing to the normalization and stabilization of hemodynamics. Mineral baths significantly enhance non-specific protective factors and improve specific immunity, improve carbohydrate and other types of metabolism and, in addition, have a pronounced positive effect on the course of concomitant diseases of the cardiovascular and nervous systems, digestive organs, musculoskeletal system, skin , kidneys, genitals, etc. The most pronounced effect is observed when using gas mineral baths: carbon dioxide, carbon dioxide-hydrogen sulfide, radon.
According to the results of studies conducted by doctors from the Essentuki resort and the Pyatigorsk Research Institute, mud therapy can be used only in 10-15% of all patients with diabetes, since this often increases the activity of the cortical and medulla of the adrenal glands, and according to some reports, the excitability of the sympathetic department of the nervous system. The mechanisms listed above in some cases cause a deterioration in the state of carbohydrate metabolism, especially with poor compensation and a severe course of the disease. In this regard, the use of mud therapy in people with diabetes is very limited, it requires caution and special monitoring of the condition of patients.
Physiotherapy, unlike mud therapy, does not have a negative effect on impaired carbohydrate metabolism and is the method of choice in the treatment of patients in a state of sub- and decompensation, with a severe or labile course of the disease. The use of "dry" carbonic baths as part of complex spa therapy plays an important role in the prevention and treatment of diabetic microangiopathies. Phytotherapy, acupuncture, psychotherapy, physiotherapy exercises are also widely used in complex spa treatment. The inclusion of special complexes of kinesitherapy in the resort therapy of patients with diabetes is pathogenetically substantiated and has a high therapeutic significance. Systematic physical activity, corresponding to the patient's condition, reduces the need for hypoglycemic drugs. The adequacy of the load is determined by the exercise therapy doctor together with the endocrinologist - based on changes in the level of hyperglycemia, glycosuria, body weight. A wide range of treatment procedures used in the spa therapy of diabetes, allows you to choose an adequate treatment method individually for each patient. Studies conducted at the clinic of the Pyatigorsk Research Institute of Balneology indicate a beneficial effect of complex spa therapy with the use of Essentuki-type drinking mineral waters on the functional state of the kidneys and the ophthalmoscopic picture of the fundus in diabetic patients with microvascular complications (diabetic retino- and nephropathy).
Similar studies were carried out by the Ternopil State Medical Academy in the Tovtry sanatorium in the Khmelnytsky region. There, a clinical and immunological examination was carried out in 65 patients with type 1 and type 2 diabetes who were on sanatorium treatment in the Tovtry sanatorium after a course of treatment with Zbruchanskaya Naftusya, a low-mineralized (M - 0.88 g / l) bicarbonate sodium-magnesium mineral water, administered at a dose of 10 ml per kg of body weight, three times a day, 45 minutes before meals. The researchers observed a pronounced positive effect of mineral water on the clinical course of the disease, as well as laboratory parameters: bilirubin, cholesterol, serum and urine glucose. A nonspecific immunomodulatory effect of mineral water from the Zbruchany deposit was revealed, which was more pronounced in patients with type 2 diabetes.
Comprehensive treatment of diabetic patients at the Bulgarian National Rehabilitation Center "SKK Narechenski Bani" included drug therapy, diet therapy, drinking treatment with low-mineralized (1.46 g/l) radon, bicarbonate-sulfate sodium mineral water, physiotherapy, kinesitherapy, hypnotherapy. As a result of the treatment, positive dynamics of clinical symptoms, a statistically significant decrease in blood sugar (from 10.2 to 5.85 mmol/l), and a significant improvement in lipid metabolism were revealed.
The results of studies conducted by the Research Institute of Rehabilitation Medicine and Balneology of the Belarusian State Medical University in the sanatorium "Krasnousolsk" showed that mineral drinking water has a preventive effect on the progression of glucose intolerance disorders, thereby delaying the timing of the manifestation of diabetes. Treatment at the resort allows you to achieve a more benign course of the disease, helps to reduce clinical manifestations, and in some cases prevents the occurrence of complications, reduces the manifestations of concomitant ailments.
According to studies conducted at the Dorokhovo resort, the use of sulfate magnesium-calcium Dorokhovskaya mineral water contributes to the creation of a reserve of substances in the body that determine the activity of insulin, and microelements make it possible to achieve inactivation of the insulinase enzyme, which, in turn, leads to the normalization of blood glucose levels . In most cases, with diabetes, mineral water is prescribed 200.0 ml 3 times a day. The time of taking mineral water and its temperature are set depending on the concomitant diseases of the gastrointestinal tract according to general indications.
With these concomitant diseases in patients with diabetes, other methods of internal use of mineral waters are also used: duodenal drainage, gastric lavage, microclysters, siphon intestinal lavages. Rectal methods of introducing mineral water in patients with diabetes contribute to the rapid elimination of ketoacidosis.
Magnesium-containing mineral waters occupy a special place in the crenotherapy of diabetic patients. Magnesium ions occupy a special position in the general range of macro- and microelements. Together with calcium ions, magnesium determines the activity of more than 300 enzymes. It has been proven that with diabetes there is a decrease in the concentration of magnesium ions in the blood by 10-12%. Therefore, the additional supply of magnesium ions through the internal intake of mineral water allows you to effectively replenish the reserves of magnesium homeostasis and promotes the activation of metabolic reactions, which is vital in diabetes.
The results of clinical testing of Donat Mg therapeutic mineral water (Mg content 1014 mg/l), carried out on the basis of the endocrinological department of the ICD No. 11 and the diabetological sanatorium named after. V. Chkalov, testify to the high efficiency of crenotherapy with magnesium water in the complex treatment of diabetes.
Crenotherapy with bottled mineral waters, such as Donat Mg, Essentuki No. 17, Essentuki No. 4, Essentuki Novaya, should be included in the complex therapy of diabetes in the post-resort period. Mineral waters have an impact on the main links in the pathogenesis of diabetes, its manifestations. At the same time, there is an improvement in the islet apparatus of the pancreas, which manifests itself in optimizing the producing ability of b-cells by increasing the labile and basic insulin pools, and the effectiveness of its action in tissues. The disturbed interaction of insulin and glucagon is restored. Activated enteric-pancreatic and neuroendocrine relationships, secretion of gastrin, intestinal hormones that affect the function of the islet apparatus of the pancreas. Counter-insular effects are inhibited, which removes the intense stimulation of b-cell islets and leads to an increase in their functional reserves.
It is generally accepted that a rational diet plan and pharmacological hypoglycemic therapy are the foundations of diabetes therapy. Statistics show that 17% of all conflict situations arising from poor-quality organization of medical care in resorts are associated with diabetes, or rather, with the lack of proper catering for this category of patients in sanatoriums. According to Israeli doctors, the diet of a diabetic patient is ideal for anyone. healthy person. In all specialized sanatoriums, six meals a day are organized according to two diets: for patients receiving insulin and for people with non-insulin-dependent diabetes. In many sanatoriums, natural soy products are included in the diet of diabetic patients.
Many spas have a "diabetes management school" in which the patient is taught how to manage their disease and control their diabetes, which allows patients to actively participate in treatment. The possibility of combining non-drug therapy with the use of highly effective pharmaceutical preparations and the use of modern medical technologies available at the resort made it possible to revise the contraindications of resort treatment for many categories of patients. Significantly expands the circle of people who are shown resort rehabilitation, the use of drinking water, mud, balneotherapy. Treatment of this category of patients is possible only if the principles of phasing of therapy and continuity between city health care facilities and health care facilities of resorts are observed. The main principles of carrying out rehabilitation measures in long-term ill patients are a systematic analysis of the clinical status, which is carried out in order to individualize rehabilitation programs, as well as the principle of specialization and integration.
Another important aspect of the resort treatment of diabetic patients is dialysis at the resort. Patients with diabetes suffering from diabetic nephropathy can undergo complex treatment at the resorts of Russia (Sestroretsk resort) and the Czech Republic (Marianske Lazne, the Windsor clinic in the Pacific Astoria sanatorium). Mineral waters, climatotherapy, landscape therapy, along with the main methods of treating diabetes, significantly increase the effectiveness of complex treatment for this category of patients. According to recent studies, the mental state of patients requiring permanent dialysis is regarded as an astheno-depressive syndrome. Symptoms of depression are often "masked" by a decrease in contacts, initiative, sleep disorders, and appetite. These patients need sanatorium-and-spa treatment and simply high-quality rest. The possibility of dialysis in the conditions of the resort - a new direction in the treatment of this severe disease - can not only improve the patient's condition, but also significantly improve the quality of his life.
We have developed a resort selection system (SPK) (), which reflects the main natural healing factors. Resorts are systematized by region and, consequently, by climate zone. This is especially important for people with chronic diseases and the elderly, as well as for short courses of spa therapy, since the processes of adaptation and re-adaptation that inevitably occur when changing climatic conditions can significantly reduce the effect of treatment and even worsen the course of the disease. The table shows the climatic characteristics of the resorts, the main types of mineral waters, therapeutic mud.
Given the fact that in Russia there is a unique resort and recreational potential focused on the provision of medical services, the SPC allows you to choose a resort taking into account the main and concomitant (competing) diseases in any region of Russia. The SEC also includes European resorts available to the Russian consumer of spa services and represented on the market by leading travel companies.
The list of resorts in Russia and Europe indicated for diabetic patients includes resorts and sanatoriums operating under special programs for the treatment of diabetic patients, organizing "diabetes management schools", as well as sanatoriums accepting patients with concomitant and competing diseases that occur against the background of SD.
N. V. Manshina
Medsi Medical Center, Moscow
A trip to a sanatorium is a great opportunity to combine relaxation with treatment. Patients with chronic diseases, which include diabetes, are recommended by doctors to visit such institutions at least once a year.
Staying in a sanatorium has a positive effect not only on physical well-being, but also on emotional state patient. Fresh air, nature and therapeutic procedures help a person to endure the disease more easily and strengthen his immune system.
How to choose a sanatorium?
There are quite a lot of sanatoriums for diabetics in Russia, and sometimes patients are lost when choosing this institution. It is best if the attending physician recommends specific sanatoriums to the patient, based on the characteristics of the course of diabetes and the presence of concomitant diseases. But if the patient wants to choose a place to relax on his own, it is important for him to remember some of the nuances:
- a permanent appointment with an endocrinologist and other narrow therapeutic specialists should be organized in the sanatorium;
- on the territory of the institution there should be its own laboratory so that, if necessary, diabetics can take general and biochemical blood tests, undergo a urine test for sugar, etc .;
- exercise classes should be held on the territory of the institution;
- patients should be able to seek medical help at any time of the day (for example, with hypoglycemia or the development of other complications of diabetes);
- food in the dining room should be dietary and low-fat, preferably diet number 9.
The patient should consult a doctor about the possibility of providing a free ticket to a sanatorium. The conditions for obtaining it depend on the severity of the disease, the presence or absence of a disability group, and the features of the annual funding of such institutions by the healthcare system.
Balneological resorts
Mineral water has a positive effect on the general condition of the body, including the endocrine system. It helps to normalize the concentration of hormones and lower blood sugar levels. That is why resorts with natural mineral water springs have become very popular among diabetics. Essentuki urban district is considered one of the best such places. Here are the following sanatoriums for the treatment of patients with diabetes:
- "Victoria",
- sanatorium them. M.I. Kalinina,
- "Healing Key"
- "Hope".
In the sanatorium "Victoria" patients can undergo mud therapy, as well as treatment with such mineral healing waters: "Essentuki-4", "Essentuki-17", "Essentuki new". On the territory of the institution, trails for therapeutic walking are equipped, and there are also areas for light exercises. exercise on the fresh air. Light exercise is very useful in diabetes to improve metabolism and normalize body weight. In the dining room, a 4-time menu is organized by prior order, children are accepted for rest from 4 years old, accompanied by their parents. The resort has two swimming pools (outdoor and indoor). Patients can undergo a course of massage, therapeutic baths, acupuncture, inhalations and other types of physiotherapy.
Mineral water speeds up metabolism, intensifies body cleansing processes and helps to get rid of excess weight.
Sanatorium named after M.I. Kalinina is a specialized institution for the treatment of patients with diabetes, on the territory of which there is a special center for the recovery of patients using physiotherapy methods. This is one of the sanatoriums with many years of practice, which has established itself as a good place for treatment and rehabilitation. Here, doctors will always help patients choose individual variations of diet No. 9 in accordance with their needs, making it easier to keep sugar at a normal level in the blood.
In the institution, patients can undergo the following types of treatment:
- mud treatment;
- drinking mineral water "Essentuki";
- electrophoresis of the pancreas;
- magnetotherapy;
- treatment with currents of different frequencies;
- baths with mineral water;
- bowel irrigation.
At the sanatorium M.I. Kalinin operates the School of Diabetes Mellitus, where patients are taught the principles of compiling a daily diet, counting insulin and bread units, and also explain the importance of preventing complications of the disease. In addition to physiotherapy, in this medical institution, diabetics have the opportunity to engage in exercise therapy and undergo a massage course.
Sanatorium "Tselebny Klyuch" is located in a park area in an ecologically clean area of Essentuki. According to the doctor's prescription, patients can undergo such types of treatment as balneotherapy (drinking mineral water), exercise therapy, massage, health path. The canteen of the institution offers a system of pre-ordering dishes, according to the doctor's recommendations regarding the diet of a diabetic. In the sanatorium, a joint vacation of parents with children from 4 years old is possible.
Sanatorium "Nadezhda" accepts patients with endocrine disorders, diseases of the cardiovascular, nervous and digestive systems. In addition to treatment with mineral water, vacationers can undergo sessions of pneumomassage, ozone therapy, pearl and hydrogen sulfide baths, irrigation, electric and mud therapy. The menu in the dining room is dietary; in addition, patients can purchase oxygen cocktails based on natural apple juice. Children from the age of 4 are accepted accompanied by adults.
Treatment and prophylactic institutions at sea
Staying at sea benefits the weakened body of a sick person, but so that such a vacation does not harm, it is important to follow some rules. You can swim and be on the beach only during “safe hours” - in the morning before 11:00 and in the evening after 17:00. It is better for diabetics not to sunbathe under direct sunbeams, since excessive exposure of the skin to ultraviolet radiation makes it drier. Considering that in this category of patients the skin is already prone to dryness and cracking, it is better to avoid excessive insolation.
Sanatoriums where diabetes is treated are mainly located in the forest park zone or in the mountains, but some of them are also in the Krasnodar Territory (Sochi) on the sea coast.
Here is some of them:
- "Arctic",
- "Black Sea",
- "Green Grove",
- "South Coast".
And although these sanatoriums are not narrow-profile institutions, they accept patients with diabetes. Here they are offered to undergo sessions of therapeutic baths, a course of massage and exercise therapy, and cleanse the intestines. The lack of mineral water from the source in these institutions is compensated by bottled water, which is offered to patients half an hour before the main meals.
Rest in a sanatorium by the sea is well suited for patients with mild forms of diabetes who do not need specific intensive rehabilitation. Supportive procedures and healing sea air help to keep the body in normal condition and strengthen immunity
Sanatoriums in the Moscow region
Some sanatoriums located in the Moscow region are also suitable for the treatment of diabetics. These include the following institutions:
- "Pines" in the Ramensky district;
- "Tishkovo" in the area of Pestovsky and Uchinsky reservoirs;
- "Zvenigorod";
- "Peredelkino";
- Erino.
Sanatorium "Sosny" is located in the village of Bykovo. It is located in a deciduous-coniferous forest, the local climate is favorable for patients with disorders of the cardiovascular and endocrine systems. On the territory of the institution there are trails for therapeutic walking (health path), which is very useful for diabetics. There is access to a pond with an equipped beach and a small promenade. Nutrition is selected individually, in accordance with the characteristics of the disease. Children of any age are accepted accompanied by their parents.
Sanatorium "Zvenigorod" is located in the ecologically clean Odintsovo district of the Moscow region. There is an equipped beach on the banks of the Moskva River, a pine forest and birch groves. On the territory of the sanatorium there are natural ponds and therapeutic fonts. The menu in the dining room is dietary, the choice of dishes is carried out by prior order (delivery of meals to the room is also possible). Children from any age are accepted accompanied by relatives.
Sanatorium "Peredelkino" is located in a cozy and quiet forested area, its area is more than 70 hectares. Here patients are treated not only with diabetes, but with disorders of cardio-vascular system and diseases of the musculoskeletal system. You can come here at any time of the year; for convenience, warm passages are equipped between the buildings. The menu in the dining room is dietary, by prior order. In this sanatorium, patients can always be provided with full medical care, as it has its own laboratory and doctors on duty. On the territory there is a separate building for diagnostic procedures and a swimming pool. Children are accepted on vacation from the age of 7 with their parents.
Sanatorium "Erino" is a medical institution with its own source of mineral water "Erinskaya". It is located in the Podolsky district of the Moscow region at the confluence of two rivers - Pakhra and Desna. The institution is located on the territory of the park and mixed forest. This sanatorium is optimally suited for patients with diseases of the endocrine system, chronic diseases gastrointestinal tract, as well as for people with problems of the heart and blood vessels, respiratory organs. The food here is dietary, and, in addition to diet number 9, you can also choose another table (as agreed with the doctor). Children are accepted on vacation from the age of 4 with relatives, the sanatorium has playgrounds and rest rooms, a swimming pool, a beach.
Indications for treatment in sanatoriums can be diabetes, both the first and second types, as well as impaired glucose tolerance and metabolic syndrome.
Patients with decompensated diabetes and severe complications of the disease (for example, severe nephropathy or advanced syndrome) should not visit such institutions. diabetic foot). Before planning a trip, the patient should definitely consult a doctor, as this will allow you to be sure of the benefits of a future vacation. In the absence of contraindications, treatment in a sanatorium is always beneficial, charges positive emotions for the whole year.
Last update: April 18, 2018