Diabetes & Lifestyle Disorders - Best Private Hospital in Dubai Al Mankhool | IMH Dubai

Gestational Diabetes

Gestational diabetes is a condition in which your blood sugar level becomes high during pregnancy, affecting up to 10% of pregnant women, diagnosed by a blood test done at 24 to 28 weeks of pregnancy. Women with gestational diabetes don’t have diabetes before their pregnancy – and it usually goes away after giving birth.

What causes gestational diabetes?

Hormones produced by the placenta cause a build-up of glucose in the blood. Usually, enough insulin is produced to control blood sugar levels. However, if the body is unable to produce insulin or stops using it, then the blood sugar levels rise, causing gestational diabetes.

Who’s at risk of gestational diabetes?

At your first antenatal appointment, a healthcare professional should check if you’re at risk of gestational diabetes.
The likelihood of getting gestational diabetes increases if you:
• were overweight before you got pregnant.
• have had gestational diabetes in the previous pregnancy.
• have had a large baby in earlier pregnancy (4.5kg/10lb or more)
• have a family history of diabetes – parent or sibling.
• come from a South Asian, Black or African Caribbean or Middle Eastern background.
• have high blood pressure .
• have given birth to a stillborn baby.
• are older than 30 years.
Having gestational diabetes increases your risk of developing it again in future pregnancies. It also increases your risk of developing Type 2 diabetes later in life. You can reduce the risk of developing gestational diabetes by managing your weight, eating healthily and keeping active before pregnancy.

Gestational diabetes symptoms.

Women with gestational diabetes don’t usually have symptoms. Most find out that have it during a routine screening.
You may notice that:
• You’re thirstier than usual
• You’re hungrier and eat more than usual
• You urinate more than usual

Gestational diabetes tests and diagnosis.

Gestational diabetes is diagnosed by routine screening, called Oral Glucose Tolerance Test, also known as an OGTT. The OGTT is done when you’re between 24-28 weeks pregnant. If you’ve had gestational diabetes before, you’ll be offered an OGTT as soon as possible, and another OGTT between 28-32 weeks if the first test result is normal.

How do you manage gestational diabetes?

The goal is to reduce blood glucose to the normal levels exhibited by a woman without gestational diabetes.

This involves:
• Measuring your blood sugar level four times a day
• Eating a healthy and balanced diet
• Performing moderate physical activity for about 150 minutes per week (Running, walking and swimming are good options)
• Reducing stress as much as possible.

These measures must be taken while continuing regular checkup with your doctor and adjusting them as needed. Changes in habits will sometimes not be enough; in such cases, metformin or insulin injections should be used during the pregnancy.

Target blood sugar levels in pregnancy:
• Before a meal: 95mg/dl or less
• An hour after a meal: 140mg/dl or less
• Two hours after a meal: 120mg/dl or less

Tips for eating well with gestational diabetes:
• Eat regular meals.
• There’s no need to ‘eat for two’. Portion size will have the most significant effect on your blood glucose level.
• Include carbohydrates but look for low GI (glycemic index) options and keep the consumption to the optimum level
• Get your five vegetables a day for vitamins, minerals and fibre.
• Cut back on salt, too much salt is associated with high blood pressure, which increases the risk of diabetes complications.
• Stick to water or sugar-free drinks.

What are the potential complications?

In the child:
• Macrosomia (above-average weight)
• Risk of being born with low blood sugar levels and respiratory problems
• Risk of obesity and type 2 diabetes later in life

In the mother:
• Risk of a difficult delivery, possibly by C-section, depending on the baby’s weight
• Surplus of amniotic fluid, which could trigger premature delivery
• Gestational hypertension & Preeclampsia
• Risk of developing type 2 diabetes later
• Risk of suffering from gestational diabetes again in a future pregnancy

Most of the complications can be prevented with appropriate treatment.
In conclusion, in the vast majority of cases, gestational diabetes is easy to control, with your blood sugar levels likely to normal in about six weeks after childbirth. However, the risk of developing gestational diabetes in the next pregnancy increases, with the women also likely to develop type 2 diabetes in the future. It would help if you got follow-up tests every year. Many problems can be avoided through healthy lifestyle habits. Don’t panic and talk to your doctor to see how you can put the odds in your favour.

Diabetic Retinopathy

What is Diabetic Retinopathy?

Diabetics are at risk of developing certain eye conditions. These include cataract, diabetic retinopathy and problems involving the optic nerve. A common manifestation of diabetes in the eye is diabetic retinopathy.
Diabetic retinopathy is basically a disorder of the retinal blood vessels. The retina is the light sensitive membrane in your eye that enables vision. Damage to the retinal blood vessels can cause vision loss or even blindness.
When the blood glucose levels fluctuate, the cells that line the blood vessels swell and become damaged. As a result, the blood vessels may leak fluid or blood into the retina and causes vision loss. As the blood vessels become increasingly damaged with poor blood sugar control, they can become completely obstructed, depleting the retina of blood and nutrients. Abnormal new blood vessels may then grow, and possibly bleed into the cavity of the eye, causing a more severe vision loss.

Who is at risk of developing Diabetic Retinopathy?

All people with diabetes are at risk of eye disease. In younger people with diabetes the onset can be rapid, whereas in older people it may come on more slowly. After ten-fifteen years of the disease most people with diabetes will have some degree of retinopathy. Incidence also increases with associated hypertension, other retinal diseases, smoking, sedentary lifestyle.

What are the symptoms of Diabetic Retinopathy?

a) Blurred vision (often linked to blood sugar levels)
b) Floaters and flashes
c) Sudden loss of vision.

How is Diabetic Retinopathy treated?

There are two basic types of retinopathy:
a) Non Proliferative Diabetic Retinopathy- It is the milder form, and patients may not have any symptoms initially. Retina shows tiny blood spots and fatty cholesterol deposits. Detection is through regular screening with Ophthalmologist. Diabetic patients who have vision problems from retinopathy can usually be successfully managed with laser and/or other treatment options. Early treatment is better for providing a successful outcome.
b) Proliferative Diabetic Retinopathy- New blood vessels and fibrous tissue grow on the surface of the retina. When this tissue contracts it gives rise to bleeding inside the eye (vitreous hemorrhage) or it can pull the retina causing detachment. Both these lead to sudden loss of vision. Sometimes in such cases retinal surgery is required.

How to prevent Diabetic Retinopathy?

a) Good control of the blood sugars will reduce the risk of retinopathy
b) Control of hypertension
c) Avoid Smoking
d) Regular eye checks including a retinal examination by Ophthalmologist is by far the most important preventive measure for avoiding diabetic vision loss.
e) Close monitoring of your diabetes by your family doctor is also imperative.
f) Special care needs to be taken by diabetic patients who are pregnant.

50 Years Young!

50 Years Young!

Women spend a lifetime looking after their families and often ignore their own wellbeing. It is important for women to take care of themselves. As time passes, our bodies change. Each one of us is unique and hence aging touches us in different ways. Thanks to the growing awareness and advances in medicine and nutrition, we are seeing higher life expectancies and healthier lives(average life expectancy of a US woman is 82 years).To be healthiest,we need to know our family medical history, understand our body changes, integrate beneficial habits into our lifestyle and keep up with routine preventive health screenings.

50s Body Basics:

Menopause:-Menopause:-For most women, her 50s mean menopause. But it is not really a pause at all. Menopause is more like a shift. Your hormone levels shift and change, and your body shifts out of its childbearing years into a new state of balance. Before that, you may experience hot flashes and night sweats, upset sleep and stress, mood swings, irritability, or depression.
Due to drop in estrogen, you may also notice other changes. Reduced vaginal lubrication can make sexual intercourse difficult, even painful, and increase your risk of urinary and vaginal infections.

Estrogen dips also cause you to lose bone density – putting you at risk of osteoporosis – and have been linked to a gain in belly fat.

Belly fat, in turn, may boost your risk of heart disease, diabetes, and cancer. To lose this fat, you may need to bump up your workouts and lower your caloric intake.

Your risk of colorectal cancer increases during this decade, so screening becomes crucial.

Weakened pelvic muscles may play a role in urination issues like incontinence and in some women a condition called pelvic prolapse. Women who are obese or have had children are more susceptible.


Other than Menopause, the main health concern are:-

Heart disease

Heart disease is the leading killer of both men and women. In women, the condition is responsible for about 29% of deaths, reports the CDC. Although more men die of heart disease than women, females tend to be underdiagnosed, often to the point that it’s too late to help them once the condition is discovered.

The earlier people adapt healthier behaviors, the lower their overall risk for heart disease or stroke outcomes.


Osteoporosis threatens 44 million Americans, of which 68% are women, reports the National Osteoporosis Foundation. Osteoporosis is largely preventable. The behaviors that women develop in their childhood and early adult years play a significant role in the development of the disease. That’s because bodies build up most of bone mass until age 30. Then new bone stops forming and the focus is on maintenance of old bone. It is never too late to keep bones strong and avoid fractures. Your body will do what it can to repair bone damage, but you have to provide the tools for it, such as adequate calcium consumption and weight-bearing physical activity

When you age, your body absorbs your old bone tissue faster than it can create new bone tissue, which makes your bones weaker. This condition is called osteoporosis. The bones become so thin and fragile that they can easily break when you fall or sometimes, while you are going about your daily lives. It is estimated that 1.5 million fractures happen every year because of osteoporosis. Women are more susceptible to osteoporosis because they lose more bone mass right after menopause.

Flu/Pneumonia:  the elderly are more susceptible to it because the immune system does become weaker with the passing years. It also means that the flu can lead to pneumonia, if not treated on time. The research done by Centers for Disease Control and Prevention, US, believes that 71–85 percent flu-related deaths in occur in people around the age of 65 or more


In countries like the USA, more than 25 percent people over the age of 60 have this health condition. When a person has diabetes, they have a very high level of blood sugar, which leads to complications like damage to the kidneys, nerves, eyes as well as stroke or heart disease. Some of the early signs to look out for are fatigue, extreme thirst or hunger, blurry eyesight, and a frequent need to urinate.

Incontinence: Women over the age of 50 are more likely to have urinary incontinence. This is because the pelvic muscles lose strength, and aren’t able to control the bladder as well as they did before. Some of the other reasons for incontinence after menopause include less elasticity in the vaginal tissue and thinning of the lining of the urethra. This leads to a few types of incontinence: stress incontinence, which means that you leak out some urine when you laugh, sneeze or cough; urge incontinence, when the need to urinate comes very suddenly; nocturia, where some women feel the need to use the bathroom several times at night; and, painful urination, which may happen because urinary tract infections that some may get more frequently after menopause.

Breast Cancer

It is second to lung cancer as the leading cause of death for women..

The American Cancer Society lists the following as risk factors for breastcancer:

American Cancer Society recommends controlling your weightexercising, quitting smoking, and talking to your doctor about your risk and appropriate screening for breast cancer.

  • “Just because your mother didn’t have breast cancer, it does not mean you are immune to this problem,”. At the same time, it’s also important to note that some women who have one or more risk factors never get breast cancer.


Depression / Anxiety

Depression appears to affect more women than men. The National Institute of Mental Health reports that about 12 million women are affected by a depressive disorder each year compared to about 6 million men. Many women suffer silently as they battle with depression, which also impairs their daily functioning. Post-menopausal women are more prone to suffering from depression because when there is a dip in the level of estrogen in the body, mood-regulating brain chemicals like norepinephrine, dopamine and serotonin also get disrupted.

Anxiety is one of the least talked about health issues that women over 55 suffer from. Often undiagnosed or undertreated, studies in the US show that 18 percent of people over 60 suffer from anxiety issues. Women have more anxiety disorders than men due to chemical differences, hormonal changes and different responses to neurotransmitters. The affected person cannot stop worrying about a problem, situation or even the future, to the extent that sometimes it can hamper day-to-day living. Anxiety can even lead to panic attacks, high blood pressure, palpitations, dizziness and insomnia. If you suffer from any of these symptoms or suspect that you have an anxiety disorder, do not hesitate to reach out for help.



50s: healthy habits

Nutritional needs of your changing body.

As you pass through menopause, your changing body may require fewer calories. At the same time, you might contend with a slowed metabolism and become more prone to belly fat. Switch out high-fat foods for lower-fat options, and slice into leaner sources of protein, like chicken, fish, beans, or quinoa. Give your body an antioxidant advantage by increasing your intake of fruits and vegetables, and support healthy cholesterol and digestion with plenty of fiber.Cut back on salt and processed foods-aiming for 1500mg of salt(halfteaspoon/day).Eat colorful foods. It’s important for women over 50 to get plenty of fruits and vegetables. And eat more fatty fish (like salmon) to get heart-healthy omega-3 fatty acids. Learn to love whole grains, lentils, and skinless lean protein. Treat yourself to sweets, but only occasionally. When you use oils, lean toward the good ones,like extra-virgin olive oil.

Get fit

50-something fitness should focus on maintaining a healthy weight, supporting strong bones, and building muscles to boost a lagging metabolism. Cardiovascular exercise will help keep your heart strong, but you also need flexibility and muscle strengthening training like yoga or Pilates to help keep your joints mobile. You also need strength training or a weight-bearing workout like climbing stairs, jogging, lifting weights, to help bump up your calorie burn and support your bones and muscles. Keep up with regular physical activity, and you’ll be more likely to sleep well and to handle stress.


Your first bone density test may occur in your 50s. Your mid-60s is when you are at a greater risk for osteoporosis, so you should work now to fortify and protect your bones. If you cannot reach your daily calcium quota of the recommended 1,200 mg from the foods you eat, consider supplements. And pair your calcium with vitamin D to get the full benefits. Some vitamin D can be found in foods you eat, but you may need to take supplements to get the 800 IU of vitamin D per day that is recommended for osteoporosis prevention. You could also spend about 5 to 15 minutes outside, 2 or 3 times a week, to soak up vitamin D from the Sun. Generally always wear sunscreen to help prevent skin damage that can lead to skin cancer. You can also add B12 supplements to your diet.

Mental health

Meditate, pray, visualize your day. Read something that inspires you. Focus on self-renewal.#Set aside quiet time every morning. Be optimistic. Take time to understand what you want out ofyour life. Find thepurpose and meaningin your life. Then spread the joy to others.#Have fun. Go bungee jumping, rock climbing, backpacking, skiing, and dancing,whatever makes you happy. Act like you feel, and you’ll feel youthfulness. Find a creative outlet. It helpsto prevent depression and depression affects memory. Having a creative outlet helps stimulate your mind. Take up painting. Create a wonderful garden. Engaging your creativity stimulates your brain more than reading, and certainly more than TV. Eliminate clutter. Fill your home with great music, books, and friends. Withdraw and recharge when you need to. Associate with positive-focused people. They will not drain your valuable energy with complaints. They will help you pursue the best that life has to offer.

Maintain proper Hydration

Skin care regimen should include moisturizing creams

Ensure adequate Sleep Maybe you got along with four hours a night when you were 40, but your body can’t take that abuse when you’re older.

Quit smoking

Stop or limit alcohol

Reach and maintain healthy weights.

Maintain protection from the Sun

Screening check-ups



Your 50s: checkup checklist

  • Bone density test:You may get your first bone density test during your 50s. Some people who fall into particular risk categories may need one sooner or more regularly. Taking certain medications may speed bone loss, and certain medical conditions can compromise bone density as well. Ask your doctor if you are concerned about osteoporosis, especially if it runs in your family.
  • Diabetes screening:If you are in your 50s, you may be at risk for type 2 diabetes. Your doctor can screen your risk by testing your levels of Hemoglobin A1C (a blood test that reflects your average blood glucose levels over the last 3 months) or your blood glucose levels. How often you need to be screened for diabetes will depend on your risk of diabetes. If you are overweight, your risk of diabetes will probably be higher and you should be tested earlier and/or more often. Ask your doctor how often you should be screened for diabetes.
  • Blood pressure and cholesterol:Anytime you go in for any health care visit, your blood pressure will be taken, and you should get a cholesterol work-up every 1 to3 If you fall into certain risk groups, your doctor may screen your levels more frequently. You may be at risk if you have diabetes or a large waist circumference, or if you smoke or are inactive or eat an unhealthy diet.
  • Colorectal cancer screening:A Fecal Occult Blood Test (FOBT) helps to identify polyps before they become cancerous. When caught early, 90% of colorectal cancers can be cured. This test should be conducted every 2 years. A flexible sigmoidoscopy or double-contrast barium enema may be done every 5 years as an alternative to the FOBT. Another screening option is a colonoscopy, which should be done at 50 and every 10 years after. If you have certain risk factors, you may need this test every 1 to 5 years.
  • Pap test and pelvic exam:You should be having routine pelvic exams and Pap tests every 2 to 3 years. Pap tests screen for cervical cancer, while the pelvic exam allows your health care provider to examine your cervix and vagina and to get a sense of the health of your uterus. Your health care provider might also look for signs of infections.
  • Breast exam:Breast cancer is a very common cancer among women. Your health care provider may do an exam when you go in for your Pap test and pelvic exam. If not, ask your doctor if you should have a clinical breast exam and, if so, how often? You should also become familiar with the look and feel of your breasts so you know what’s normal for you. If you fall into a high-risk category for breast cancer, your doctor may suggest you have a mammogram every year or so. Otherwise, mammograms should be done every 2 or 3 years when you are in your 50s.
  • Skin check:Anyone at any age can develop skin cancer. In addition to minimizing your risk with healthy sun habits, your health care provider should do a thorough skin check annually to screen for new or changed moles or marks. You can also do a skin check yourself (or with a helpful partner) each month.
  • Dental check-ups:Visit your dentist for preventive check-ups and routine cleanings. The frequency of visits will really depend on individual needs, though most authorities on the subject recommend at least once or twice a year.
  • Eye exams:Even if your vision is 20/20, you should have your eyes examined every 1 to 2 years. After all, optometrists check for other things besides how good your vision is – like signs of glaucoma. If you have a condition like diabetes or high blood pressure, or a family history of vision problems, your optometrist will let you know if you need more frequent eye exams and check-ups.
  • Immunizations:
  • Get shots to protect you from measles, mumps, and rubella (MMR)if you’ve never had the vaccination before.
  • The tetanus, diphtheria, and pertussis (Tdap)vaccine is recommended for everyone, once in adulthood (you may have received vaccinations against these in childhood). The Td (tetanus and diphtheria) vaccine is recommended every 10 years.
  • Each year, get the influenza vaccine.
  • Consider being vaccinated against meningitisand hepatitis A and B.


  U.S Preventive Guidelines- 

50 Years Young!

Guidelines are based on current U.S Preventive services Task Force (USPSTF) recommendations.

Explore the best in class facilities at International Modern Hospital 

You can expect all-round treatment and lifestyle management at the Diabetes center. With IMH, you not only can bring down the effects of a chronic condition like diabetes, but also get to know how to manage it smartly later, so that you remain protected from a high blood sugar spike later on. While we provide great services in the outpatient department and during your hospital stay, our association doesn’t just end there. We also help you recover to your full capabilities post discharge and show you ways in which you can bring your life back on track.

Connect with us at IMH and get treatment carried out from the best hospital in Dubai, UAE.

Gestational Diabetes

Whats is Gestational Diabetes?
Diabetes (poor tolerance to blood sugars) diagnosed for the first time during pregnancy. It usually starts in the middle or ed of pregnancy.

Gestational diabetes occurs when you body cannot make enough insulin during pregnancy.High levels of hormones with weight gain of pregnancy causes your body cells to use insulin less effectively. The risk of developing pregnancy diabetes is higher in the following situations.

    • If you are overweight (BMI>30)
    • You had a previous large baby weighing more than 4.5 KG
    • You had diabetes in the previous pregnancy.
    • You have a family member like parents or siblings with diabetes
    • Some nationalities like Asians, Middle Eastern, African – Caribbean


Diagnosis is by checking your blood sugar level during pregnancy. It is done in early pregnancy if you have risk factors as mentioned. Routinely its done in the 6th or 7th (24 to 28 Weeks) month of pregnancy. The test is called GTT and it is done by checking your fasting levels of glucose and bp levels 1 to 2 hours after having a glucose drink.


What are the risks of diabetes to my baby?
If the blood glucose levels are too high , the baby can grow bigger which increases the risk of long labour, c section, birth injuries during delivery and still birth. The baby produces more insulin and can have low glucose levels after birth. Future risk to the baby include obesity and diabetes.

Once you are diagnosed diabetic during pregnancy, the treatment involves 3 steps:
1. Referral to a Dietitian : Diet should reduce your blood sugar levels and it should give you the calories required for pregnancy
2. Medications : Medications are started if diet does not lower blood sugar levels within 2 weeks. Medications safe in pregnancy are metformin and insulin.
3. Exercise : It also helps lower blood sugar level.


1. You will have follow up visits every 2 weeks
2. You will be instructed how to monitor your blood sugar levels at home at least twice during the week
3. Aim of treatment is to maintain blood sugar level within normal range (fasting less than 90mg and post meals more than 1 hour = 140 mg / dl)

1. Your baby growth will be monitored by Ultra sound
2. Increased fluid and large baby are signs of poor sugar control
3. If sugar levels are well controlled labour will be induced between 39 – 40 weeks.
4. If sugar control is poor baby is large and water around baby is increased. Labour will be induced soon after 38 weeks.
5. Normal delivery is possible if baby weight is average.
6. Large baby is many to be delivered by c section.
7. After deliver the baby’s blood sugar will be checked as it can be low.
8. Your diabetes medications may be stopped after checking your blood sugar levels.
9. You should check your fasting blood sugar 6 weeks after delivery.
10. Life style modification in the form of diet and exercise can postpone development of overt diabetes later in life.



What is Anorexia?

Male-AnorexiaAnorexia Nervosa is a psychological and possibly life-threatening eating disorder defined by an extremely low body weight relative to stature (this is called BMI [Body Mass Index] and is a function of an individual’s height and weight), extreme and needless weight loss, illogical fear of weight gain, and distorted perception of self-image and body.

Additionally, women and men who suffer with anorexia nervosa exemplify a fixation with a thin figure and abnormal eating patterns. Anorexia nervosa is interchangeable with the term anorexia, which refers to self-starvation and lack of appetite.

Types of Anorexia

There are two common types of anorexia, which are as follows:

  • Anorexia Nervosa Binge / Purge Type – The individual suffering from anorexia nervosa binge / purge type, will purge when he or she eats. This is typically a result of the overwhelming feelings of guilt a sufferer would experience in relation to eating; they compensate by vomiting, abusing laxatives, or excessively exercising.
  • Restrictive Anorexia Nervosa – In this form of anorexia nervosa, the individual will fiercely limit the quantity of food consumed, characteristically ingesting a minimal amount that is well below their body’s caloric needs, effectively slowly starving him or herself.


Anorexia is not a simple disorder. It has many symptoms and effects, and its causes are complex as well

  1. Environmental factors

The effects of the thinnessculture in media, that constantly reinforce thin people as ideal stereotypes

  • Professions and careers that promote being thin and weight loss, such as ballet and modeling
  • Family and childhood traumas: childhood sexual abuse, severe trauma
  • Peer pressure among friends and co-workers to be thin or be sexy.
  1. Biological factors
  • Irregular hormone functions
  • Genetics (the tie between anorexia and one’s genes is still being heavily researched, but we know that genetics is a part of the story).
  • Nutritional deficiencies

Signs and Symptoms 

Living with anorexia means you’re constantly hiding your habits. This makes it hard at first for friends and family to spot the warning signs. When confronted, you might try to explain away your disordered eating and wave away concerns. But as anorexia progresses, people close to you won’t be able to deny their instincts that something is wrong—and neither should you.

food behavior signs and symptoms

  • Dieting despite being thin – Following a severely restricted diet. Eating only certain low-calorie foods. Banning “bad” foods such as carbohydrates and fats.
  • Obsession with calories, fat grams, and nutrition – Reading food labels, measuring and weighing portions, keeping a food diary, reading diet books.
  • Pretending to eat or lying about eating – Hiding, playing with, or throwing away food to avoid eating. Making excuses to get out of
  • Preoccupation with food – Constantly thinking about food. Cooking for others, collecting recipes, reading food magazines, or making meal plans while eating very little.
  • Strange or secretive food rituals – Refusing to eat around others or in public places. Eating in rigid, ritualistic ways.

appearance and body image signs and symptoms

  • Rapid weight loss with no medical cause.
  • Feeling fat, despite being underweight – You may feel overweight in general or just “too fat” in certain places, such as the stomach, hips, or thighs.
  • Fixation on body image – Obsessed with weight, body shape, or clothing size. Frequent weigh-ins and concern over tiny fluctuations in weight.
  • Harshly critical of appearance – Spending a lot of time in front of the mirror checking for flaws. There’s always something to criticize. You’re never thin enough.
  • Denial that you’re too thin – You may deny that your low body weight is a problem, while trying to conceal it (drinking a lot of water before being weighed, wearing baggy or oversized clothes).

purging signs and symptoms

  • Using diet pills, laxatives, or diuretics – Abusing water pills, herbal appetite suppressants, prescription stimulants, ipecac syrup, and other drugs for weight loss.
  • Throwing up after eating – Frequently disappearing after meals or going to the bathroom. May run the water to disguise sounds of vomiting or reappear smelling like mouthwash or mints.
  • Compulsive exercising – Following a punishing exercise regimen aimed at burning calories. Exercising through injuries, illness, and bad weather. Working out extra hard after bingeing or eating something “bad.”

Steps to recovery

  • Admit you have a problem. Up until now, you’ve been invested in the idea that life will be better—that you’ll finally feel good—if you lose more weight. The first step in anorexia recovery is admitting that your relentless pursuit of thinness is out of your control and acknowledging the physical and emotional damage that you’ve suffered because of it.
  • Talk to someone. It can be hard to talk about what you’re going through, especially if you’ve kept your anorexia a secret for a long time. You may be ashamed, ambivalent, or afraid. But it’s important to understand that you’re not alone. Find a good listener—someone who will support you as you try to get better.
  • Stay away from people, places, and activities that trigger your obsession with being thin.You may need to avoid looking at fashion or fitness magazines, spend less time with friends who constantly diet and talk about losing weight, and stay away from weight loss web sites and “pro-ana” sites that promote anorexia.
  • Seek professional help. The advice and support of trained eating disorder professionals can help you regain your health, learn to eat normally again, and develop healthier attitudes about food and your body.

The difference between dieting and anorexia

Healthy Dieting


Healthy dieting is an attempt to control weight. Anorexia is an attempt to control your life and emotions.

Your self-esteem is based on more than just weight and body image.

Your self-esteem is based entirely on how much you weigh and how thin you are.
You view weight loss as a way to improve your health and appearance. You view weight loss as a way to achieve happiness.
Your goal is to lose weight in a healthy way.

Becoming thin is all that matters; health is not a concern.

Learn to tolerate your feelings

Identifying the underlying issues that drive your eating disorder is the first step toward recovery, but insight alone is not enough. Let’s say, for example, that following restrictive food rules makes you feel safe and powerful. When you take that coping mechanism away, you will be confronted with the feelings of fear and helplessness your anorexia helped you avoid.

Challenge damaging mindsets

People with anorexia are often perfectionists and overachievers. They’re the “good” daughters and sons who do what they’re told, try to excel in everything they do, and focus on pleasing others. But while they may appear to have it all together, inside they feel helpless, inadequate, and worthless.

Develop a healthier relationship with food

Even though anorexia isn’t fundamentally about food, over time you’ve developed harmful food habits that can be tough to break. Part of recovery is developing a healthier relationship with food.

Medical treatment

The first priority in anorexia treatment is addressing and stabilizing any serious health issues. Hospitalization may be necessary if you are dangerously malnourished or so distressed that you no longer want to live. You may also need to be hospitalized until you reach a less critical weight.

Chronic Kidney Disease (CKD)

Chronic kidney disease (CKD) is a condition characterized by a gradual loss of kidney function over time. The term chronic is used to refer to a condition which is permanent and irreversible. In addition, it progressively worsens even with treatment. This will eventually, over a period of time lead to need for dialysis or renal transplantation.
This is associated with complications such as high blood pressure, weak bones, low blood dialysis-access-management-the-miller-procedure-for-steal-syndromeDialysis-Treatment    hemoglobin and cardiac and nerve and brain damages.
Causes of Chronic Kidney Disease
The two main causes of chronic kidney disease are Diabetes mellitus and High blood pressure. These two diseases together are responsible for up to two-thirds of the cases.
High blood pressure, if uncontrolled, or poorly controlled, can be a leading cause of heart attacks, strokes and chronic kidney disease. Also, chronic kidney disease can cause high blood pressure.
Several other conditions can cause chronic kidney disease.
• Glomerulonephritis:A group of diseases that cause inflammation and damage to the kidney’s filtering units. These are unique diseases which generally affect the kidneys primarily and as a result of kidney damage can cause damage to other organs of the body. These disorders are the third most common type of kidney disease.
• Polycystic kidney disease An Inherited diseases, which causes large cysts to form in the kidneys and damage the surrounding tissue.
• Malformations and developmental abnormalities that occur during intrauterine development.
• Systemic lupus erythematosos and other diseases that affect the body’s immune system.
• Obstructions to urine flowcaused by problems like kidney stones, tumors or an enlarged prostate gland in men.
• Repeated urinary infections.
Most people may not have any symptoms until their kidney disease is advanced. However, the following symptoms occur as the disease progresses.
Tiredness and feeling less energetic in day to day activities; have trouble concentrating have a poor appetite and have difficulty in sleeping. These are non-specific symptoms and occur very slowly and are difficult to recognize in the beginning.
In addition patient may also have certain specific symptoms like swelling in the feet, and puffiness of the face especially around the eyes more so in the morning. Decrease in urination sometimes associated with the need to urinate more often at night occurs.
In severe cases and advanced renal failure patients have breathing difficulty, headache, convulsions, visual disturbances, and loss of consciousness. This warrants emergency treatment.
Detection of chronic kidney disease: Important tests of kidney function.
The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.
Blood Urea Nitrogen: This is a chemical which accumulates in the body during day to day activities. It is normally excreted by the kidney and it accumulates in the blood in patients in whom the kidney function is reduced.
Serum Creatinine: this is also a waste material which accumulates in the body and if not cleared by the kidneys its blood levels raise. A raised blood urea and creatinine levels generally indicate kidney failure; however the values need to be interpreted taking in to account several other variables. Generally both blood urea and serum creatinine levels are to be considered.
If these tests are abnormal then several other chemicals in the body need to be measured to decide on the severity of the disease and to guide the treatment.
It is important to note that these tests indicate the severity of the disease and cannot confirm whether the disease is reversible or permanent.To decide if the damage is permanent or reversible renal scan is necessary
Ultra sound scan or CT scan of the kidneys will give information regarding the size of the kidneys and presence or absence of obstruction
In patients with Chronic kidney disease the kidney size is usually reduced to less than 9cms which is the normal size. In addition the appearance of the kidneys in the scan also is abnormal.
Kidney Biopsy:
In some patients if the kidney size is normal taking a small bit of kidney tissue though a needle and studying the microscopic structure may be necessary
Additional tests may be necessary to detect the complications or response to treatment measures.
Salient points:
Early detection can help prevent the progression of kidney disease to kidney failure.
Heart disease is the major cause of death for all people with Chronic kidney disease.
Hypertension can causechronic kidney disease and chronic kidney disease can cause hypertension
Persistent proteinuria (protein in the urine) means Chronic kidney disease is present and may in some cases lead to kidney failure.
High risk groups include those with diabetes, hypertension and family history of kidney failure.
Two simple tests can detect Chronic kidney disease: blood pressure, urine albumin and serum creatinine.
Treatment options

These include the following:
Supportive treatment in the early stages:
Renal replacement therapy when the disease is advanced:
Supportive treatment:
This is started when the patient has kidney failure but the degree of failure is not severe and the patient can be managed with medications and diet.
The aim of therapy is to
1. Control the symptoms
2. To delay the progression of kidney failure
3. To prepare the patient for eventual dialysis support.
Control of Symptoms:
These include medication to control blood pressure, blood sugars in patients with diabetes, and some medications to alleviate the problems due to alterations in electrolytes, water content of the body and the bone minerals. With strict control of blood pressure the progression of kidney failure can be significantly slowed down.
Salt restriction:to control blood pressure and fluid accumulation in the body.
Fluid restriction: to control swelling and fluid accumulation
Low protein: Protein in the diet acts as an additional burden on the already malfunctioning kidneys. Moderate reduction in dietary protein intake is known to reduce the progression of the kidney failure.
Fruits; generally fruits are very rich in a mineral called potassium. This is normally excreted only through the kidneys. In conditions where kidneys are unable work normally potassium accumulates in the body. High blood potassium levels are harmful to the heart and require urgent treatment.
Dietary advice from an experienced dietician is very helpful.
Renal Replacement therapy:
There are two treatment options for kidney failure:
Dialysis (hemodialysis or peritoneal dialysis) and kidney transplantation
Briefly Dialysis means removing the waste products from the blood periodically with the help of an artificial kidney or the patient’s own abdominal membrane.
Transplantation involves placing a normal kidney surgically from a donor either living or cadaver.

Hemodialysis is a treatment that removes wastes and extra fluid from the blood.During hemodialysis, the blood is pumped through soft tubes to a dialysis machine where it goes through a special filter called a dialyzer (also called an artificial kidney). After the blood is filtered, it is returned to the bloodstream.-peritoneal-dialysis-catheter
Dialysis is necessary if the kidneys no longer remove enough wastes and fluid from your blood to keep the body healthy. This usually happens when there is only 10 to 15 percent of kidney function left. The patient usually has severe symptoms such as nausea, vomiting, swelling and fatigue. However, one can still have a high level of wastes in the blood that may be toxic to the body and yet have minimal symptoms. Your doctor is the best person to tell you when you should start dialysis.
Blood is removed from the body using needles placed in the veins or through tubes inserted in to major veins. This is called dialysis access
For the peripheral veins to give good amount of blood for cleaning a small surgery to connect the vein to the artery is required. This needs to be done several weeks before dialysis is anticipated.
Dialysis is generally required 3 times a week each time lasting for 4-5 hours. This can be done as an outpatient procedure and the patients usually can get back to work after the session is over. Blood tests are done monthly to assess the adequacy of dialysis.
Peritoneal dialysis:
In this process a small soft rubber tube is placed in the abdomen and once the wound heals sterile fluid can be instilled in to the abdominal cavity through this tube. The fluid is left in place for 3-4 hours and during this time it takes up the waste material from the blood and it can then be removed through the same tube. This is called one exchange. Usually 3-4 exchanges are required daily and the patient is trained to do the same at home. The quality of dialysis is assessed monthly by the Nephrologist.
Renal Transplantation:
This is the most physiological way of replacing the kidney function. It involves placing a new kidney in the patient’s body usually the lower abdomen. The kidney can be donated by a close relative or it can also be from a brain dead person. The donor and recipient pair undergo a series of tests to confirm mutual compatibility and matching. The recipient will require medications life long and close and frequent monitoring.


Hanging abdomen with an apron is unsightly and uncomfortable for any woman. Not able to wear the dress of their choice is so depressing to anyone. The self esteem gets down with every morning seeing the self profile. But they can be happy that there is a sure way out.
Causes of hanging abdomen
1) Overweight or obesity : General adiposity (excess fat) as part of increase in Body Mass Index can cause an increase in abdominal circumference. The ideal BMI is 18-23. Once it is above 23 till 27.5 it is overweight and 27.5 onwards is obesity. BMI is calculated as weight in Kg/Ht in M2 e.g. If a person has 100kg weight and 2m height, BMI= 100kg/ 2m x 2m=25 Kg/M2

2) Truncal Obesity (Abdominal obesity) : Increasing abdominal obesity is more dangerous than the overall increase in weight. Ideally, the abdominal circumference at umbilical level should be below 80 cm in women. The increase in BMI and abdominal circumference leads to various medical illness like Diabetes, hypertension (increase in blood pressure), dyslipedemia (increase in cholesterol), sleep apnoea (breathing difficulty/ snoring with respiratory arrest), PCOS (Polycystic ovarian disease) and fatty liver. It also increase the risk of cancers of breast and ovary.

3) Divarication Recti (separation of muscles of abdominal wall) : This happens mainly and commonly following pregnancy when there is excessive stretch of abdominal wall muscles making it fall apart from the midline. This leads to bulging of abdomen and patient will have a state similar to pregnancy look. This is highly distressing to any woman. The abdominal bulge will be such that it projects out and comes anterior than breast level in a profile view.

4) Ventral hernia : muscle defect with herniation/ projection of abdominal contents in to the sac formed at the muscle weakness. The intestines or omentum get trapped in this defect and can cause life threatening problems.

5) Sagging fat and skin : The lower abdominal wall fat and skin is redundant (extra) and hangs down in an unsightly manner. The skin sagging may be unrelated to the muscle weakness. The pulling down of the abdominal wall by the weight of this apron itself will be causing discomfort and muscle weakness. The disfigurement in these patients is unexplainable.

Patients need to consult a surgeon who is well-versed with the problem and its corrective measures. Detailed physical examination with abdominal girth, height, weight, BMI, BP, Pulse, oxygen saturation to be checked. The co-existing problems like diabetes, hypertension, snoring, respiratory difficulty with walking, menstrual irregularities, stress incontinence and psychological problem (mainly depression).
The psychological impact of these illness on the patient is very significant. They will be always worried about and other is depression seeing the bad body contour every day. Being not able to wear the dress they like and not able to move around comfortably also keeps them introverts and less sociable. Many jobs also demand people with normal BMI and body shapes. Even promotions are jeopardized by these abnormalities. The associated medical problems and the need for medication for the same will also be making patients uncomfortable and dissatisfied in life.

Treatment Options
Those who have increased BMI should be advised for weight reduction. To a good extend it is possible by diet regulations and exercise. There are some drugs available to reduce weight but it helps in reducing weight around 4-5 kg only. Those with higher BMI will be benefitted by intra-gastric balloon placement or by bariatric surgery of which sleeve gastrectomy is the best. Abdominal obesity also gets controlled to a great extent by these procedures.
Divarication of recti (the separation of muscle in the central abdomen), the ventral hernia and sagging skin with fat (the abdominal apron) needs tummy tuck (abdominoplasty). The exercises to tone the abdominal wall, weight reduction or application of any kind of solutions or application of slim devices like vibrators are not going to give any kind of benefit to these patients.
The procedure of tummy tuck involves a pre-hospitalization checkup including blood tests. Ultrasound abdomen is performed to rule out any other surgical problem in abdomen like an ovarian cyst or gall bladder stones which can be talked at the same time. The necessary consultations will also be done with other specialists as needed.
The operation is done under anaesthesia, either general or regional, so that patient will be comfortable. The incision will be made at the lowest skin crease of abdomen to give excellent cosmetic outcome. The skin and subcutaneous fat will be mobilized. The muscles which are far apart will be brought together. In case of hernia a net like material (mesh) will be used to give additional strength. The excess fat and skin will be removed and wound closed. The wound closure is also done in a careful manner with no stitches outside. This also will add to the perfect healing with very minimal scar. The scar will be completely hidden by the smallest of dress.
Patient needs to be in hospital for 2-3 days and can resume normal activities after that. All kinds of job can be started within two weeks time. Wearing an abdominal binder during this period will give additional comfort.
The outcomes are such great that patients get immediate results and regain self esteem. The profile changes and any modern dress will suit the person. The medical issues related to the divarication like dragging pain in abdomen and backache due to the abnormal posture and weight of ventral hernia will also get resolved. In those with higher BMI and sagging abdomen the procedure to reduce weight (sleeve gastrectomy) is done along with the tummy tuck thereby avoiding scars of the bariatric surgery and unnecessary second hospitalization. Combination of these procedures is an innovative method developed at our centre to give maximal benefit for patient with superior quality of life.

Dear Dr Padmakumar

My tummy tuck (abdominoplasty) was done in september 2013. I was very uncomfortable and had very strong inferiority complex due to my sagging abdomen and hernia. My friends are asking me ” oh you are pregnant again”. After my tummy tuck surgery , ” I can’t believe , all tummy had gone and I was flying in heights”.

Now am happy that I can wear any kind of dress I wish and my confidence level increased.

Thank you all doctors “you are all so special in my life”

Mrs. Liji Chandran


Dr. R. Padmakumar MBBS, DNB, MNAMS, DipALS, FAIS
Specialist Surgeon , International Modern Hospital, Dubai

Senior Consultant Surgeon & Medical Director, Sunrise Hospital, Cochin (Specialist in Laparoscopy, Hernia, Cancer, Endoscopic Thyroid Surgery,
Thoracoscopy, Obesity and Diabetic Surgery)

GC Member – Association of Surgeons of India
National President Elect – Indian Hernia Society
Jt. Secretary – Indian Association of Endocrine Surgeons
Founder Member – Obesity and Metabolic Surgery Society of India &
Association of Minimal Access Surgeons of India
International Faculty of IASGO on Hernia and Diabetic Surgery
International Faculty of IFSO on Ileal Interposition (Diabetic Surgery)

Mob : +919447230370 (India) ; 00971567581025 (UAE)
Email : drrpadmakumar@gmail.com


The World Diabetes Day 2014 campaign marks the first of a three-year (2014-16) focus on healthy living and diabetes. This year’s activities and materials will specifically address the topic of healthy eating and its importance both in the prevention of type 2 diabetes and the effective management of diabetes to avoid complications.

The latest estimates from the International Diabetes Federation indicate that there are 382 million people living with diabetes worldwide. By 2035, 592 million people or one person in ten will have the disease. A further 316 million people are currently at high risk of developing type 2 diabetes, with the number expected to increase to almost 500 million within a generation. What makes the pandemic particularly menacing is that throughout much of the world, it remains hidden. Up to half of all people with diabetes globally remain undiagnosed.

These facts and figures reiterate the importance of urgent action. Most cases of type 2 diabetes can be prevented and the serious complications of diabetes can be avoided through healthy lifestyles and living environments that encourage and facilitate healthy behaviour.

The key messages of the campaign aim to raise awareness of how the healthy choice can be the easy choice and the various steps that individuals can take to make informed decisions about what they eat. Special focus on the importance of starting the day with a healthy breakfast.

All campaign activities with the slogan “Diabetes: protect our future.”

The campaign will continue to promote the importance of immediate action to protect the health and well-being of future generations and achieve meaningful outcomes for people with diabetes and those at risk.

The key messages of the campaign include:

  • Make healthy food the easy choice
  • Healthy eating: make the right choice
  • Healthy eating begins with breakfast

Dr  Sushum Sharma
Specialist Internal Medicine