Objective Recent clinical studies including UKPDS scientifically showed the inevitable progression of type 2 diabetes mellitus due to the deterioration of insulin secreting pancreatic beta cell function. At now, it is clear that many type 2 diabetic patients should eventually receive insulin treatment for the appropriate metabolic control. But starting insulin treatment for the insulin naïve type 2 diabetic patients in clinical practice is very difficult, due to the low acceptance of the patients. This study was designed to analyze the pre-occupied conception on the insulin treatment of the type 2 diabetic patients with poor glycemic control on multiple oral hypoglycemic agents. Methods Total two hundred type 2 diabetic patients with multiple oral hypoglycemic agents were included. Known diabetes duration, HbA1c, other metabolic parameters including lipid profile, the status of micro- and macro-angiopathic complications were recorded. A questionnaire survey consisting of 10 questions on the pre-occupied conception on the insulin and insulin injection were done. The results of the questionnaire were analyzed according to the status of multiple laboratory and clinical parameters. Results The most of the type 2 diabetic patients knew well about the necessity of insulin treatment for the sound metabolic control, but they did not know the exact pharmacological characteristics of the insulin. The main reason of the reluctance for the initiating insulin treatment was the fear for the long-term safety. The degrees of fear and anxiety were highest in the patients with poor metabolic control despite of multiple oral hypoglycemic agents. Conclusion These results suggest that the detailed education in the nature and the characteristics of the insulin, and the long-term benefit and the safety is mandatory to improve the compliance of the diabetic patients before starting insulin treatment. Further studies would be necessary.