Objective: This study aimed to determine the frequency of diabetic ketoacidosis (DKA) as initial presentation among patients with type-1 Diabetes Mellitus (DM-1) following in Aseer Diabetes Center of Aseer Region, Southwestern of Saudi Arabia. Patients and Methods: Retrospectively we reviewed and analyzed medical records of type-1 DM children who were less than 15 years and diagnosed with DKA at initial presentation, over period of 7 years from February 2006 till January 2013. Results: Out of 508 diabetic patients, 244 (48%) patients had DKA at the initial presentation. The mean age was 8.5 years. 120 (49.1%) with DKA were males and 124 (50.9%) females. Six patients with type-1 DM were less than one year and 5 (83.3%) of them were in DKA, compared with the 239 patients (47.6%) of the remaining 502 patients beyond this age. Generally, frequency of DKA among patients from (1-5) year was 51.7% (N=176) and more than 5 years was 46.9% (N=153). No death, renal failure or permanent neurological damage was reported at the initial presentation. Conclusion: A significantly high percentage of children with newly diagnosed DM-1 still have DKA at the onset of DM. This calls for health education and awareness of the parents / public and primary health care physicians through continuous medical education and mass media to achieve early diagnosis of type-1 DM before the development of DKA.