A large study finds that people with type 1 diabetes who still make some insulin have much lower rates of a serious complication.
4 min read · Published 2026-07-13
This is a plain-language summary, written by Celio Health, of a study published in Diabetes Care (2026-07-09). Read the original: Detectable C-Peptide and Diabetic Ketoacidosis Risk in Type 1 Diabetes (PMID 42423477).
Diabetic ketoacidosis, or DKA, is a serious medical emergency that happens when the body breaks down fat too quickly, creating harmful acids in the blood. It can occur in people with type 1 diabetes when blood sugar gets out of control. DKA is dangerous and requires immediate hospital care.
Even though doctors have better tools to manage type 1 diabetes than ever before, DKA still happens to some people. Understanding what might lower the risk could help prevent these emergencies.
Scientists at several Canadian institutions looked at data from over 1,400 people with type 1 diabetes who were followed for an average of 6.5 years. During that time, about 9% of participants experienced at least one DKA event—180 episodes total across the group.
The key finding was striking: of all the DKA events that occurred, 99% happened during years when people's insulin production had dropped to very low levels. Only one DKA event occurred when someone still had detectable insulin production. People who continued to make measurable amounts of their own insulin had about 93% lower risk of DKA compared to those who weren't making insulin.
In type 1 diabetes, the immune system attacks the cells in the pancreas that make insulin. Eventually, most people lose the ability to make insulin on their own. However, some people retain the ability to produce at least small amounts of their own insulin for longer.
This study suggests that even modest amounts of remaining insulin production can be protective against DKA. The findings point to a potential benefit of treatments designed to slow down or preserve this remaining insulin-making capacity—an active area of diabetes research.
When evaluating insulin production in type 1 diabetes, clinicians may discuss two markers: C-peptide and insulin levels. C-peptide is a byproduct released when the pancreas makes insulin, so it's a reliable indicator of how much insulin the body is actually producing. Insulin itself can be harder to measure because injected insulin interferes with the test.
In this study, researchers measured stimulated C-peptide—insulin production triggered by a glucose tolerance test—once per year. A detectable level (above 0.2 nmol/L) was strongly linked to lower DKA risk. These markers can help clinicians and patients understand how much natural insulin-making capacity remains.
This research used data from a large, well-designed clinical trial that ended in 1993, so the findings come from a specific group of people studied decades ago. Treatment approaches and technologies for managing type 1 diabetes have changed significantly since then.
The study shows a strong association between detectable insulin production and lower DKA risk, but association is not the same as proof of cause-and-effect. Other factors related to having better-preserved insulin production might also play a role in DKA prevention.
If you or a loved one has type 1 diabetes, this research highlights why doctors are interested in treatments that preserve remaining insulin production. Even small amounts of the body's own insulin appear to offer substantial protection against DKA. Discussing C-peptide or insulin levels with your clinician may provide useful information about your individual risk profile and help guide treatment choices.
A study of over 1,400 people with type 1 diabetes found that those who still produced measurable amounts of their own insulin had dramatically lower rates of diabetic ketoacidosis. The findings suggest that preserving the pancreas's remaining ability to make insulin could be protective, though more recent research is needed to confirm these results in today's treatment landscape.
This summary is for general education, is not medical advice, and does not diagnose or treat any condition. Studies like this describe what researchers observed, not a recommendation for you. Talk with a qualified clinician about your health, and read how we write about research in our editorial policy.
This research touches on markers a clinician might discuss. Learn what they measure, or order a physician-reviewed test — no appointment needed.
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