The incidence of diabetes is set to rise dramatically in the next five years so there is a growing focus on ‘shared care’ for people with diabetes, involving healthcare professionals from primary and secondary care in patient management. Insulin initiation and dose adjustment in patients with type 2 diabetes are increasingly being carried out in the primary care. This article discusses the important role of practice nurses in managing the care of patients with type 2 diabetes and the specific challenges presented by patient fears and resistance to insulin treatment. Current recommended targets for glycaemic control are identified and treatment plans discussed with a focus on transferring patients from oral hypoglycaemic drugs to insulin treatment.