Type 2 diabetes mellitus (T2DM) is a chronic, progressive disease characterized by a steady decline in beta-cell function and insulin resistance. As a result, most patients with T2DM may require treatment with insulin after 15–20 years of diagnosis. Various pathophysiological defects were identified leading to hyperglycemia, including reduced insulin secretion due to beta-cell failure. They reduced beta-cell mass and a defect in insulin secretion, which leads to a relative insulin deficiency in these patients requiring insulin treatment. Most international guidelines recommend starting insulin treatment in patients with poor glucose control, mainly if the glycated hemoglobin (HbA1c) is above 9% with the presence of symptoms, especially in relatively newly diagnosed patients with T2DM. We present a 45-year-old patient with T2DM of 5 years duration who attended our center with severe hyperglycemia with evidence of insulin deficiency both clinically and biochemically, who responded well to oral antidiabetic agents achieving adequate glycemic control.