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Aphasic status epilepticus is a rare neurological complication of the hyperosmolar hyperglycaemic state, a severe metabolic emergency in diabetes mellitus. Symptoms include language disturbance without significantly impaired consciousness. The diagnosis is complex, and management of the aphasic status epilepticus involves metabolic correction and antiseizure medications. We describe a 66-year-old man with type 2 diabetes who presented with progressive speech decline and impaired coordination following a fall. EEG confirmed non-convulsive status epilepticus, and MR brain scan showed transient left temporal changes with later hippocampal atrophy. Initial treatment with insulin and levetiracetam led to significant recovery. This case underscores hyperosmolar hyperglycaemic states as a reversible cause of aphasic status epilepticus and highlights the varied neurological presentations of uncontrolled diabetes. We include a review of the literature to contextualise this under-recognised clinical entity.