Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disease 
responsible for moderate to severe hemolytic anaemia. Despite being the most 
common erythrocyte enzyme disorder, it is often overlooked in the regular 
diagnostic parlance. A 40-year-old male patient admitted to the casualty with an 
acutely exacerbated diabetic ketoacidosis, showed features of hemolytic anaemia 
on peripheral smear examination. Crucially, the spherocytes and bite cells 
suggested a possibility of G6PD deficiency. This was substantiated by an 
increased reticulocyte count (6.8%) and a reduced quantitative G6PD enzyme assay 
(7.2%). There was no significant family or prior medical/ drug history. 
Interestingly, the hemolytic features were evidenced when blood glucose levels 
were returning to normal values. The insulin mediated NADPH loss may have 
resulted in an increased erythrocyte oxidant sensitivity and a loss of 
sulfhydryl group availability; causing hemolysis to manifest. G6PD deficiency is 
conventionally affiliated with drug induced oxidative stress. But an association 
with a diabetes mellitus is seldom reported. This case is being presented as it 
highlights the lesser known complication of diabetic crisis such as hemolysis 
secondary to a G6PD deficiency.