Supporting adults with type 2 diabetes is an important part of primary care nursing. Insulin therapy is key to managing hyperglycaemia and reducing the risk of long-term diabetes-related complications, so many patients with type 2 diabetes will require insulin therapy as their condition progresses. However, they may have concerns about burdensome side effects such as hypoglycaemia and weight gain or about implications for driving. They may also struggle with concordance with treatment, for example if a suboptimal injection technique leads to pain and lipohypertrophy. This article provides nurses working in primary care with a practical guide to initiating insulin therapy in patients with type 2 diabetes, such as how to determine whether a patient needs insulin therapy, selecting the most appropriate regimen for each patient, supporting patients to overcome psychological insulin resistance and minimising common side effects.