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Diabetic ketoacidosis presents with dehydration, hyperglycemia, anion gap metabolic acidosis, and compensatory Kussmaul respirations. Prehospital management focuses on airway/ventilation support, cautious isotonic fluid resuscitation to restore perfusion, electrolyte and rhythm monitoring, and rapid transport. Insulin therapy is typically hospital-based due to the need for electrolyte (especially potassium) assessment; premature insulin can worsen hypokalemia and precipitate dysrhythmias. Routine sodium bicarbonate is not indicated unless there is severe acidosis with life-threatening hyperkalemia or cardiac arrest, and then only under strict indications. Fluid restriction risks ongoing hypoperfusion and worsened acidosis. Paramedic medical objectives emphasize assessment for precipitating factors (infection, missed insulin), trending mental status, monitoring ETCO₂ as a noninvasive surrogate of acid-base status, and addressing nausea/vomiting. Avoid excessive fluid boluses if signs of fluid overload develop, but initial volume resuscitation is beneficial. Early recognition and supportive care stabilize patients before definitive hospital management of insulin and electrolyte replacement.