Aims: To measure the proportion of psychological insulin resistance (PIR) in elderly diabetic patients and identify its predictors. Methods: 132 elderly patients with diabetes were included in a cross-sectional study. A validated questionnaire which mainly based on Insulin Treatment Appraisal Scale (ITAS) and Barriers to Insulin Treament Questionnaire (BIT) was used to obtain information. Results: 33.3 percent of the patients were unwilling to use insulin. PIR in insulin naTve patients was higher than that in insulin treated patients. The most common reasons for PIR were afraid of failure of anti-diabetic oral agents, diabetes get worse, affect on work, daily activities, embarrassment of injection, low self-efficacy, fear of needle and fear of pain. Consclusion: The results of this study identified several misconceptions regarding insulin therapy. The efforts to reduce PIR should be a clinical priority in the treatment of elderly diabetic patients.