Patient description: The patient is a 24-year-old man who has had type 1 diabetes for 11 years. He presents to the emergency room with hyperglycemia and concern for possible diabetic ketoacidosis after not taking his insulin for 3 days. The patient reports that he is currently homeless and has lost his supply of insulin, syringes, glucometer, and glucose testing supplies. The patient states that at the time of his initial diagnosis with type 1 diabetes he was hospitalized with a glucose value >1000 mg/dL. At the time, he was experiencing polyuria, polydipsia, and polyphagia. He reports that he has been on insulin since the time of his diagnosis, and he has never been prescribed oral agents for diabetes management. Most recently, he has been using insulin glargine 55 units once daily, and insulin aspart sliding scale 3 times daily. The patient has had previous episodes of diabetic ketoacidosis, for which he was hospitalized. With this episode of hyperglycemia, he is not experiencing any nausea, vomiting, or abdominal discomfort, and he appears well. His lab studies showed: A1c: 11.3% Creatinine: 0.9 mg/dL with eGFR >60 mL/min Aspartate aminotransferase (AST): 17 U/L Alanine aminotransferase (ALT): 14 U/L Beta-hydroxybutyrate: 0.1 mmol/L Bicarbonate: 25 mEq/L Anion

Clinical trial eligibility criteria: eligible ages (years): 18.0-65.0,  Type 1 Diabetes Mellitus Mentally stable and able to comply with study procedures Clinical history compatible with type 1 diabetes with onset of disease at less than 40 years of age, insulin dependence for at least 5 years at study entry, and a sum of age and insulin dependent diabetes duration of at least 28 Absent stimulated C-peptide (less than 0.3 ng/mL) 60 and 90 minutes post-mixed-meal tolerance test Involvement of intensive diabetes management, defined as: 1. Self-monitoring of glucose no less than a mean of three times each day averaged over each week 2. Three or more insulin injections each day or insulin pump therapy 3. Under the care of an endocrinologist, diabetologist, or diabetes specialist with at least three clinical evaluations during the past 12 months prior to study enrollment At least one episode of severe hypoglycemia, defined as an event with one of the following symptoms: memory loss; confusion; uncontrollable behavior; irrational behavior; unusual difficulty in awakening; suspected seizure; seizure; loss of consciousness; or visual symptoms, in which the participant was unable to treat him/herself and which was associated with either a blood glucose level less than 54 mg/dL or prompt recovery after oral carbohydrate, intravenous glucose, or glucagons in the 12 months prior to study enrollment Reduced awareness of hypoglycemia. More information about this criterion is in the protocol  Body mass index (BMI) greater than 30 kg/m^2 or weight less than or equal to 50 kg (110 lbs) Insulin requirement of more than 1.0 IU/kg/day or less than 15 U/day HbA1c greater than 10% Untreated proliferative diabetic retinopathy Systolic blood pressure higher than 160 mmHg or diastolic blood pressure higher than 100 mmHg Measured glomerular filtration rate using iohexol of less than 80 mL/min/1.73m^2 Presence or history of macroalbuminuria (greater than 300 mg/g creatinine) Presence or history of panel-reactive anti-Histocompatibility Antigen (HLA) antibody levels greater than background by flow cytometry. More information about this criterion is in the protocol Pregnant, breastfeeding, or unwilling to use effective contraception throughout the study and 4 months after study completion All women more than 35 years and women of any age who have first degree relatives with a history of breast carcinoma or who have other risk factors of breast carcinoma. More information about this criterion is in the study protocol