Services

Prevention

Diabetic retinopathy cannot always be avoided. However, regular eye exams, proper blood sugar and blood pressure management, and early intervention for vision problems can prevent severe vision loss. Keep an eye on your blood sugar levels. You may need to check and record your blood sugar several times a day, but more often when you're sick or stressed. Ask your doctor how often you should check your blood sugar. The glycated hemoglobin test, also known as the hemoglobin A1C (HbA1c) test, measures your average blood sugar levels over a period of 2-3 months. People with diabetes should maintain their HbA1c level below 7%.

Other types of diabetic eye disease

Diabetic retinopathy is the primary cause of vision loss for people with diabetes but they are more likely to develop several other eye conditions:

Cataracts - People with diabetes are 2 to 5 times more prone to develop cataracts. It also makes you more likely to get them even at a young age.

Open-angle glaucoma - Diabetes nearly doubles your risk of developing a type of glaucoma called open-angle glaucoma.

Diagnosis and Tests

The collaborative effort of diabetologists and ophthalmologists makes the implementation of a screening programme for retinopathy possible in our country. The fundamental issue in diabetic retinopathy is that patients will not have any visual or ocular symptoms until the central seeing area of the retina (macula) is affected or if there is bleeding in the eye. The retinal examination must be done once a year (annually) starting from the time of diagnosis of diabetes for all people with diabetes.

It is recommended for every person with diabetes to take an annual comprehensive eye examination at the centre. This involves:

• Checking vision using the latest equipment
• Measurement of the eye pressure
• Investigation of the front portion of the eye by slit lamp for cataract assessment
• Dilatation of the pupils using eye drops
• Retinal/Fundus examination

Digital Retinal Colour Photography:

Newer techniques of screening for retinopathy by using state-of-the-art digital retinal cameras are available at our centre. Retinal Colour Photography is used as a screening procedure to record colour images of the condition of the interior surface of the eye, in order to document the presence of disorders and monitor their change over time. Tele-ophthalmology is a boon for patients in remote areas who don’t have access to medical care. Tele screening for diabetic retinopathy is a cost-effective and reliable method for screening, is done at all our branches where ophthalmologists are not available, using smartphone-based fundus cameras.

Fundus Fluorescein Angiography (FFA) & Optical Coherence Tomography (OCT):

Fundus Fluorescein Angiography (FFA) is a procedure which involves injecting dye into the bloodstream and taking a picture of it as it runs through the eyes. It allows the careful study of retinal circulation. This helps the ophthalmologist to have a complete assessment of the changes in the retina and pinpoint the specific areas in the retina which are diseased for treatment. It helps to determine the need for laser treatment of the retina. Optical Coherence Tomography (OCT) is a non-contact non-invasive retinal imaging technique, that uses infrared light to visualize the biological tissues/ layers of the retina, especially the central vision area of the retina, namely the macula. Qualitative and quantitative measurements of retinal morphology by the OCT make it a powerful adjunct to conventional fundus examination and FFA, not only for diagnosis but also to track disease progression and monitor response to treatment for sight-threatening retinopathy. OCT helps to diagnose and manage several sight-threatening eye conditions, including glaucoma, age-related macular degeneration, diabetes-related retinopathy, cystoid macular edema, macular pucker, macular hole, cone and cone-rod dystrophies and tumors in the choroid and retina.

Treatment for diabetic retinopathy

Good blood sugar control is the mainstay of treatment for diabetic retinopathy. Laser photocoagulation and intravitreal injections are the gold standard treatment advised for people with sight-threatening diabetic retinopathy. State-of-the-art laser photocoagulation equipment is available for treatment at our hospital.

Cataract Surgery

Cataracts are very common as you get older. Cataract Surgery, also called lens replacement surgery is the removal of the natural lens of the eye that has developed an opacification and its replacement with an intraocular lens. It is safe and helps to correct vision problems caused by cataracts. At Dr. Mohan’s Diabetes Specialities Centre, we have screened the eyes of several thousand people with diabetes. We are one of the few centres exclusively devoted to management/treatment and research in diabetic retinopathy in our country. We follow an internationally accepted system for grading of diabetic retinopathy (ETDRS Grading System) and the International Clinical Classification of Diabetic Retinopathy.

Diabetic Kidney Care

Diabetes can cause many kidney problems. That's why it's important to be proactive about keeping your kidneys healthy. If you have diabetes, it's important to control your blood sugar and blood pressure. You must take prescribed medicine. This way you can keep your kidneys healthy and avoid possible problems later on.

Ask your doctor about your kidney health at your next doctor's visit. Because early kidney disease can be asymptomatic, tests may be the only way to tell if your kidneys are healthy. Consult the doctor and get yourself tested. If you have a urinary tract infection (UTI), consult the doctor immediately because it can lead to kidney damage if left untreated.

Prevention

Maintain blood glucose levels that are near to your target. Checking your blood glucose, or blood sugar, level is an important part of diabetes management. Your doctor may advise you to monitor your blood glucose levels many times every day. Maintain blood pressure levels that are near to your target. Most diabetics aim to keep their blood pressure below 140/90 mm Hg. NIH external site for further information about high blood pressure. Take all of your medications exactly as directed. Consult your doctor about ACE inhibitors and ARBs, which are blood pressure medications that may protect your kidneys.

Diagnosis and Tests

• Dialysis unit

Dialysis is a procedure to substitute the normal functions of the kidney in people with renal failure. Dialysis helps individuals to live a productive life, even though their kidneys are not functioning normally.

At DCS, we have a dialysis unit to take care of our patients who require the procedure. Our dialysis unit is best-equipped with facilities to manage people with diabetes on regular hemodialysis. We have highly trained clinical team of nephrologists, diabetologists, nutritionists and dialysis technicians to ensure quality care to our patients.

FAQs

• 1. How are kidneys affected by diabetes?

The kidneys are one of the body's most important organs which helps to remove waste, maintain fluid balance, regulate blood pressure, make red blood cells, and build bones. All these functions would be impacted by renal impairment. High blood pressure and uncontrolled diabetes are the two main causes of kidney injury. The term "Diabetic Kidney Disease," also known as "Diabetic Nephropathy" and "Chronic Kidney Disease," refers to kidney issues brought on by excessive blood sugar levels in the body.

2.How to protect your kidneys from diabetes?

By leading a healthy lifestyle and managing your diabetes and high blood pressure, you can prevent or delay diabetic kidney damage. Here are a few useful pointers:

• Exercise and physical activity should be a part of your daily routine if you want to control your blood pressure and keep your blood sugar levels within safe limits.
• Regularly check your blood sugar levels. Discuss a healthy blood sugar range with your doctor and diabetes educator, and make an effort to maintain your readings within this target
• Don't wait to get screened for renal disease. Early detection of kidney disease allows for prevention or management. Consult your doctor to find out what lifestyle changes you may make to maintain healthy kidneys.
• Give up smoking. Your kidneys' function declines due to smoking because it decreases blood supply to them. Additionally, smoking raises blood sugar levels, which deteriorates kidney function.

3.Can diabetes be a reason for kidney failure?

Diabetes is one of the main causes for kidney failure. People with diabetes must regularly check their kidney function. Early detection can help to prevent from developing complications and it also helps doctor to give proper treatment based on that.

Weight Management

Weight is a sensitive issue for many people and getting to an ideal, healthy weight is easier said than done. But when you have diabetes, there are huge benefits to losing weight if you're carrying extra weight.

You’ll have more energy and you’ll reduce your risk of serious complications like heart disease and stroke. Losing weight can help with your diabetes control too. And if you have type 2 diabetes, losing weight could even mean going into diabetes remission.

But millions of people with diabetes find keeping to a healthy weight a huge struggle. You're not alone in this, there's support out there to help – a good first step is to ask your healthcare team for help and advice.

On this page:

• What are the benefits of losing extra weight?
• What’s a healthy weightto aim for?
• Diabetes diet plansto help you lose weight, including your weight-loss planner
• Can diabetes cause weight gain?
• Your feelings about food
• Being activeto help with weight loss
• Weight loss surgery.

Around 60% of people with type 1 diabetes  and around 85% of people with type 2 diabetes  are carrying extra weight or are living with obesity.

Benefits of losing extra weight

There are so many benefits to losing extra weight – both physically and emotionally. 

Extra weight around your waist means fat can build up around your organs, like your liver and pancreas. This can cause something called insulin resistance. So losing this weight could help the insulin you produce or the insulin you inject work properly.

And as you start to lose weight and get more active, you and your healthcare team may need to look at your medication, especially if you treat your diabetes with insulin or sulphonylurea. This might mean reducing the dose or making other adjustments, but talk to your healthcare team about it. For some people, needing fewer diabetes medications is a great motivation for losing weight. 

Although getting type 1 diabetes has nothing to do with weight, losing any extra weight will help you reduce your risk of complications and could mean injecting less insulin.

And if you have type 2 diabetes, losing around 5% of your body weight can have real benefits for your health. If you have obesity, you are more likely to put your diabetes into remission if you lose a larger amount of weight,15kg (or 2 stone 5lbs), as quickly and safely as possible following your diagnosis. This could mean coming off your diabetes medication completely – a life-changing possibility. This is even more likely if you lose the weight nearer to your diagnosis and quickly. It's a myth that losing weight slowly is better for you. 

Most people say they also feel better in their mood, have more energy and sleep better.

We’ve got lots of information to help you maintain a healthy weight too, to help keep you on track and prevent putting weight back on.

“We know that losing even 5% of your weight helps improve blood pressure and cholesterol levels. This can have a big impact on your overall health and go a long way to reducing your risk of serious complications, like heart disease and stroke.”

What’s a healthy weight to aim for?

Before you get started, you need to know what a healthy weight is and what numbers you’re aiming for. This is about working out your Body Mass Index (BMI) and your waist size. 

Know your weight

Research shows that the more weight you lose, the greater the health benefits, but even losing just 5% of extra weight will improve your health. 

BMI uses your height and weight to work out if you're a healthy weight. It doesn’t look at how much fat you have around the middle, so that’s why you need to measure your waist too. You can work your BMI out for yourself using this – it will show you your target range.

For many people living with obesity, aiming for a healthy BMI may not be realistic.

Reduction of HbA1c

The average of your last two to three months' blood glucose (sugar) levels is called HbA1c. An ideal HbA1c level for diabetics is 48 mmol/mol (6.5%) or lower.

Your target HbA1c level should be below 42 mmol/mol (6%) if you are at risk of developing type 2 diabetes.

We will discuss the meaning of HbA1c and the significance of aiming for your target level on this page. We will also give you a more in-depth explanation of the HbA1c test and show you how to lower your HbA1c levels if they are too high. In addition, if you want to determine your level in percentage or mmol/mol, you can use our HbA1c converter tool.

What does "HbA1c" stand for?

Glycated haemoglobin, or HbA1c, is a type of haemoglobin. This is what happens when your body's glucose (sugar) attaches to your red blood cells. Because your body is unable to properly utilize the sugar, more of it adheres to your blood cells and accumulates in your blood. Since red blood cells are active for about two to three months, the reading is taken every three months.

A high HbA1c indicates excessive blood sugar levels. As a result, you are more likely to experience complications from diabetes, such as serious issues with your eyes and feet.

You can lower your risk of complications by knowing your HbA1c level and what you can do to lower it. This means regularly checking your HbA1c. As part of your annual review, it's an essential check. However, it will be performed every three to six months if your HbA1c is high or requires additional attention. If you haven't had one in over a year, get in touch with your healthcare team because it's critical not to skip these tests.

It's important to know what your HbA1c level means and how to keep it from rising too high once you know it. Having a slightly elevated HbA1c level increases your risk of serious complications, so learn all you can about it here.

What exactly is the HbA1c test?

The amount of sugar (glucose) in your blood that is attached to your haemoglobin is measured using the haemoglobin A1c (HbA1c) test. The component of your red blood cells known as haemoglobin is responsible for transporting oxygen throughout your body from your lungs. It's a crucial blood test that can tell you a lot about how well you're managing your diabetes.

A doctor or nurse will perform a blood test on you to determine your HbA1c level. This will be arranged for you by your healthcare team; however, if you haven't seen your primary care physician in a while, contact them again.

The majority of individuals will take the test every three to six months. However, if you are planning a pregnancy, your treatment has recently changed, or you are having trouble controlling your blood sugar levels, you might need it more frequently.

Additionally, some individuals will require the test less frequently, typically later in pregnancy. or require a completely different test, as with some forms of anaemia. It's possible to use a fructosamine test instead, but it's very uncommon.

An HbA1c test is also used to diagnose diabetes and monitor levels if you have prediabetes, a condition that puts you at risk for developing diabetes.

The test is also known as haemoglobin A1c or simply A1c.

The results of your HbA1c should arrive quickly. Your healthcare provider will be able to tell you based on the HbA1c test result whether or not they need to alter your medication or treatment to help you better manage your levels. However, it also indicates a number, and it is essential that you comprehend its significance. To keep track of their results and see if they can identify any trends, some people find it helpful to write them down in a diary.

Additionally, a variety of factors, including:

• if you're ill
• if you take other medications like steroids
• if you change your lifestyle
• if you're stressed out or depressed.

A goal level that you should strive for will be discussed with your healthcare team. We are aware that this is not as simple as it seems, but it is essential that you do everything in your power to stay within your target range. If your HbA1c level is even slightly elevated for a longer period of time, you run a greater chance of developing complications that can be fatal.

Normal range of HbA1c levels:

An ideal HbA1c level for diabetics is 48 mmol/mol (6.5%) or lower.

A1C value	eAG value	ADA diagnosis
5.6% or less	114 mg/dl or less	Normal
5.7–6.4%	117–137 mg/dl	Prediabetes
6.5% or more	140 mg/dl	Diabetes

Therefore, your healthcare team may provide you with an individual target level based on your current level and the date of your next test. so that you can bring it down gradually rather than all at once.

Also, we are not saying that reaching and remaining at this level is simple. We are here to offer you assistance and advice because we are aware that it is challenging.

If you're at risk of developing type 2 diabetes, there are various target HbA1c levels for those who are at risk. Your target level should be below 42 mmol/mol (6%), if you have been told you are at risk. If you are at risk for type 2, we have a lot more information for you.

Remission from type 2 diabetes is when a person with the disease maintains healthy long-term blood glucose (also known as sugar) levels without taking any diabetes medications.

Diabetes type 2 remains a serious condition. For many, it can last a lifetime and get worse over time, but not everyone experiences this. This could change your life.

HbA1c converter:

 This tool can assist you in converting HbA1c mmol/mol to % or the other way around.

Millimoles per mole is spelled Mmol/mol. Since 2009, the standard way to measure glucose levels has been the mole, a scientific unit that is frequently used to measure chemicals. A percentage was used before that. Because of this, percentages are often included in measurements.

How to lower your HbA1c levels If your levels have been higher than your target since your last check, it's normal to be concerned. A slightly elevated HbA1c level increases your risk of developing serious health issues. However, knowing your numbers and what they mean is a good first step; you must now know how to lower them.

Your HbA1c levels can fluctuate due to a variety of factors, and you and your healthcare team can reduce them to your desired level by taking the following actions:

• Your diabetes team may need to look over your medication and decide whether to try a new one or increase the dosage.
• Ask them about diabetes education classes in your area. There is always more you can learn about diabetes, and taking a class will help you take concrete steps to lower your HbA1c.
• Increase your physical activity—moving around more is beneficial for everyone, but it can specifically assist in lowering your HbA1c levels.
• Get advice on eating in a healthy, balanced way.
• Quit smoking because it makes it more difficult for blood to circulate throughout your body.

Exercise and lifestyle recommendations to lower A1C levels include the following:

• Physical exercise: According to current guidelines, adults should exercise moderately for at least 150 minutes each week. A suitable exercise plan should be discussed with your doctor if you use insulin or have special considerations.
• Daily routines: A person can keep moving by doing things like gardening, housework, and other routine activities.
• Keeping an eye on blood sugar: This is essential to ensuring that an individual achieves their goals and makes any necessary adjustments.
• Keeping the treatment plan in mind: This includes lifestyle therapies and medication.
• Managing your weight: The individual might think about working with a healthcare professional to set weight loss goals that are both attainable and achievable.
• Monitoring progress: Self-motivation, change monitoring, and determining which strategies work best for a person can all benefit from this.
• Involving other people: If you can get support from others and keep track of your progress, making changes to your lifestyle is often easier.

Tips for a healthy diet: A diet, that is low in sugar, salt, and fat and includes a lot of fresh fruits and vegetables and whole foods can be beneficial to everyone, but it is especially beneficial to people with diabetes.

Keeping track of how much carbohydrate a person eats can help them control their glucose levels.

The following are some general dietary recommendations for lowering A1C levels:

• Planning meals ahead of time
• Keeping a food, medication, and exercise journal
• Spreading out carbohydrate-rich foods throughout the day
• Choosing less-processed or whole foods like whole grains, fruits, vegetables, legumes, and nuts
• Eating a balanced diet that includes healthy proteins, fats, and carbohydrates, and seeking the assistance of a registered dietitian

 A healthcare professional will advise each person on their dietary requirements, including the amount of carbohydrates they should consume. This will be contingent on individual factors, such as the individual's exercise regimen and treatment strategy.

The control of blood sugar levels relies heavily on nutrition. A healthy blood sugar and A1C level can be maintained by following a healthy eating plan.

An eating plan can also be recommended by a dietitian. People can also try the ‘healthy plate’  concept.

Include the following important dietary trends in an eating plan for diabetics:

consuming enough fruits and vegetables; • choosing foods with less added sugar; • limiting trans fats; • consuming less processed food

Our team of experienced doctors, dieticians, diabetes educator and nurses provide high quality, personalised care to each of our patients. We take the time to get to know our patients and their individual needs, so that we can provide them with the best possible care

Diabetes And Blood Pressure

Heart attacks and strokes are more common in people with diabetes and high blood pressure. As a result, controlling your blood pressure is critical. A healthcare professional should check your blood pressure at least once a year if you have diabetes. This check is included in your annual evaluation.

You will need treatment to lower your high blood pressure, or hypertension. This is due to the fact that it can strain and damage your blood vessels. Because of this, it may be more difficult for blood to circulate throughout the body and reach all of the essential organs, including your heart. Additionally, you are more likely to suffer a heart attack or stroke. Additionally, it increases your risk of developing any and all diabetes complications, including serious issues with your feet, eyes, and kidneys.

Because your lifestyle has a direct impact, you can do a lot to help manage your blood pressure on your own. However, a lot of people also need to take medication to lower their risk of complications and treat high blood pressure.

Because there are typically no symptoms, it is very important to be aware that you could have high blood pressure despite feeling fine. However, even if you appear to be in good health, high blood pressure is causing damage to your blood vessels and requires treatment. As a result, you should never miss a blood pressure check, which is a free and quick test.

What is blood pressure?

The pressure your heart uses to move blood through your blood vessels and around your body is called your blood pressure.

Blood pressure is measured in millimeters of mercury (mmHg) and is described by two numbers. It is written as follows: 120/80mmHg. Additionally, your physician will state, "120 over 80."

The systolic pressure is the first number. When your heart beats, it exerts the greatest amount of pressure to move blood around your body.

The diastolic pressure is the second number. When your heart is relaxed between beats, this is the lowest possible pressure.

By way of illustration, the systolic pressure is 120 mmHg and the diastolic pressure is 80 mmHg in this case.

What is the range of recommended blood pressure for people with diabetes?

Maintaining a healthy blood pressure range is essential. This lowers the likelihood that your body will experience additional health issues.

If you have diabetes, your blood pressure should be below 140/80 mmHg, and if you have kidney, eye, or any other condition that affects the blood vessels and blood supply to the brain, it should be below 130/80 mmHg. However, it is essential to discuss your individual goal with your healthcare team.

Even if you don't show any symptoms, high blood pressure can be bad for your health if you don't treat it. This is because your heart, eyes, kidneys, and other organs are under more pressure.

As previously stated, high blood pressure makes your body more susceptible to conditions like heart attack and stroke.

 The following conditions increase your risk:

You can lower your risk of developing kidney disease, cardiovascular disease, cardiovascular dementia, heart failure, and heart failure by maintaining healthy blood pressure.

High blood pressure is sometimes referred to as a "silent problem" or "the silent killer" due to the absence of symptoms. Occasionally, people with very high blood pressure report experiencing headaches, but this is uncommon.

Getting your blood pressure checked by a medical professional is the best way to determine whether you have high blood pressure.

High blood pressure causes and risk factors:

For the majority of people, there is no single cause of high blood pressure. However, we are aware that some things can increase your risk. Diabetes is one of these "risk factors," and it is one of them.

A condition known as atherosclerosis can result from blood sugar levels that are too high. This occurs when fatty deposits build up inside your blood vessels and cause them to narrow. The pressure builds up more as the blood vessels get smaller.

The more pressure your blood vessels are under, the more difficult it is to move blood around your body's important organs. This indicates that your heart, eyes, and feet are in serious complications.

There are additional risk factors that you cannot control:

• Your age
• A family history of high blood pressure
• Race

There are also risk factors over which you can exercise control:

If you make changes to your diet and lifestyle, you can lower your risk of developing high blood pressure. Other risk factors include eating too much salt, being overweight, not being active, smoking, drinking too much alcohol, and how you deal with stress. We don't say it's easy, but it's important to know how to do it. You can get a lot of support to lower your levels and reach your goals.

How to Lower Your Blood Pressure:

Making positive lifestyle changes is a big part of lowering your blood pressure. However, we are aware that things may not always be as simple as that, and some individuals may require medication as well.

Maintain a healthy weight, get more exercise, cut back on salt in your diet, quit smoking, drink less alcohol, try new ways to deal with stress, and cut back on caffeine. Your healthcare team can help you make these changes. Find out what medical services and checks you are eligible for.

BP check-up:

Your doctor or nurse checks your blood pressure with a blood pressure monitor. They will inflate a cuff, which looks like a band that goes around your arm. The blood flow is limited for a few seconds as a result. This is not painful, but it can be uncomfortable. After that, the cuff deflates, a reading is taken by the monitor, and your doctor or nurse will remove the cuff.

This test should be taken at least once a year. One of your essential diabetes health checks, it typically forms part of your annual review.

You can purchase a home blood pressure monitor if you want to. This can be purchased from our shop or from a chemist or pharmacy. You are not required to do this, but some individuals find that it improves their diabetes management.

You are welcome to use a monitor on your own, but you should first check with your healthcare team to make sure you are using it correctly. If you're ever worried, write down your readings and talk to your doctor or nurse.

Your blood pressure results You will immediately receive your results. Your medical team can determine whether your blood pressure is too high, too low, or just right from the reading on the monitor. However, you must also comprehend your outcomes. At each appointment, take a note of your reading and learn what the numbers mean.

A safe target level will be agreed upon by your healthcare team. You must make every effort to remain within your target range. The greater your risk of developing serious complications, the longer your blood pressure stays high. We have a lot of information and advice to help you lower your blood pressure to the level you and your healthcare team have agreed upon.

Medication for high blood pressure: Some people with diabetes also need to take medication, so making lifestyle changes may not be enough.

Diuretics, ACE inhibitors, beta-blockers, antiotensin-2 receptor blockers, and calcium channel blockers are the most frequently prescribed medications for high blood pressure. If you want more information about these, ask your medical team.

Even if your blood pressure is within the normal range and not high, your healthcare team may still prescribe medication to you. This is normal, but you can request an explanation from your healthcare team. Most of the time, it's because the medication itself can protect your kidneys and heart from diabetes complications.