Background <p>Knowledge and practices related to insulin injections often remain suboptimal among patients even those on insulin therapy. These faulty knowledge and practices can lead to erratic glucose control and higher complications.</p> Objective <p>This study aimed to evaluate insulin injection knowledge and practices, and knowledge related to hypoglycemia management among diabetes patients on insulin therapy at a tertiary care center in North India.</p> Material and Method <p>A cross-sectional survey was conducted among 200 diabetes patients on insulin therapy. Data were collected on insulin injection techniques, insulin storage, blood glucose monitoring, and hypoglycemia management. Statistical analysis was performed using SPSS version 20.</p> Results <p>Of the 200 participants, 97.5% had received formal training on insulin injection techniques, but 71% expressed a need for further education. Most patients (89.5%) rotated injection sites, but only 12.5% had their injection sites routinely inspected by diabetes care team. Despite 87.5% owning a glucometer, 30% rarely checked their blood glucose levels. Local site-related issues with insulin injections were common: 50.5% experienced leakage, 45.5% bleeding or bruising, and 20% reporting pain. Regarding hypoglycemia, 57% were aware of its symptoms, but only 20.5% checked their blood glucose post-correction of hypoglycemia. Most patients (98%) stored insulin properly at home, though 27.5% did not use correct storage methods while traveling. Additionally, 95% of patients disposed of needles improperly posing environmental and safety risks.</p> Conclusion <p>There are significant gaps in knowledge and practices related to insulin management and management of hypoglycemia among patients on insulin therapy. There is a need for targeted education to improve insulin practices, blood glucose monitoring, and safe disposal methods to reduce complications and enhance diabetes management.</p>