Initiation and continuation of insulin in Type 2 Diabetes patients has been one of the major challenges faced by physicians of the developing world due to various factors like cost, availability, literacy status, and patient's belief that its use is the only last option. The aim of this study was to know the clinico-epidemiological characteristics of Type 2 Diabetes patients treated with insulin and their knowledge of practical aspects of insulin use. This descriptive comparative cross-sectional study was conducted in Koshi Hospital, Biratnagar, Nepal from 1st January 2022 to 31st May 2022 applying consecutive sampling and face-to-face interviews after informed verbal consent. Out of 485 participants, 59.6 percent were male (the rest 40.4 percent female) with a mean age of participants 52.04 ± 11.31 years, and 12 percent of them using insulin (premixed human insulin, premixed insulin analogs, basal insulin analogs, and basal-bolus insulin by 43.01, 12.06, 36.2 and 8.62 percent respectively). Of those using insulin, 41.37 percent were ≥ 60 years old with 62.06 percent male participants, 44.83 percent with diabetes for ≥ 10 years, 50 percent with a degree of school level education or more, and 68.97 percent were aware of chronic complications of diabetes. Participants treated with insulin were older with a longer duration of disease, more literate, more frequent monitoring their blood sugar level, more aware of hypoglycemia management at home, and more aware of chronic complications of diabetes than their counterparts. Among insulin-taking participants, appropriate knowledge of insulin storage, proper site, correct technique of administration, hypoglycemia management at home, and mixing insulin prior to use among those using premixed insulin was found in 94.83, 62.06, 56.89, 22.8, and 50 percent respectively. This study explores the need for proper counseling for Type 2 Diabetes patients by physicians and counselors focusing on the advantages of timely initiation of insulin and knowledge on practical aspects of insulin use, especially in the developing world.