Substantial numbers of poorly  controlled type 2 diabetes mellitus (T2DM) patients require insulin. However, insulin injection  practices and usage vary widely. We did this  cross-sectional retrospective registry  study in an urban referral clinic in North East India including 1454 T2DM patients (60% male and 40% female) on insulin therapy, whose   insulin utilization pattern and injection techniques were audited.  The mean duration of T2DM was 12.13 (7.45) years at enrolment.While  47.73% were treated with insulin alone,  52.27% received other oral antidiabetic drugs(OAD) along with insulin.  Majority (62.93%) used Pen device for insulin administration was used by majority(62.93%). The patient-reported  main reasons for insulin therapy initiation were OAD failure (33.15%), glucotoxicity (30.26%) and diabetes associated complications (20.36%), as reported by patients. About 2/3rd had HbA1c > 8%. Mean±SD total daily dose of insulin   was 33.05±17.09units (0.53 ±0.30units/kg/ day). Majority (67.88%)used premixed insulin, while smaller basal insulin users were in much smaller numbers(10.90%).     With regard to  injection practices, patients with lipohypertrophy were less likely to rotate the site of injection (0.85 vs. 17.90%; p = 0.000), space the injections (10.71 vs. 23.91%; p = 0.000), injected less often in right site (7.81 vs. 29.0%; p = 0.000), more likely to use wrong angles (10.08 vs. 22.73%; p = 0.000) and reuse the needles (5.63 vs. 14.86%; p = 0.000).   8.87% of patients had experienced at least one episode of hypoglycemic event during preceding 6 moths .  This audit reflects the current injection  practices amongst T2 DM patients, highlights the faulty ones, suggests the benefits of adopting correct practices for avoiding complications such as lipohypertrophy and hypoglycemia.