People with intellectual disabilities may be "invisible" to pharmacists. They are a complex group of patients many of whom have diabetes. Pharmacists may have little experience of the challenges faced by this high risk group of patients who may be prescribed high risk medications. This case report details information supplied by Pat, a 33 year old gentleman with intellectual disabilities and diabetes to a pharmacist researcher. The aim of the research project, which received ethics approval from a university research ethics committee, was to determine the views and knowledge of people with intellectual disabilities about medication use. Pat proved to be an excellent source of information concerning the complexity of "self care" by a person with intellectual disabilities and diabetes. Many quality issues became evident to the pharmacist researcher during the interview. These issues included "self care", diabetes distress, health literacy, medication information provision, safe practices around storage of insulin and glucagon, appropriateness of a monitored dosage system, repeat dispensing of insulin and the complexity of care co-ordination. The international trend to deinstitutionalise the care of people with intellectual disabilities will require that this complex group of patients to get support from care givers and health and social care professionals in the community setting to ensure quality medication use. Pharmacists must rise to challenge to provide accessible patient centred pharmaceutical care to this high risk population.