Non-islet cell tumor hypoglycemia (NICTH) is a rare paraneoplastic syndrome caused by the secretion of high molecular weight insulin-like growth factor II (IGF-II) from tumors, particularly those of mesenchymal and epithelial origin. This case report describes a 71-year-old male with pelvic sarcoma who presented with severe hypoglycemia with blood glucose levels dropping below 40 mg/dL and exhibiting neuroglycopenic symptoms.