Objective: To explore self reported knowledge and attitudes to insulin treatment among a group of adults with poorly controlled diabetes in the Torres Strait islands. Design: Cross-sectional survey in 2014, interviews with 29 adults with HbA1c ≥ 8.5% (69 mmol mol−1) and not taking insulin, using Insulin Treatment Appraisal Scale (ITAS) and Barriers to Insulin Treatment Questionnaire (BITQ) scores. Setting: Five remote Torres Strait Island communities in the Torres Strait region. Participants: Poorly controlled insulin-naïve type 2 diabetics. Main outcome measures: BITQ and ITAS scores on items related to knowledge and attitudes to insulin treatment, clinical and demographic measures. Results: Overall, 34% of the cohort had poor glycaemic control. Compared to those with HbA1c ≥ 8.5% and taking insulin (n = 37), the 29 insulin-naïve participants were more obese, more likely to smoke and drink alcohol, have lower mean HbA1c and fewer years with diabetes. Among the insulin-naïve group, those reporting higher ‘barriers’ (BITQ scores) were older and with lower formal education than those reporting fewer barriers. Torres participants consistently scored low on ‘knowledge’ items in the ITAS, especially those which would guide insulin initiation (insulin improves glucose control and prevents complications). Conclusion: Compared to other published studies, the Torres participants had higher scores for BITQ ‘barrier’ items and lower ‘knowledge’ scores. This suggests better education around glycaemic control with medication and discussion of perceptions and exchange of experiences with peers who are taking insulin might improve the uptake of insulin in this high-risk group.