A Simple Blood Test May Help Doctors Assess How Severe Your DKA Is

Diabetic ketoacidosis (DKA) is a serious medical emergency that can happen in people with type 1 diabetes. It occurs when the body breaks down fat too quickly for energy, producing acids called ketones that build up in the blood and urine. This causes the blood to become dangerously acidic and can lead to confusion, difficulty breathing, and organ damage if not treated promptly.

When someone arrives at the hospital with DKA, doctors need to know right away how severe it is so they can provide the right level of care. Identifying severity early helps doctors make faster decisions about treatment and can improve outcomes.

Researchers in Saudi Arabia looked back at medical records from 170 people with type 1 diabetes who were admitted to the hospital with DKA between 2023 and 2025. The average age was about 22 years old, and just over half were female.

The study measured something called the neutrophil-to-lymphocyte ratio (NLR)—a calculation based on two types of white blood cells that are already counted during routine bloodwork. The researchers compared NLR levels to how severe each person's DKA was, measured by blood pH and bicarbonate levels.

The main finding: patients with more severe DKA tended to have higher NLR values. The study also found that severe DKA correlated with higher blood sugar levels and higher white blood cell counts overall. About 60% of patients had moderate DKA, while 12% had severe DKA.

NLR is attractive because it requires no extra testing—it's calculated from blood cells doctors already count when someone comes to the emergency room. If future research confirms that NLR reliably signals DKA severity, it could help doctors prioritize care and make faster treatment decisions.

However, this was a retrospective study, meaning researchers looked backward at records that were already created for other reasons. It doesn't prove that NLR can predict what will happen to a patient or that changing treatment based on NLR would improve outcomes. Much more research is needed before any change to how DKA is assessed in practice.

This study suggests NLR is worth investigating further as one potential tool among many for assessing DKA severity. To move forward, researchers would need to study patients in real time as they arrive at the hospital, track whether NLR predictions hold up, and test whether using this information actually helps doctors provide better, faster care.

If you or a loved one has type 1 diabetes and experiences symptoms of DKA—such as nausea, vomiting, fruity-smelling breath, rapid breathing, or confusion—seek emergency medical care immediately. Your medical team will use established clinical and laboratory measures, along with their expertise, to determine the best course of treatment.

Source: Cureus. 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.