A case is reported of a patient with hypoglycemia episodes secondary to a large sized malignant insulinoma with metastases to the liver. For the control of hypoglycemic episodes, both diet and octreotide were initially used but the response obtained was poor. Later, oral diazoxide was used and a good initial response was obtained but treatment was stopped due to severe adverse effects. To obtain a decrease in the tumoral size both adrimaycin and streptozotocin were administered but results were unsuccessful. Finally, embolization of the right hepatic artery was performed and no further hypoglycemic episodes occurred during the following 14 months. We conclude that selective hepatic embolization is a good therapeutic option to control hypoglycemic episodes in malignant insulinoma with metastases to the liver when other therapeutic options have proved unsuccessful.