37-year-old man with a history of poorly controlled T2DM on insulin presented with unconsciousness, bloody vomiting and tender left upper abdomen. BP = 70/40 and HR = 110/min. Labs showed HCO3 = 13 mmol/l, pH = 7.25, Glu = 2088 mg/dl, ketonemia,  Lactate = 9 mmol/l, creatinine = 7.6 mg/dl, Hypertriglyceridemia, hypophosphatemia and lipase = 2900 U/l. Abdominal CT showed no signs of pancreatitis. Septic work-up, EEG, urine drug screen and MRI brain were negative. Here, INS is linked to hypophosphatemia.