A 46-year-old lady with background of type 2 DM with severe insulin resistance, hemochromatosis, bipolar disorder, glaucoma, diabetic neuropathy, hypertension, GERD, necrobiosis lipoidica, PCOS and hypercholesterolemia is followed up in complex type 2 diabetes clinic for severe insulin resistance. Her BMI is 25.7, she has freestyle libre with blood glucose readings around 15mmol/l85% of the time. HbA1c 111 on June 2022, she is on humalog 265units 7 times/day and 285units at bedtime, dapagliflozin 10 mg OD, liraglutide 1.8 mg OD, metformin 1g BD. Lab tests: eGFR >90, U&E, LFTs, FBC were normal. Blood pressure in the clinic 167/103mmhg. She is checking the insulin injection sites and rotating the sites of injections. She had extensive work up at Manchester diabetes centre and Addenbrookes Hospital, however, no identified genetic syndrome to explain her severe insulin resistance could be found. She was on pioglitazone in the past with little success. Tresiba 60 units OD was added to her medications and her follow up HbA1c improved to 91 mmol/mol on October 2022. Her other medications are gabapentin 600 mg TDS, pentoxifylline 400 mg TDS, pantoprazole 40 mg BD, atorvastatin 40 mg ON, mirtazapine 45 mg ON, ramipril 10 mg OD, bendroflumithiazide 2.5 mg OD. I am curious if there is any work up or change in the management plan that can improve her diabetes control.