Introduction: Diabetes is a recognizable and major health burden in Saudi Arabia. The incidence of Diabetes Mellitus Type 1 (DM1) reached 109.5 per 100,000 child and adolescent. One of the major life-threatening complications of DM1 is Diabetic Ketoacidosis (DKA). This study aims to estimate DKA incidence among DM1 patients and possible risk factors. Methods: Retrospective review for DM1 patients at King Abdul-Aziz Medical City, and who was presented with DKA during the past six and half years. Results: Three hundred and fifty DM1 patients were included and (72) experienced DKA during study period. The average annual DKA onset was (6.2%). Mean age was (22.82 ± 5.567) years, and females constituted (66.7%) of this group. Poor medication compliance was the commonest risk factor associated with DKA, and this relationship was found significant (P-value 0.003). Out of the total DKA sufferers, (28) patients experienced recurrent or multiple DKA episodes, and those had higher HbA1C levels (11.7 ± 2.9 Vs 12.4 ± 3.3). Patients who had multiple DKA episodes reported less visits to the diabetes educator when compared to the single DKA group. (On average (9) Vs (11) per year). Conclusion: DKA was found relatively uncommon among our DM1 patients, and usually seen in young females with poor medication compliance. More comprehensive education on DKA is needed to protect against life threatening complications.