Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are both diabetic emergencies that require immediate identification and intervention. Advanced clinical practitioners (ACPs) play a crucial role in the early detection, management and co-ordination of care for patients with these conditions, although some may feel less confident in handling such complex cases. This clinical review explores the role of ACPs in managing DKA and HHS, focusing on their responsibilities in diagnosis, treatment initiation, and communication within multidisciplinary teams. It also examines the epidemiology, pathogenesis, risk factors, and causes of these conditions, alongside diagnostic criteria and management strategies. In addition, the review highlights the importance of minimising risks and preventing recurrence to ultimately enhance patient outcomes.