Both women wanted doctors’ prescriptions for the free pharmacy on the grounds.

In a backward baseball cap with a tattoo of stars and musical notes on her neck, Robin Neal, looking unwell, was interviewed by a triage nurse. Checking her blood sugar, the nurse saw a reading of 529 and immediately raised an arm for attention.

“You need to go to the E.R.,” she told Ms. Neal. Emergency medical technicians arrived to take her to a MASH-style hospital tent for emergency care.

Meanwhile, Angel Neal was suffering abdominal pain and nausea. Cindy Straub, a nurse practitioner who examined her, called them “pancreatic symptoms” and said she, too, needed to go to the emergency tent. An aide walked her over. She was placed on a bed next to her spouse.

Dr. Joseph A. Aloi, an endocrinologist from Wake Forest School of Medicine, examined both women. Standing outside the tent later, he said: “Insulin is coming up on its 100-year anniversary. People know how to take care of their diabetes. They can’t afford the insulin. They run out, they spiral out of control and end up in the hospital.”

After an hour in the tent hooked up to intravenous drips, the women were discharged. They walked the central artery of the fairground, passing medical personnel inviting them to presentations about breast cancer and opioid abuse. The Neals skipped these come-ons. They headed to a big, crowded pavilion offering eye tests. Robin Neal, whose vision was tested at 20/100, desperately needed a pair of the free eyeglasses RAM offered. She joined another long line on the sweltering day.