In our study, among the 10 participants treated with insulin pen, 90% had HbAlc values in the last two times exceed the recommended range of 7.5 gm/dl, and even 70% of them had values exceeding 10 gm/dl, which not only interfered with their sleep but also made some of them lose confidence in disease self-management due to depression. Here, INS is linked to major depressive disorder.