Case Presentation: A 34-year-old, un-domiciled, woman with T1DM, hypertension, hypothyroidism, polysubstance use disorder, and depression presented with nausea, vomiting, and diffuse abdominal pain for 24 hours. She had run out of her long-acting insulin one month prior and was substituting with short-acting insulin until she ran out of that as well two days before admission. [...]