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Objective: This study aimed to explore the T2DM patients' reasons for refusing insulin therapy and their initial barriers to use insulin. Study Design: Cross-sectional Observational study. Setting: Primary Outpatient Health Care Center Karachi. Period: 15th October 2022 to 15th January 2023. Material & Methods: Total 800 diagnosed patients of type-II diabetes mellitus having HbA1c level about 7.0% were included in study, participants were interviewed and necessary data and their response against insulin was recorded on designed questionnaire. Results: Total 800 number of patients were enrolled in study, 434 were female (54.25%) while 366 were male (45.75%) participants. The average age of total patients was 45.6±10.5. Study reported that 28.5% patients mentioned that its painful procedure. 25% patients were unaware about insulin, 15% mentioned that it is difficult to self-inject, 10.5% lack of technical person or medical staff that can inject over there, 7.5% patients believe that insulin is last resort of treatment, 5% needle phobia, 4.5% reluctant due to un affordability of insulin, 3% insulin would be addictive, and 1% patients with religious restriction was reported. Conclusion: Study explore many reason that are mainly influencing use of exogenous insulin for the treatment of diabetes mellitus. Insulin therapy is painful procedure consideration have been recorded more common while other factors unawareness about insulin, needle phobia, lack of technical people in home specially in backward areas and insulin is last resort of treatment beliefs are also major important factors reported during study. [ABSTRACT FROM AUTHOR]