Critical Care & ICU Dr. Dante Ruskin, PPK Hospital Marthandam

When diabetes becomes an emergency

Most diabetes care is quiet and gradual — tablets adjusted, HbA1c tracked, feet checked. Then, occasionally, it is not.

Diabetic ketoacidosis turns very high sugar into vomiting, rapid breathing, dehydration and drowsiness within hours, usually triggered by an infection or missed insulin.

Severe hypoglycemia does the opposite, dropping sugar until a person is confused, fitting or unconscious.

A diabetic foot infection can move from a small wound to a limb-threatening, life-threatening emergency in days. And people with diabetes carry a higher risk of stroke and heart attack, sometimes without the usual warning pain. Every one of these is a genuine emergency where the response is the same:

Call 108 and get to a hospital with an ICU.

Emergencies we treat

PPK Hospital’s emergency department and intensive care units handle the full range of medical crises this district produces: strokes and cardiac emergencies, diabetic ketoacidosis and severe hypoglycemia, sepsis and severe infections including diabetic foot infections, respiratory failure requiring ventilator support, poisoning and snakebite, complications of kidney and liver disease, and post-operative critical care.

Patients arrive by 108 ambulance directly to the highway entrance, by referral from local clinics and camps in the network, and as walk-ins from Marthandam and the surrounding villages.

Stroke — act now →

Chest pain — act now →

ICU and ventilator care →

The continuity advantage

Here is what usually happens elsewhere. A patient has seen one doctor for diabetes for eight years. They collapse. They are taken to a hospital where nobody knows them, received by a duty doctor who has never seen their file, and treated by an ICU team reconstructing a decade of history from a plastic bag of medicine strips and a frightened relative’s memory. Insulin doses, kidney function, drug allergies, previous heart disease — all of it has to be guessed at or discovered, while treatment cannot wait.

At PPK Hospital that reconstruction is unnecessary for the practice’s own patients.

Dr. Ruskin is both the diabetologist and the intensivist, so the ICU decisions are made by the doctor who set the insulin regimen, knows which kidney numbers are new, and remembers which infection put the patient in hospital two winters ago. Families notice the difference in the first hour: fewer questions, faster decisions, one person accountable for the whole picture.

What intensive care at PPK provides

The ICU is equipped for the work that defines critical care — ventilator support for patients who cannot breathe adequately on their own, continuous monitoring of heart rhythm, oxygen, blood pressure and circulation, intravenous treatment of infection, dehydration and metabolic crises, and round-the-clock nursing at intensive-care ratios.

Because the hospital is a 100-bed multispecialty facility, the supporting services critical care depends on are on the same campus rather than a referral away: laboratory testing at any hour, imaging and diagnostics, operating theatres for surgical emergencies, and inpatient wards for step-down care once a patient stabilises.

NABH accreditation audits the systems behind all of it — medication safety, infection control, emergency readiness and handovers between shifts.

Getting to emergency care fast

Call 108 first, every time. The government ambulance service is free, runs 24 hours across Tamil Nadu and Kerala, reaches villages that private services will not, and carries a trained emergency technician who begins treatment during transport and alerts the hospital before arrival.

Say clearly what is happening — “possible stroke,” “chest pain,” “unconscious, diabetic” — give the location with a landmark, and keep the phone line free. Do not spend the first ten minutes phoning relatives for advice, and do not drive a collapsing patient around town looking for an open clinic.

PPK Hospital’s emergency entrance is on the Trivandrum–Nagercoil highway, opposite the CSI Church in Marthandam, and receives 108 ambulances directly.

Infections: the trigger behind most diabetic emergencies

Ask why a diabetic patient is in intensive care and the answer is usually an infection that was underestimated. High blood sugar impairs the immune response, and diabetes simultaneously blunts the warning signs — fever may be modest, pain may be absent in a numb foot, and the patient often feels “only a little unwell” until they are seriously ill.

Urinary infections, pneumonia, skin and foot infections, and dental abscesses are the common culprits. Two things happen at once: the infection worsens because sugar is high, and sugar rises sharply because of the infection, each driving the other. This is why any fever, any wound that is spreading, and any sudden unexplained rise in sugar readings in a person with diabetes deserves prompt medical attention rather than a week of home remedies.

Sick-day rule: during any illness, never stop insulin without advice, drink fluids, check sugar more often, and seek help early if vomiting begins.

What families should carry

If there is time — and often there is, during the wait for the ambulance — bring three things.

• The medicines.Every strip, box and insulin pen the patient uses, including tablets prescribed by other doctors.
• The reports.The most recent blood tests, ECG, discharge summaries, or a phone with photographs of them.
• The timeline.When symptoms started, or when the person was last seen normal, written down.

For stroke especially, that time determines which treatments remain possible. A relative who can answer questions about the patient’s usual health should travel with them and stay reachable by phone.

After the ICU: recovery and follow-up

Discharge from intensive care is a beginning, not an ending, and this is where fragmented care usually fails patients. Someone who survives ketoacidosis needs to understand what triggered it — a missed insulin dose, an untreated infection, a fever managed at home for too long — or it recurs within the year.

A patient discharged after a stroke needs blood pressure, sugar and cholesterol driven to target, along with physiotherapy and swallowing precautions. After a heart attack, medicines change permanently and adherence decides survival. Because Dr. Ruskin continues as the outpatient diabetologist for these patients, the discharge plan and the follow-up plan are written by the same person: doses reconciled rather than duplicated, the trigger addressed rather than filed away, and review dates that actually get kept.

Families are counselled before discharge on warning signs that mean returning immediately.

Prevention is the real critical care

The most effective intensive care is the admission that never happens. Nearly every diabetic emergency seen in this ICU was preceded by months of signals: sugar drifting upward at each review, blood pressure treated as optional, a foot wound “waiting to see if it heals,” tobacco continuing, appointments postponed because the patient felt fine.

Diabetes is dangerous precisely because it feels like nothing for years and then costs everything in an afternoon. Regular review, honest numbers, blood pressure and cholesterol treated as seriously as glucose, and prompt attention to wounds and infections are what keep patients out of this unit.

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