What Happens to the Heart During Diabetic Ketoacidosis at Type 1 Onset?

Diabetic ketoacidosis (DKA) is a serious metabolic emergency that can occur when type 1 diabetes is first diagnosed. It happens when the body cannot produce enough insulin and acids build up in the blood to dangerous levels. While doctors have long known DKA affects the whole body, its impact on the heart—especially in children—has not been well studied.

Previous research in adults suggested that DKA may cause temporary changes in heart function and elevate markers of heart stress. This new study is the first to look systematically at whether these changes occur in children diagnosed with type 1 diabetes who develop DKA.

Researchers enrolled 81 children (median age 9.8 years) at a single center between January 2024 and March 2025. Of these, 43 children (53%) developed DKA at the time of their type 1 diabetes diagnosis, while 38 did not.

The study measured two cardiac biomarkers—troponin I and NT-proBNP—which are proteins released when the heart is under stress. Both were significantly higher in children with DKA at baseline and remained elevated 24 hours after treatment began. Troponin I levels were more than 1.5 times higher in the DKA group, and NT-proBNP was more than twice as high.

Heart ultrasounds performed after 24 hours and again at 6 days revealed subtle but measurable differences. The DKA group showed abnormal patterns of how the heart fills with blood between beats and had reduced overall squeezing strength, measured through a technique called strain analysis. These findings suggest the heart was working harder than normal during the acute crisis.

These findings suggest that DKA at diabetes onset may cause temporary stress on the heart, even in children who may not have any symptoms. The fact that some cardiac changes improved by day 6 suggests these alterations may be reversible.

However, important questions remain unanswered. This study was conducted at a single center with 81 patients, so larger studies are needed to confirm the findings. It is unclear whether these changes have any long-term effects on heart health or whether children need special cardiac monitoring after DKA. The study also did not examine what happens in the weeks and months following the acute episode.

This research adds to growing evidence that DKA triggers multiple systems in the body, including the heart. For families navigating a new type 1 diabetes diagnosis complicated by DKA, this emphasizes the importance of rapid medical treatment and close follow-up—but does not suggest a need for new, home-based cardiac screening.

Source: Cardiovascular diabetology. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.