DOI: https://doi.org/10.36347/sasjm.2026.v12i03.001

Pages: 165-168

Hypoglycemia is a frequent and sometimes life‑threatening complication of diabetes therapy, especially with insulin and insulin secretagogues. In primary care the prevention, early recognition, and prompt treatment of hypoglycemia are fundamental to safe, person‑centered care. This narrative review synthesizes current global and regional evidence on the epidemiology, mechanisms, clinical manifestations, awareness, and management of hypoglycemia, with a particular lens on primary health care and recent data from Saudi Arabia and the Middle East and North Africa. We summarize contemporary definitions and thresholds, outline the pathophysiology of impaired counter regulation and impaired awareness of hypoglycemia (IAH), and highlight the clinical and psychosocial burden, including fear of hypoglycemia and its downstream effects on adherence, quality of life, and health care use. Evidence from multinational and regional studies shows that hypoglycemia nocturnal and daytime, mild and severe remains common across insulin‑treated type 1 and type 2 diabetes, while patient awareness and first‑aid practices are highly variable and often suboptimal. Determinants of low awareness include longer diabetes duration, older age, intensive insulin therapy, comorbidity, and inconsistent structured education. We translate guideline recommendations into brief, actionable steps that primary care teams can implement within routine visits: systematic screening for IAH, the 15–15 rule and rescue glucagon, individualized targets and de‑intensification after level 2–3 events, and the strategic use of continuous glucose monitoring. We conclude with practice priorities and research gaps for primary care in Saudi Arabia, including culturally tailored education and digital support to strengthen self‑management and reduce preventable hypoglycemia.