Endocrine Case Report: Vomiting and Drunk

Our latest case report from Dr. Brady Pregerson features a man in his 30s presenting to the ED after drinking and admits to forgetting his insulin and poor adherence to other antidiabetes medication. Can you determine the correct diagnosis?

History:
A man in his early 30’s is brought to the emergency department for vomiting. Medics state she said he has been drinking and often forgetting to take his insulin and his Jardiance. Over the past few hours, he vomited multiple times and she saw some blood and proceeded called 911. The patient is alert but a bit giddy. He denies any fever, pain, melena, or other complaints.

Vital Signs & Physical Exam:
Vital signs are normal except for a pulse of 110. Physical exam is otherwise normal except for the odor of alcohol and a bit of non-bloody emesis on his shirt

Initial Diagnostic Testing:

CBC: normal except for a hemoglobin of 10.2 with macrocytic indices

Chem-7: normal except for a gap of 21 and a glucose of 193

Imaging: none

What is the most likely diagnosis?