Type 2 diabetes is characterised by defects in insulin secretion and insulin action. Hyperglycemia may exacerbate these defects. The early introduction of insulin to achieve near euglycaemia in patients with type 2 diabetes has been reported to improve these defects and thus promote long-term β cell preservation.  Early intensive insulin therapy is difficult to implement. However, new data from renal transplant recipients with new onset diabetes would suggest that early insulin therapy is implementable and beneficial despite the complex care needs of these patients and the greater risks of hypoglycaemia.