@T West
DTU usage is measured as a combination of CPU, IO, and Memory usage in your database, and high DTU usage could be the result of one or multiple issues with these resources.
The first step in diagnosing high DTU usage is to figure out which resource is contributing to your high usage by querying the sys.dm_db_resource_stats table
SELECT * FROM sys.dm_db_resource_stats ORDER BY end_time DESC;