OBJECTIVES: Hypoglycemia presents a challenge for patients using insulin. The fear and anxiety related to hypoglycemic episodes may inhibit intensified insulin treatment and cause patients to reduce driving, limit social activities and eat snacks. However, published estimates of health-related quality of life values (utilities) for hypoglycemia have been based on database studies and not directly measured in interviews. Our objective was to elicit societal and patient utilities in Canada for five health states including: diabetes, rare (quarterly), intermittent (monthly), frequent (weekly), and nocturnal hypoglycemia episodes. METHODS: The health state descriptions were based on the validated Hypoglycemia Fear Survey and the opinions of four experts. Time trade-off (TTO) interviews were used to elicit utilities from 79 non-diabetic and 50 diabetic respondents in Canada. The TTO method estimates utilities between 0 and 1, where 1 expresses full health and 0 represents dead. Interviewers used a TTO board that allowed respondents to trade between zero and 30 years of perfect health against 30 years in each health state. RESULTS: The diabetes health state was estimated at 0.92 (SD 0.13) and 0.88 (SD 0.13) by diabetics and non-diabetics, respectively. The disutility was greater with increasing hypoglycemia: rare episodes ranged from -0.01 to -0.03 in the two groups; intermittent -0.05 to -0.11; frequent -0.17 to -0.22; and nocturnal -0.12 to -0.17. In both groups, the disutility of nocturnal hypoglycemia was intermediate between intermittent and frequent rates hypoglycemia. CONCLUSION: Rare hypoglycemia episodes occurring only a few times a year, was rated as having only a minimal impact, whereas frequent episodes and nocturnal hypoglycemia had substantial impacts. This study is the first to directly estimate utilities for hypoglycemia, incorporating appropriately developed health states, using direct elicitation techniques, and including diabetic and non-diabetic respondents.