Background: Focal seizures are a notable complication in patients with poorly controlled diabetes, particularly in the context of non-ketotichyperglycemia (NKH). Seizures associated with NKH are refractory to conventional antiepileptic drugs (AEDs) but respond effectively to glycemic control. This study evaluates the efficacy of insulin and rehydration over AEDs in managing NKH-induced seizures, highlighting the importance of early blood glucose monitoring in seizure presentations. Methods: A single-case observational study was conducted on a 58-year-old female with type 2 diabetes mellitus presenting with focal seizures. Diagnostic evaluations included blood glucose levels, serum osmolality, and imaging studies. The patient received both AEDs and insulin-based therapy, and seizure outcomes were monitored. Results: Despite maximum doses of phenytoin, seizures persisted until blood glucose levels were normalized through insulin therapy and hydration. The patient’s seizures resolved completely following glycemic correction, allowing successful withdrawal of AEDs. Conclusion: Insulin and hydration are more effective than AEDs in managing NKHinduced focal seizures. Early recognition of hyperglycemia and appropriate glycemic management can prevent unnecessary AED use and improve outcomes.