The article analyzes the mechanisms of development and clinical manifestations of diabetic ketoacidosis (DKA), presents an intensive care program, discusses the prospects for the use of infusions based on xylitol in the treatment of DKA. The authors presented their own experience of using a solution with a 5% xylitol. It was shown that the use of xylitol can have a positive effect on various parts of the pathological process — from the elimination of dehydration to the correction of acid-base disorders. The authors also discuss the causes of severe ketoacidosis in patients with COVID-19 and present their own experience in the treatment of 14 patients with DKA on the background of COVID-19.