Background <p>Diabetic ketoacidosis is a major complication of diabetes, with the prevalence ranging from 4.8 to 30% globally for type 1 diabetes and from 1 to 10% for type 2 diabetes. The humanitarian crisis increases DKA risk due to the collapse of support systems. This study looked at the prevalence and determinants of DKA in Northern State, Sudan, during the 2025 humanitarian crisis.</p> Methods <p>A prospective cross-sectional study was conducted in Northern State’s primary healthcare centers from April to May 2025. We enrolled 140 diabetic patients presenting to hospitals through consecutive sampling and this final sample was smaller than planned due to extreme field constraints. Data was collected via a pre-tested, physician-administered questionnaire and a review of available medical records. Diagnosis of DKA was based on adapted UK criteria, and statistical analysis was performed using Jamovi software (v2.3).</p> Results <p>The prevalence of DKA was 97.9% (137/140). Patients with type 2 diabetes mellitus constituted the majority of cases (82.9%). The key factors associated with DKA included rural residence (67.1%), medication scarcity (59.3%), and recent respiratory infections (51.4%). Severe metabolic derangement was prevalent: 88.6% presented with blood glucose &gt; 300&#xa0;mg/dL, and 97.1% met the criteria for metabolic acidosis.</p> Conclusion <p>Among diabetic patients presenting to hospitals during the crisis, the prevalence of DKA was catastrophic and far exceeds global averages, likely reflecting a collapse of routine care. This finding may not be generalizable to the wider diabetic population. Our findings highlight an acute need for urgent humanitarian interventions, including guaranteed insulin supply and infection prevention programs. There is a critical gap in the integration of diabetes care into emergency response frameworks that must be addressed.</p> Clinical trial number <p>Not applicable.</p>