INS and Hypoglycemia: Despite these being rare events while under expert management, severe hyperglycemia, ketosis, and ketoacidosis could be the result of an exaggerated drop in insulin requirement because of fear of hypoglycemia following an initial insulin sensitivity improvement, or in case of missing insulin bolus or basal administration due to gastrointestinal side effects (nausea or emesis) hindering food intake or predisposing patients to prolonged fasting.