Background: The health burden due to diabetes in Saudi Arabia is considerable and expected to rise as the prevalence of diabetes escalates in future years. One of the most common acute causes for diabetics seeking medical attention is the result of inadequate glycemic control, often resulting in hypoglycemia. Hypoglycemia is a serious and potentially life-threatening complication of diabetes and requires prompt intervention. Due to the climate and physical geography of Saudi Arabia, it is likely that many hypoglycemic episodes occur in the desert environment. To effectively manage hypoglycemia in such a setting requires specialized knowledge, flexibility, ingenuity and experience providing care in remote places. The skills and knowledge required to effectively care for ill or injured residents or visitors in remote, isolated and potentially hazardous parts of the world are unique and do not fit into any of the traditional medical specialties. Wilderness Medicine is a relatively new field which encompasses the information, competencies and experience that is required by physicians and other healthcare providers who routinely provide medical care in such environments. Aims: The aim of this paper is to discuss the management of diabetic hypoglycemia, taking into account the unique challenges in Saudi Arabia, as well as identification of knowledge gaps and future research required. Method: The information presented has been drawn from published literature as well as from the authors’ practical experience in providing medical care for severely hypoglycemic patients in the pre-hospital setting. Discussion: Potential hazards for the diabetic individual visiting Saudi Arabian deserts and considerations to avert these, have been discussed. Conclusion: To effectively manage hypoglycemia in such a setting requires specialized knowledge and ingenuity. Critical knowledge gaps and research priorities to inform this area have been identified. Keywords: diabetes, desert, wilderness, travel, heat-related illness, hypoglycemia.