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We offer a wide range of health care, educative and support services.
The common diseases which we treat hereare as follows:
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Diabetes and its complications |
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Obesity and Bariatric Surgery |
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Thyroid disorders |
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Other endocrine disorders, including pituitary tumour |
 DIABETES
AND ITS COMPLICATIONS |
Around the world, more people are living in large towns and cities, more people are being born and more people are living longer lives. At the same time, people are exercising
lesser and eating larger quantities of unhealthy foods than they
ever did before. As a result, the total number of people in the
world with diabetes is spiralling out of control.
When first diagnosed, diabetes creates a sense of bewilderment and confusion in the mind of the patient. There is so much to
be learned and to be mastered instantly for survival. We firmly
believe that persons with diabetes can lead a healthy and happy
life. They have to be armed with knowledge and in due course,
they mix it with their wisdom and develop a lifestyle which
will permit them to cope with diabetes successfully. As it is
said, “It is not as important to see what disease a person
has, but to see which person has a given disease”.
You are not Alone
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More than 30 million people in India have diabetes |
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India is the diabetes capital of the world! |
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1 in 3 would need insulin for better control |
| Millions of people in our society are fighting diabetes with
all their will. You too
are one amongst those brave-hearts. Diabetes can be managed
with proper care and understanding,
leading to a normal life. |
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 Managing Diabetes |
| Diabetes currently affects 8 crore people in India. More than half to three fourth of all people with Diabetes are unaware of their condition. |
What is Diabetes?
Diabetes mellitus is a condition where the amount of glucose in the blood is too high because the body cannot use it properly. This causes high blood glucose (sugar) levels, which can lead to a number of complications if untreated, like heart and kidney diseases, increased risk of stroke and may result in blindness as well. |
| Diabetes types |
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Type 1 Diabetes |
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Type 2 Diabetes |
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Gestational Diabetes |
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Type 1 Diabetes?
Type 1 Diabetes develops if the body is unable to produce any insulin. This type of Diabetes usually appears before the age of 40. All such patients would need insulin treatment from the beginning.
Type 2 (Commonest form of Diabetes)
Type 2 Diabetes develops when the body can still make some insulin, but not enough or when the insulin that is produced does not work properly (known as insulin resistance). In most cases, this is linked with being overweight.
GDM (Gestational Diabetes Mellitus)
Gestational Diabetes develops in 5 % of all pregnancies but usually disappears when the pregnancy is over. Women who have had gestational Diabetes are at an increased risk (up to 40%) of developing type 2 Diabetes later. |
| The signs and symptoms of Diabetes are |
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Increased thirst |
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Increased frequency of urination |
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Extreme tiredness |
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Weight loss |
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Blurred vision |
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Genital itching or regular episodes of UTI |
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Slow healing of wounds |
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Excessive hunger |
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General feeling of ageing |
| In both types of Diabetes, the symptoms are quickly relieved once the diabetes is treated. |
| Causes and risk factors |
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Indians or those of South Asian origin are predisposed towards Diabetes |
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A close member of your family has Diabetes (parent, brother or sister) |
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Body Mass Index more than 23 |
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Overweight or if waist size is 80 cms for women and over 90 cms for men |
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Habitual physical inactivity |
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Impaired glucose tolerance |
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Gestational Diabetes |
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If you're over 30 |
| Complications of Diabetes |
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Diabetes mellitus is a chronic condition that can lead to complications over time. Every 10 seconds a person dies from Diabetes related causes |
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Every 1% rise in HbA1c leads to extra 30% Diabetes related complications. These complications can include: |
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Coronary heart disease, which can lead to a heart attack |
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Cerebrovascular disease, which can lead to a stroke |
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Retinopathy (disease of the eye), which can lead to blindness |
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Diabetic retinopathy is the leading cause of vision loss in adults of working age (20 to 65 years) |
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Nephropathy (disease of the kidney), which can lead to kidney failure and the need for Dialysis. 10% to 20% of people with diabetes die of renal failure |
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Neuropathy (disease of the nerves), which can lead to, among other things, ulceration of the foot requiring amputation including Stomach Nerve Damage (Gastroparesis) |
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Erectile dysfunction, sexual and urologic problems stemming from Diabetes |
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Managing your Diabetes
Although Diabetes cannot be cured, it can be managed very successfully.
The main aim of treatment of both types of Diabetes is to achieve blood glucose, blood pressure and cholesterol levels as near to normal as possible. This, together with a healthy lifestyle, will help improve well-being and protect against long-term damage to the eyes, kidneys, nerves, heart and major arteries.
Eat well
Eating a balanced diet, managing your weight and following a healthy lifestyle will benefit your health enormously.
It's better to make small changes that you feel you can stick to rather than completely altering your diet and not sticking to it. You are sure to have lots of questions about your diet. A regular review will widen the available options and would help in choosing the best ones.
Keeping active
Being active is good for all of us but is especially important for people with Diabetes. Physical activity, combined with healthy eating and medication that you may be taking will help you to manage your Diabetes and prevent long term complications. If you have any concerns at all about becoming active, don't be afraid to ask for advice. The Diabetes Team is there to help you.
Medication
Early treatment will reduce the chances of developing serious health problems.
People with Diabetes often need additional treatment along with lifestyle changes such as medication to control their blood pressure and blood fats. Treatment is decided by your specialist. But you should be aware of timings, dosage and its function in the body and how much flexibility is available in a particular treatment.
In Diabetes, stopping the treatment on your own can create lots of problems. Always consult an expert before doing so.
Structured education
Living with Diabetes becomes a lifelong process. Regular sessions will make life easy and comfortable without much hassles. We in Max have a world-class Diabetes Educator Team who have been approved by International Diabetes Federation(IDF). In fact, we are one of the centres for training of Diabetes Educators in India approved by Project Hope, USA.
Role of Diabetes Educator
Diabetes Educators are either Nurses or Dieticians who have been specially trained by Doctors and International Diabetes Federation(IDF) and certified to teach/ instruct Diabetes related information. They would discuss with you in details about insulin, sugar monitoring and related aspects of Diabetes.
Register yourself for education sessions every Monday at Max Medcentre, Panchsheel Park and every Wednesday at Max Super Speciality Hospital, Saket.
Monitoring your Diabetes through Max Diabetes packages
Monitoring your health when you have Diabetes is crucial to prevent some of the complications associated with Diabetes. This involves your blood checks at regular intervals.
We have designed Diabetes packages based on international guidelines. We have also included investigations which not only assess the Diabetes status but also assess you general health.
You may choose a package suited to your budget and the one which addresses severity of the disease. Discuss these packages with your Doctor or Diabetes Educators.
Detailed information on Diabetes Packages and Diabetes Preventive Care, Complications and Assessment Programme tests available at our facilities in Saket, Gurgaon & Panchsheel Park, is given overleaf. |
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| OBESITY
AND BARIATRIC SURGERY |
The Bariatric Surgery Programme at Max Hospital has helped obese patients lose weight through either laparoscopic gastric banding or sleeve gastrectomy or gastric bypass surgery. Among our team of experts are dedicated surgeons, physicians, endocrinologists, nurses, dieticians, physiotherapists and psychologists - all ready and willing to meet with patients one-on-one to share their knowledge and expertise and ensure their full recovery. Our holistic, multi-disciplinary approach addresses all aspects of health - including psychological and medically related conditions - before, during and after surgery.
In fact, we provide patients life-long, post-surgery support to be absolutely certain they achieve and maintain lifestyle changes and their goals. |
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| Bariatric
Surgery Options |
| After a rigorous review that examined safety, surgical outcomes, quality of care and overall performance, the Bariatric Surgery Programme at Max Hospital, New Delhi offers eligible patients three Bariatric Surgery options: |
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Laparoscopic adjustable gastric band |
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Laproscopic sleeve gastrectomy |
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Laparoscopic gastric bypass surgery |
We believe these procedures provide the best surgical options for weight control in the obese patient. These procedures have been shown to offer the best combination of weight loss with fewer nutritional risks.
Additionally, we are committed to the long-term success of our patients and we maintain an extensive database of our patient records, so we can stay in touch and continue to provide support.
Weight loss operations fall into three categories: |
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Restrictive procedures, which make the stomach smaller to limit the amount of food intake |
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Malabsorptive techniques, which reduce the amount of intestine that comes in contact with food so the body absorbs fewer calories |
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Combination operations, which employ both restriction and malabsorption |
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| Restriction
Operations |
| These procedures are the least commonly performed. They encourage weight loss in two ways: |
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Reduce the amount of food you can eat - We shrink your stomach by creating a small pouch at the top of the stomach where food enters from the oesophagus. This makes it impossible for you to eat much. At first, the pouch only holds about 1 ounce of food. It expands to hold 2-3 ounces over time. |
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Slow the speed food empties from your stomach - The lower outlet of the pouch is only about 1/4 inch in diameter. Because it's so small, food empties slowly and you feel full longer. |
| There are two types of laparoscopic restrictive operations: |
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Gastric banding: A band of special material (Siliastic band) is placed around the upper end of the stomach. This creates a small pouch and narrow passage into the rest of the stomach. |
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Sleeve gastrectomy: In this surgery approximately 80 percent of the stomach is removed laparoscopically with the help of staplers so that the stomach takes the shape of a tube or "sleeve". |
| Surgical procedures are recommended only for people with severe obesity who have failed to respond to diet, exercise or medication. Indian guidelines for Bariatric Surgery include: |
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BMI above 32.5 with co-morbidity not responding to optimal medical management including weight loss drugs or causing incapacitation |
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BMI above 37.5 without co-morbidity (like diabetes, heart disease, hypertension, etc.) not responding to optimal medical management including weight loss drugs or causing incapacitation |
| We are the leading centre for obesity related treatment which includes: |
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Restrictive gastroplasty, banding, sleeve |
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Malabsorptive Biliopancreatic diversion with or without duodenal switch |
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Mixed gastric bypass |
| Our Package Services include: |
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Diabetes Packages |
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Obesity Packages |
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| Laparoscopic Gastric Bypass Operations |
Gastric bypass procedures are combination operations. That is, they combine both restrictive and malabsorptive techniques.
This is the most common bariatric procedure. First, we create a small stomach pouch with staples or a vertical band. This restricts food intake. Then, we attach a Y-shaped section of the small intestine to the pouch to allow food to bypass the first and second segments of the small intestine. This reduces your body's ability to absorb nutrients and calories. |
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| Comparing the Procedures |
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Patients generally have more success with gastric bypass operations than restrictive procedures. |
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Risks are similar for both restrictive and gastric bypass procedures. Except the risk of nutritional deficiencies for iron, calcium and Vitamin B12 - are higher in patients who undergo gastric bypass operations. Also, there is risk of intestinal leaking. |
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Gastric bypass operations also may cause 'dumping syndrome'. This is when food moves too fast through the small intestine. It causes nausea, weakness, sweating, faintness and sometimes diarrhoea. |
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In sleeve gastrectomy, there is no intestinal bypass so malabsorbtion i.e. vitamin and protein deficiency is minimal. |
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No intestinal obstruction with sleeve and band as no bypass of intestine is done. |
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| Open vs. Laparoscopic Surgery |
Open and laparoscopic refer to how the abdominal cavity is entered and not the type of surgery being performed. So each type of weight loss surgery may be performed as either an open or a laparoscopic procedure.
When performing open surgery, surgeons create a single incision to open the abdomen for the operation. Typically, for women it is 4.5 to 6 inches, and for men, it is 5.5 to 7 inches.
With laparoscopic surgery, multiple, small incisions are made in the abdominal wall to accommodate a small video camera and surgical instruments. The surgeon views the procedure on a separate video monitor. Most laparoscopic surgeons believe this gives them a better view and access to key structures.
Recent studies show patients who have had laparoscopic weight loss surgery experience: |
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Less pain after surgery |
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Easier breathing and lung function |
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Fewer wound complications, such as, infection or hernia |
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Quicker return to pre-surgical levels of activity |
| We offer the less invasive laparoscopic procedure whenever possible. Speak with your surgeon to find out if you are a good candidate for laparoscopic surgery. And remember, laparoscopic surgery uses all the same techniques as open surgery and has similar results in terms of excess weight loss. |
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| Laparoscopic
Sleeve Gastrectomy |
Sleeve gastrectomy is a technique that offers the same results as gastric bypass but with less risk. The Gastric Sleeve is a new procedure that induces weight loss by restricting food intake (a restrictive procedure). The patient is going to eat a smaller amount of food.
With this procedure, the surgeon removes approximately 80 percent of the stomach laparoscopically and with the help of staplers so that the stomach takes the shape of a tube or "sleeve" or a very slim banana which measures from 30 to 50 cc depending upon the surgeon performing the procedure. In addition of being restrictive, this procedure has seen that the hormone that regulates the appetite, the ghrelina diminishes, diminishing the patient's desires to eat. |
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| Highlights |
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Performed laparoscopically with 5 small incisions (most less than 5 mm, two 12 mm) |
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Endostapler used to divide stomach |
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Takes about 1-2 hours to complete |
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Stay in hospital for 2-3 days |
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Begin drinking on the second day |
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Liquid diet for 2 weeks after the operation |
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Return to work in 1-2 weeks |
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Resume strenuous activity in one month |
| Advantages |
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It is performed laparoscopically |
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It does not require disconnecting or reconnecting the intestines, as in bypass |
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No implant and adjustment required as in band surgery |
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Food is absorbed normally |
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No vitamin and protein deficiency |
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It is a technically simpler operation than the gastric bypass |
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Weight loss surgery for high risk patients, especially those with anaemia, severe asthma, for patients on steroids, inflammatory bowel disease etc. |
| Disadvantages |
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Remaining stomach may stretch out |
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May require follow-up weight loss surgery for super-obese |
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Not reversible |
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| Laparoscopic
Adjustable Gastric Banding (LAGB) |
| In this procedure, a silicon band lined with an inflatable balloon is placed laparoscopically around the stomach near its upper end creating a small pouch (15-30 cc vol.) and a narrow passage is made into the larger remainder of stomach. When you eat, satiety or fullness of stomach comes early and thus you would start eating less, which in turn leads to significant weight loss. This balloon is connected to a small reservoir that is placed under the skin of the abdomen through which the diameter of the band can be adjusted by injecting fluid into it, as an outpatient procedure. |
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| Highlights |
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Performed laparoscopically with 5 small incisions (most less than 5 mm and one 15 mm ) |
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Adjustable silastic gastric band used |
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Operative time approximately one hour |
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Short hospital stay, 1 to 2 days |
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Oral intake of liquid on first post-operative day |
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Quick recovery, one week to work |
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Resume strenuous activity after 2 weeks |
| Advantages |
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Eliminates the feeling of being hungry |
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Food is absorbed normally |
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No vitamin and protein deficiency |
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No cutting or stapling of the stomach |
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Adjustable without additional surgery |
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Fully reversible: stomach returns to normal if the band is removed |
| Disadvantages |
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Band complication : Leak, infection , slippage and migration |
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Office adjustments |
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| Laparoscopic
Gastric Bypass Surgery (LGBS) |
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| In a laparoscopic gastric bypass, the stomach is made smaller by creating a small pouch (30 ml) at the top of the stomach using surgical staples. The smaller stomach is connected directly to the middle portion of the small intestine (jejunum), bypassing the rest of the stomach and the upper portion of the small intestine (duodenum). The small stomach makes you feel full more quickly and part of the small intestine bypass causes reduced calories and nutrient absorption, which ultimately leads to weight loss. |
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| Highlights |
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Performed laparoscopically by 5-6 small 5 mm incisions, one 15 mm |
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Hospital stay 3 to 5 days |
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Begin drinking on the second day |
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Liquid diet for two weeks after the operation |
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Return to work in 2 to 4 weeks |
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Normal activities in 2 weeks |
| Advantages |
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Eliminates feeling of being always hungry |
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You eat small amounts of normal food |
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Diabetes and other co-morbidities are usually resolved early |
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No need for adjustments |
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Lose 65 to 80% excess weight, usually in 1-2 years |
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Sustainable long term weight control |
| Disadvantages |
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This operation is more risky than the band or the sleeve gastrectomy |
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Usually not reversible |
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Long term supplements of vitamins and minerals required |
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| PITUITARY
ADENOMA AND SURGERY |
| Pituitary Gland |
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The pituitary gland is also called the master gland. It controls many body functions, including growth, metabolism, thyroid function, reproduction and the body's response to stress.
Pea-sized and reddish-grey, the pituitary gland is located in the centre of the brain, just above the back of the nose. It is made up of three lobes, each of which produces different hormones. It is attached to the hypothalamus (a part of the brain that affects the pituitary) by nerve fibres. It controls hormones that directly or indirectly affect most basic body activities. (The word hormone comes from Greek meaning to set in motion. A hormone is a chemical messenger from one cell or collection of cells to another.)
Pituitary Adenomas |
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The pituitary gland is a small oval gland at the base of the brain. It controls most of our hormones. These control thyroid activity, the monthly cycle in women, sex drive, growth in children, adrenal gland activity, urine output, childbirth and milk-production after pregnancy.
Doctors describe these tumours in several ways. One way of describing them is: |
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Secreting, which release hormones - These can trigger symptoms such as impotence, stopping of a woman's monthly periods, galactorrhea, abnormal body growth, Cushing's syndrome or hyperthyroidism. |
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Non-secreting, which are usually larger when found and treated with surgery and radiation therapy. |
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Microadenomas, which are smaller than one centimetre. |
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Macroadenomas, which are larger than one centimetre. These can be quite large if not found until they affect nearby brain tissues. The optic nerves are particularly vulnerable. Early on, the vision at the edges of the field of sight can be affected. Pituitary tumours can spread into the area of the head that contains the carotid artery and cranial nerves. |
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When this occurs, the tumours may be particularly difficult to remove completely. |
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| Symptoms |
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| Symptoms vary based on the tumour's size, where it is and whether it secretes or not. They may include: |
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Overproduction of hormones: Functional tumours, which secrete hormones, can produce too many hormones. Almost 20% secrete prolactin, a hormone that causes milk production in women. Very high levels can cause milk production in men and women who are not pregnant. Menstrual irregularities may also occur. |
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Underproduction of hormones: Some 75% of pituitary tumours don't produce hormones. These can grow and damage normal gland tissue. This cuts hormone production. Often the first hormones affected are those that relate to sex. This can cause irregularity or loss of menstruation in women and sterility with loss of sex drive in men and women. |
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Growth disorders: These cause excessive growth (gigantism) in children. In adults, they cause acromegaly, or abnormal growth of the face bones, enlarged hands and feet, excessive sweating and heart disease. |
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Disturbances in vision will occur if the tumour presses on the optic nerves. |
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| Diagnosis of Pituitary adenoma |
A. MRI of pituitary gland: The ability to create images of the pituitary gland, which is located deep inside the skull, has led to tremendous advances in diagnosing and treating pituitary disorders.
B. Hormone testing: Endocrinologists may order other tests that are useful in diagnosing pituitary disorders including: |
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Routine and specialized blood tests. |
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Urinalysis: This involves collecting a sample of urine for chemical analysis. Because hormone levels naturally go up and down during the day and night, it may be necessary to do a 24-hour urine collection. |
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Provocative/Suppressive lab tests: These are tests that are designed to cause or prevent hormones from being secreted to help identify the cause of a pituitary disorder. These include glucose tolerance tests to help diagnose acromegaly, arginine infusion tests to help detect growth hormone deficiency and dexamenthasone suppression tests and inferior petrosal sinus sampling to help diagnose Cushing's disease. |
| C. Neuro-opthalmological evaluation (including a visual field exam): This involves looking at a screen with flashing lights and pressing a button when you see one of the lights. The pattern of flashing lights that you may or may not see maps areas of your vision affected by the tumour. |
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| State-of-the-Art Pituitary Surgery |
Advances in technology such as the endoscope,surgical microscope and image guidance systems have led to major advances in pituitary surgery. Minimally invasive pituitary surgery that allows for precise removal of tumours, in or around the pituitary gland, also leads to faster recoveries, little or no scarring and fewer complications.
Tumours vary in size and activity. If surgery is recommended it may be for one of three reasons: |
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to remove hormone-producing tissue (typically in Acromegaly or Cushing's disease) |
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to reduce the volume of a tumour that is compressing the optic chiasm or other structures |
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to reduce the volume of or to remove non hormone-producing tissue that is likely to threaten surrounding structures in the future, for example, in a relatively young patient, in whom continued growth of the tumour is suspected or has been proven by sequential scans |
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| Transsphenoidal
Surgery |
Transsphenoidal surgery is the most usual method but sometimes transcranial surgery is required in some tumours with major intracranial extension. The transsphenoidal approach allows the surgeon a clear, direct view of the tumour (through an operating microscope) and avoids a craniotomy (making a hole in the skull) with its associated risks of damage to the brain and epilepsy.
Recently an endoscopic approach has been introduced in some centres. Fine tubes (endoscopes) are pushed through the back of the nose. MRI and/or CT scans will give the surgeon information on the size and position of the tumour. Successful outcome of this surgery is very dependent on the experience of the surgeon.
Multiple Endocrine Neoplasia
We offer dietary and medical and surgical treatment. Our dieticians are specially trained to deal with obese patients. Along with dietary intervention, we also offer drug treatment which has approval not only in India but also by US and European authorities. This treatment can lead up to weight loss of 10% or more.
Patient management
Follow-up
The patient will be referred to an endocrinologist for post-operative pituitary function assessment after 5-8 weeks and back to the surgeon after 12 weeks (for MRI and visual field assessment). In some cases, additional replacement pituitary hormones will be needed. These appointments should ideally be combined to cause minimal inconvenience to the patient.
Diabetes Insipidus
If the patient suffers from new onset polyuria and nocturia after surgery, it is likely that they have developed a degree of diabetes insipidus (DI). This is unusual after transsphenoidal surgery, but in all cases is highly amenable to treatment. In most cases, DI is temporary and disappears within a few months, but in 1-2% of patients, especially after removal of Prolactinoma and Cushing-s tumours, it may be permanent and remain treatable.
Cerebrospinal fluid leak
It is possible to develop a CSF leak from the nose in the post-operative period (this is rare). This is associated with a risk of meningitis, and is an inconvenience for the patient. Any flu-like symptoms or discharge of water-like fluid from the nose should be treated with a view to this possibility. Patients need to be referred back to the surgeon for treatment urgently.
Sinusitis
This is not uncommon after this operation, particularly for patients with acromegaly. Symptoms usually clear given time, but occasionally need further treatment or an ENT referral.
Stitches
Depending on the surgical technique, stitches are inserted in the upper gum or in the nostril. They are usually soluble. The wound itself will be completely healed in 3 weeks. Complete absorption of stitches can take 3 months and loose ends may need to be removed/snipped away. There may be some numbness around the front teeth; this may occasionally be permanent.
Weight gain
A major problem for many patients is weight gain. These patients are likely to need some encouragement to follow a suitable diet and take regular exercise. This may be particularly difficult after a period of illness and hospitalisation. However, including more exercise into their lifestyle should also improve the patient's general feeling of well-being.
Emotional impact
Surgical treatment which involves the head has a strong emotional impact for some patients. |
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| We offer a wide range of healthcare, educative and support services for diabetes, obesity and bariatric surgery, thyroid disorders and other endocrine disorders, including pituitary tumour.
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| A list of questions and answers commonly asked by people about diabetes, obesity and bariatric surgery, thyroid disorders and other endocrine disorders and diseases and their treatments.
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| Find out more about the people who care for you - our doctors.
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| You will never feel alienated at Max Healthcare. Know more about how we take care of you.
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