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Autonomic painful diabetic gastropathy is an uncommon and often overlooked cause of recurrent abdominal pain in individuals with diabetes. We describe a young man with type 1 diabetes who developed repeated episodes of severe epigastric pain and vomiting after a traumatic event, with all routine investigations failing to identify a structural, metabolic, or functional cause. His symptoms were resistant to standard therapies but showed rapid and sustained improvement with centrally acting sympatholytic treatment, and autonomic testing later supported underlying dysautonomia. This case highlights the importance of considering autonomic gastrointestinal involvement in unexplained, recurrent abdominal pain in diabetic patients, as early recognition can guide targeted therapy and help avoid unnecessary investigations and hospitalizations.