Hemichorea-hemiballism (HCHB) can be the solely presentation of a wide range of non-neurological clinical pictures, such as metabolic or hydro-electrolyte derangements. HCHB as the first presentation of type 2 diabetes mellitus has been rarely described(1-3). The case depicted herein reinforces this association highlighting that especially in elder patients with newly diagnosed HCHB, non-ketotic hyperglycemia should promptly be recognized.