In the case of diabetic patients, with mild functional restriction, the aim of treatment is for patients to have good glycaemia control. They can manage their own monitoring and treatment, (including hypo’s), and do not suffer from complications.

There should be no difficulty in walking, and no difficulty in getting about in an unfamiliar area.

Such a person would normally be able to look after all aspects of self - care with regard to bodily functions (such as bathing and showering, dressing, attending to his/her own toilet needs, planning, preparing and cooking a main meal, and going up and down stairs.) Without vision complications he/she should also be able to check and administer his/her own insulin. He/she normally would have warning of “hypo’s”, (hypoglycaemic episodes – low blood sugar), and be in a position to take the necessary steps to avoid or curtail them.

In such a person, with moderate functional restriction due to their diabetes, some complications affecting vision, cardiovascular (e.g. the heart), peripheral vascular (e.g. the blood vessels in the legs) or neurological systems (e.g. the nerves, and nerve pathways), may be present. At this stage, renal (kidney) effects would not be likely to be obvious or debilitating. The person should be able to monitor and treat his/ her own disease, unless vision is affected to a severe extent. They would normally be able to cope with hypo’s themselves.

The person may be affected by angina and/or peripheral vascular disease and/or reduced foot sensation, to some degree. However, he/she would normally be able to walk more than 100 metres on the flat, without stopping. Some individuals may have problems with reading signs, but on the whole, a person with diabetes with moderate disabling effects would normally be able to get about, unaided, in an unfamiliar place, as they can ask for directions.

A person with moderate restriction should be able to look after his/her self - care needs, relating to bodily functions, as vision would not be significantly affected to impact on general care, such as dressing, bathing/ showering, attending to toilet needs or planning and cooking a main meal. Cardiovascular and vascular effects on exertion, and neurological impairment, at this stage, would not be enough to seriously affect the above activities.

There is a chance that a person with a visual impairment might need a visual aid for reading labels and recipes, and checking medication strength and levels in the syringe, but this depends on the individual’s disablement.

Normally, he/she should be able to manage stairs, but may have to take them more slowly, and stop and rest, either halfway, or at the top.

Such a person would normally recognise hypoglycaemia (low blood sugar), and have a sugar source available to take at all times, in case of such an event. Night hypoglycaemia can be avoided as much as possible, in these people, by their checking their blood glucose level before going to bed, and having a snack if necessary.

A person with severe functional restriction may display evidence of long- term raised blood sugar, and fats, as well as proteinuria. Conversely, they may have good control at the present time, but be suffering from severe complications, (because of poor glycaemic control in the past).

Such a person is likely to be suffering from significant complications affecting one or all of the following systems. 1) the heart (coronary artery disease, leading to angina requiring treatment), 2) the peripheral blood vessels, especially in the legs, leading to narrowing of the vessels, and poor circulation of the feet or legs, 3) the nerve pathways especially affecting the lower limbs, making the patient susceptible to damage to these areas, without being aware, 4) eye complications causing vision to be affected, 5) kidney complications, causing diabetic nephropathy, which may progress to kidney (renal) failure.

He/ She may need assistance with monitoring, and treatment of his/ her condition, and may not be aware of the onset of hypo’s.

Each person would need to be assessed according to how the diabetes has affected that person.

If the person has angina and/or narrowing of the arteries in the legs (leading to cramp on walking), or nerve damage leading to pins and needles and weakness in the legs), they might be only able to manage a walking distance of 30 metres or less.

With amputation (s) he/she may be confined to a wheelchair, and not be able to walk at all. If he/ she has (or is getting used to) a prosthesis, walking may be quite severely compromised, at least for a few months.

A person with severe visual effects resulting from the condition may have great difficulty in getting around out of doors unaided, may not be able to read street or road signs, and in fact may be registered blind.

They may also satisfy the H/R Mobility criteria under the Severely Visually Impaired (SVI) deeming provisions. Click on the link H/R Mobility Severely Visually Impaired (SVI) deeming provisions.

Each person would need to be assessed according to how the diabetes has affected that person.

He/she would normally still be able to dress him/herself, but may need assistance getting out of the bath, or helping with showering, if there is significant problems with the nerve pathways in the feet, or indeed, amputations.

He/she may need assistance with testing their own blood and reading the result, with administering insulin and with checking and taking tablet medication, if vision is significantly affected.

If the heart and/or peripheral circulation in the legs is affected, he/she may have difficulty managing stairs without assistance.

If amputations of one or both legs have occurred, he/ she may need assistance on the stairs, as they may not have adjusted well to a prosthetic limb, or using stairs may not be an option at all, except by stair lift.