The study aimed to investigate factors affecting psychological insulin resistance in elderly diabetic patients. Descriptive cross-sectional study in over 60 year old patients diagnosed with type 2 diabetes according to WHO 2006 criteria. All subjects were interviewed on factors affecting psychological insulin resistance. The results showed that a misconception on the effect of insulin such as, insulin use means failure of oral anti - diabetic agents (68.1 percent), worsening diabetic condition (77.3 percent). In addition, the misconception that use of insulin decreases work productivity and daily life activities (24.2 percent). The thinking that use of insulin is time consuming (16.7 percent) and would cause more dependent on doctors (38.6 percent) were additional barriers in increasing psychological insulin resistance. Anxiety during insulin injection as fear of pain (23.5 percent), fear of needles (22.7 percent), fear of incorrect injection (39.4 percent), embarrassed when injected, low self efficacy, difficulty in time and dose were further factors in increasing the rate of psychological insulin resistance. The results of this study identified several factors regarding insulin tnerapy. The efforts to reduce PIR should be a clinical priority in the treatment of elderly diabetic patients.