A 48-year old man was seen for annual review in the diabetes centre. He had been diabetic for 2 years, well controlled by diet. On this occasion he complained of increasing tiredness, but no osmotic symptoms and had not lost weight. His home urine testing was negative for glucosuria. He had a complicated medical history with chronic pancreatitis for many years, resulting in multiple gastrointestinal operations, the most recent 2 years previously when his gall bladder and spleen were removed, along with part of his pancreas. Treatment of his autoimmune haemolytic anaemia was supervised at another hospital.