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Diabetes mellitus is a chronic complex metabolic disease in children requiring continuous medical care to decrease the possibility of lifelong complications. The initial presentation of diabetes is usually in the form of polyuria, polydipsia, enuresis, weight loss, or polyphagia. In addition, diabetes may present in its most critical form, ketosis or non-ketotic hyperosmolar syndrome. Unfortunately, this may lead to stupor, coma, and death if not promptly treated.

Diabetic ketoacidosis (DKA) is the presentation of more than half of the patients with type 1 diabetes mellitus (T1DM). DKA results in a rise of the proinflammatory markers, and oxidative stress and subsequently increases morbidity and mortality risk. Patients with type 1 diabetes are 25% more prone to develop autoimmune diseases. The most common are autoimmune thyroid disease, celiac disease, and primary adrenal insufficiency.

Many risk factors behind DKA in newly diagnosed individuals with T1DM as the absence of a family history of T1DM, low socioeconomic class younger age, and delayed diagnosis. On the contrary, DKA can occur in known diabetic patients due to several causes such as poor compliance to insulin intake, infection, dysfunction of the insulin pump, and dehydration.

Acute physical insult to the body, for example, febrile illness, poses a threat to survival and well-being. That initiates a physiological response to maintain homeostasis together with complex interactions between the immune and autonomic nervous systems. This activates the hypothalamic–pituitary–adrenal axis leading to the production of cortisol. An increase in the cortisol level occurs as a result of illness and stress to adjust the tone of the blood vessels, cardiac function, and the immune response.

Several studies have shown a positive correlation between serum total cortisol and the severity of critical illness as well as the risk of death. So, this study aimed to measure serum cortisol levels during DKA as significant predictors of DKA duration & to assess the time to recovery from (DKA) between children newly diagnosed with diabetes compared with known diabetics.