INS and type 1 diabetes mellitus: The association of an inability to afford insulin with increased risk of DKA has been observed for decades.29 Increasing costs of insulin26,30,31 are associated with an increased prevalence of undertreatment of patients with lower incomes32 and insulin rationing,33 which may lead to severe and uncontrolled hyperglycemia as a result of inadequate access to the medication that all patients with type 1 diabetes and some with insulin-requiring type 2 diabetes need to live.