Introduction: Psychological insulin resistance is the reluctance of diabetes patients or physicians to initiate or in-tensify insulin therapy. The insulin usage among Malaysian type 2 diabetes mellitus (T2DM) patients is low, only 21.4% of audited T2DM patients were on insulin therapy despite 76.2% of the audited T2DM patients had poorly controlled diabetes with HbA1c ≥ 6.5% in year 2012. This study aims to identify the predictors of psychological insulin resistance (PIR) among insulin naïve T2DM patients. Methods: A cross-sectional study using interviewer assisted questionnaires was conducted among adult insulin naïve T2DM patients in government health clinics at a district of Penang, Malaysia. Insulin Treatment Appraisal Scale (ITAS) was used to assess the dependent variable (PIR) and validated self-developed questionnaires were used for assess the independent variables (socio-demographic characteristics, diabetes profile, and individual factors). Multiple linear regression analysis was performed to identify the predictors of PIR. Results: As high as 72.7% out of 385 participants were reluctant to initiate insulin therapy. Emotional factors (fears), perceived personal failure and perceived severity significantly predicted higher PIR whereas perceived benefit and self-efficacy significantly predicted lower PIR. Total 49.8% variability of PIR was explained by the entire individual predictors (R2=49.8%, p = 0.001). Emotional factor was the strongest predictor. Conclusion: This study revealed a high level of PIR among Malaysian T2DM patients. It is vital to tackle the predictors that predict high PIR and strengthen the predictors that lead to low PIR in our health education and health intervention programs.