A case of hypoglycaemia and three cases of hyperglycaemia presenting with focal neurological deficits are presented. The focal presentations were hemiparesis and focal convulsion that returned to normal upon correction of the blood sugar. Elderly patients not uncommonly present with transient focal neurologic deficits related to abnormalities in blood sugar levels. In these patients correction of blood sugar levels per se may ameliorate symptoms and signs making it unnecessary to investigate for cerebrovascular disease. In diabetic patients on insulin or oral hypoglycaemic agents focal neurologic deficit should alert the clinician on the possibility of hypoglycaemia.