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Hypoglycemia is one of the most common complications of diabetes and a major limiting factor in the glycemic management of diabetes. Individuals with type 1 diabetes (T1D) and long-standing type 2 diabetes (T2D) have altered counterregulatory responses to hypoglycemia, which puts them at risk for recurrent hypoglycemia and may develop hypoglycemia unawareness. Acute hypoglycemia is associated with increased morbidity, impacts quality of life, and can even be fatal. Severe hypoglycemia should be treated promptly and should be followed by drastic changes in patient’s therapy and lifestyle. Optimal glycemic control while minimizing the risk of hypoglycemia is possible by applying the principles of aggressive therapy and practicing hypoglycemic risk reduction.