Background: Diabetic ketoacidosis (DKA) is a serious acute complication of diabetes mellitus, presenting differently in Type 1 and Type 2 diabetes due to variations in underlying pathophysiology. This study aimed to compare DKA's clinical and biochemical characteristics in these two groups and evaluate their management in an emergency medicine setting. Methods: This retrospective observational study was conducted at MMC General Hospital Peshawar from January 2023 to January 2024. 130 patients diagnosed with DKA were included, with data collected on demographics, clinical presentation, biochemical parameters, complications, and management outcomes. Statistical analyses were performed to identify significant differences between Type 1 and Type 2 diabetes patients. Results: Type 2 diabetes patients were older (45.2 vs. 18.5 years, p < 0.001) and had higher body mass indices (28.6 vs. 22.1, p < 0.001). Type 1 patients exhibited more severe acidosis, with lower pH (7.15 vs. 7.20, p = 0.008), lower bicarbonate levels (12.5 vs. 14.2 mEq/L, p = 0.021), and a higher anion gap (22 vs. 18 mEq/L, p < 0.001). Infections were more common in Type 2 patients (40% vs. 25%, p = 0.048), while Type 1 patients required more aggressive fluid management and achieved faster resolution (24 vs. 30 hours, p < 0.001). Type 2 patients experienced longer hospital stays (5.0 vs. 4.2 days, p = 0.008). Conclusion: This study demonstrates distinct clinical and biochemical profiles of DKA in Type 1 and Type 2 diabetes. Type 1 patients experienced more severe metabolic disturbances but recovered more quickly, while Type 2 patients had higher complication rates and longer hospital stays. These findings highlight the importance of tailored management strategies to address the unique needs of each group. Further research is needed to optimize treatment protocols and improve outcomes.