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Background Glucagonomas are rare pancreatic neuroendocrine tumours that may present with mild diabetes and necrolytic migratory erythema. Though typically associated with hyperglycaemia, paradoxical hypoglycaemia has been observed and may be related to secretion of GLP-1-like peptides. These peptides have glucose-lowering effects and may become unmasked during treatment with somatostatin analogues such as Lanreotide (Wewer Albrechtsen, Challis, Damjanov, et al. Bosn J Basic Med Sci. 2016;16(1):1-7; Unek, Celtik, Yener, et al. J BUON. 2009;14(1):135-8).Aim To describe a case of terminal hypoglycaemia in metastatic glucagonoma and explore its management within a palliative care context.Method An elderly woman with metastatic glucagonoma was admitted to hospice with frequent, severe episodes of hypoglycaemia. These were resistant to conventional interventions including intravenous dextrose, glucagon, dietary strategies, and subcutaneous dexamethasone. After discussion with neuroendocrine tumour specialists, Lanreotide was withdrawn due to its possible role in suppressing glucagon and enhancing GLP-1-mediated effects. Hypoglycaemic episodes persisted.Results Recurrent hypoglycaemia continued despite maximal intervention. Peripheral oedema compromised IV access. With disease progression and diminishing treatment options, the clinical focus shifted to symptom relief and end-of-life care. Given the psychological distress caused by hypoglycaemic episodes, a multidisciplinary team decided not to inform the patient when IV access was lost. This decision reflected both the recognition that further interventions would be futile and respect for the patient’s expressed wishes. She died following a terminal hypoglycaemic event. The team experienced moral distress, as hypoglycaemia is typically a reversible condition.Conclusion This case highlights a rare metabolic complication in advanced neuroendocrine cancer and the significant emotional and ethical challenges it presents in hospice care. It underscores the importance of individualized, team-based approaches to end-of-life care and draws attention to the under-recognised phenomenon of hypoglycaemia as a terminal event.