Diabetic Ketoacidosis Reported from U.S. Navy Submarines, 2021–2024

BACKGROUND: Type 1 diabetes mellitus (T1DM) is a complex systemic condition that poses unique challenges for diagnosis and management in military environments, particularly on submarines where access to standard medical resources is limited. CASE SERIES: This case series examines three instances of a first diagnosis of T1DM among active duty male U.S. Navy submariners, highlighting the challenges of managing this condition in austere military environments. Case 1 involves a 27-yr-old experiencing gastrointestinal symptoms during deployment and found to have diabetic ketoacidosis (DKA) complicated by renal failure and pancreatitis. Case 2 features a 22-yr-old presenting with weakness and fatigue on board leading to a diagnosis of DKA and pancreatitis. In Case 3, a 20-yr-old initially treated for pilonidal disease later manifests classic T1DM symptoms, leading to delayed diagnosis despite increased access to care in port. DISCUSSION: These cases underscore the importance of early recognition and intervention, particularly in environments with limited medical resources. Delays in communication and access to higher echelons of care further compound the challenges of managing T1DM and DKA on submarines. To address these issues, the Naval Undersea Medical Institute has developed protocols to empower medical personnel in diagnosing and managing T1DM in such settings. By sharing these experiences, this report aims to improve awareness and preparedness for managing T1DM in submarines, ultimately enhancing the care provided to patients in austere military environments. Monroe DM, Earley JP. Diabetic ketoacidosis reported from U.S. Navy submarines, 2021-2024. Aerosp Med Hum Perform. 2026; 97(5):379-383.