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A 21-year-old female with poorly controlled type 1 diabetes was admitted with diabetic ketoacidosis and a groin abscess which was incised and drained. She developed necrotising fasciitis affecting the lower abdomen and upper thighs, which required extensive debridement. Subsequent skin grafts were successful; however, injection sites were now limited. She was commenced on inhaled insulin with meals and glargine insulin once daily.This is an unusual indication for inhaled insulin. This case demonstrates the importance of alternative routes of administration of insulin when intensive subcutaneous therapy is not possible. Copyright © 2008 John Wiley & Sons.