Generally, the most common triggers for Diabetic Ketoacidosis (DKA) are infectious diseases, such as Urinary Tract Infections (UTIs) or pneumonia. However, emphysematous infections are significant diseases rarely associated with DKA. Here, we present two cases of emphysematous urinary tract infection associated to diabetic ketoacidosis, highlighting the importance of a timely intervention and treatment. We review the need for appropriate laboratory and image testing in the context of infected patients who do not reach inflammatory/ glycemic goals to diagnosticate complicated infectious processes. This case report and mini-review also explore pathophysiology, the association of DKA and urinary emphysematous infections and treatment options.