Hypoglycemia in patients with diabetes is very common in the hospital and is associated with poor outcomes. While insulin is the generally accepted treatment for diabetes, it is also the primary cause of hypoglycemia. Regular point-of-care testing for glucose is key for preventing hypoglycemia especially since inpatients may not manifest typical symptoms. Knowledge of insulin action profiles will help mitigate risk for hypoglycemia by matching the insulin to patient needs. Guidelines and protocols should be established in the hospital to assist providers with initiating and adjusting insulin to prevent hypoglycemia. Common clinical situations can be identified which may lead to hypoglycemia and require insulin dosing changes. When hypoglycemia occurs, appropriate acute treatment and steps to prevent recurrence are necessary.