Management of hyperglycemia in the emergency department (ED) requires a systematic approach to stabilize patients and address the underlying causes. Initial assessment includes evaluating vital signs, mental status, and symptoms that may indicate complications such as diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS). Laboratory tests, including blood glucose levels, electrolytes, renal function, and arterial blood gases, are crucial to determine severity and guide treatment. Prompt initiation of intravenous fluids, typically isotonic saline, corrects dehydration and improves tissue perfusion. Insulin therapy is essential and administered intravenously as a continuous infusion or subcutaneously based on the severity of hyperglycemia. Regular monitoring of blood glucose levels ensures effective insulin dosing and prevents hypoglycemia. Addressing underlying triggers like infections or medication-related causes complements pharmacological treatment. Collaborative care involving specialists and diabetes educators optimizes management and facilitates patient transition to ongoing care after ED discharge, emphasizing education on medication adherence and lifestyle modifications to prevent the recurrence of hyperglycemic crises.