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If your client is anything like the last one we had with severe uncontrolled diabetes, the risks of not getting the disease under control (ie hypers, as it is high blood sugar that casues the associated organ damage) include:
- foot injury which is not noticed due to loss of sensation, with ulcers and eventually likely amputation (this happened to my nother in law, both feet);
- total blindness caused by diabetic retinopathy;
- kidney failure (associated with high blood presssure and then heart disease);
- opportunistic infections and very poor healing after injury or surgery.
Eye problems make it impossible for the patient to check their own blood glucose levels accurately and often to administer their own injections, which for someone with the brittle diabetes you are describing will need to be done several times a day. There is some supervision needed too, not just to deal with hypos and hypers (in brittle diabetes they often come on so suddenly that the patient can't take any steps to deal with them in time to avoid getting very confused.)
Low blood sugar in itself doesn't cause direct organ damage but can lead to falls, sleepiness, irritability and abnormal behaviours.
On the mobility side, clearly if there is impaired eyesight this in itself gives rise to mobility needs. It is at least arguable that the neuropathy is as much a problem in walking because of the lack of sensation as of pain. Some people with advanced diabetic neuropathy get a very unpleasant disorder called Charcot's Foot, due to unnoticed serious injury (such as broken bones which then set distorted). This needs surgery and walking is often strongly counter-indicaed even if (as can happen) ther is no pain at all, becasue of the high risk of further damage to the foot leading to ulceration, gangrene and amputation.
It is a sad fact that anyone whose diabetes is uncontrollable is not going to make old bones.
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