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A 42-year-old South East Asian man presented with reduced conscious level. The family reported that he had had diarrhoea and vomiting for a week. He was not known to have diabetes and there was no family history of diabetes. He was known to have schizophrenia and was on depot risperidone. He was overweight.He was diagnosed with diabetic ketoacidosis with hyperosmolality. He was in the intensive care unit for five days. He made good progress and was discharged home 11 days after admission on 84 units of insulin. He managed to come off insulin but two years later he needed to be restarted on insulin. He is now on haloperidol for his schizophrenia. Copyright © 2010 John Wiley & Sons.