INS and small cell lung carcinoma: A 49-year-old female was treated with nivolumab and ipilimumab for small cell lung cancer. The patient received two doses and following the second dose presented to the emergency room with intermittent and cramping abdominal pain and mild respiratory distress. Blood tests showed elevated plasma glucose of 384 mg/dL (21.3 mmol/L), decreased bicarbonate levels of 14 mmol/L, and HbA1c of 6.6%. Urinalysis was positive for ketones and glucosuria. The patient was treated with a bolus of saline, regular insulin, and an insulin drip.