OBJECTIVES:  Hypoglycaemia is a common emergency department presentation, and is inevitable in 90% of diabetics with insulin therapy. In Malaysia, a quarter of confirmed diabetes is on insulin therapy. The objective of this study is to identify the cost of hypoglycaemia among patient Type II Diabetes Mellitus and to estimate the national burden of this condition. METHODS:  All patients aged between 20-79 years admitted to Universiti Kebangsaan Malaysia Medical Centre between January 2010 and September 2015 with primary diagnosis of hypoglycaemia in the MY-DRG® Casemix database were included in this study. Costing analysis was completed using step-down approach. Data related to hospital cost were collected using hospital-costing template, for three levels of cost centres:overhead, intermediate and Final cost centres. Information on the pattern of admissions and outpatients visits to estimate the national burden were obtained from an earlier published Hypoglycaemia Assessment Tool (HAT) global study for Malaysian cohort. RESULTS:  Within the study period, 244 diabetics were admitted to UKMMC primarily for hypoglycaemia. 88% of the cases were over 50 years old. Female had higher chance of being admitted for hypoglycaemia (52%). The median length of stay in hospital was 5 days (ranging from 2 to 26 days). The median cost for a hypoglycaemic case was RM 5,500 for severity level I, RM 6,875 for severity level II and RM 8,250 for severity level III. The total cost of care for hypoglycaemia among adult diabetes in Malaysia is estimated to be RM 117.9 million which is 0.53% of Ministry of Health budget. The national economic burden estimates based on the best-case scenario and the worst-case scenario ranges from RM 109.8 million to RM 138.3 million. CONCLUSIONS:  Regardless of seemingly a simple condition, hypoglycaemia can result in a substantial economic burden. Proper diabetic management and health education is neeed in diabetic management.