Tumor-induced hypoglycemia (TIH) associated with hepatocellular carcinoma (HCC) results from tumor production of insulin-like growth factor 2 (IGF-2), resulting in recurrent hypoglycemia. Serum levels of insulin-like growth factor 1 (IGF-1), insulin-like growth factor 2 (IGF-2), or pro-insulin-like growth factor 2 (pro-IGF-2) are required for the diagnosis. However, due to the limited availability of testing in many laboratories, this condition is often overlooked. As this condition is often overlooked, prompt recognition and implementation of tumor directed therapies and/or systemic therapies can help mitigate the consequences of hypoglycemia. We present a 38-year-old man with advanced multifocal HCC who presented with abdominal pain and was found to have recurrent symptomatic hypoglycemia. Evaluation revealed elevated levels of IGF-2, suggesting a diagnosis of HCC with production of IGF-2.