Aim This study aims to assess knowledge, and practices of primary care physician in Saudi Arabia about IAH. Method: A cross-sectional study conducted using a newly designed self-administered questionnaire among 292 primary care physicians at three tertiary hospitals and primary care clinics in Riyadh, Saudi Arabia between December 2018 and June 2019. Results Of the participants, 59.9% of them had acceptable knowledge of IAH while only 40.1% had poor knowledge. Around half (46.2%) of physicians rated their familiarity with IAH as average or above average, and these had higher mean knowledge scores than participants who reported below average familiarity (mean 5.32 versus 4.39) (P = 0.000). Higher mean knowledge scores were found among physicians who have managed IAH patients than those who have not managed IAH patients (5.58 versus 5.01) (P = 0.019). The differences between physicians’ mean knowledge scores and their ages, levels of training, and years in practice were statistically significant. Conclusion: A considerable gap was established in the knowledge, awareness, and practice of IAH among physicians in Saudi Arabia. An effort is needed to implement extensive educational activities about impaired hypoglycemia awareness to be directed to primary care physicians and further research in this area is warranted.