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Insulinoma in a patient with pre-existing diabetes is extremely rarel. Only a small number of cases have been reported all over the world 2. We report a case of Insulinoma in a patient with type 2 diabetes. A thirty five year old male was diagnosed to have diabetes mellitus three years back. He was started on Sulphonylurea and the dose was increased to achieve glycemic control. He had adequate glycemic control for one year, but thereafter, started developing recurrent episodes of hypoglycemia. These episodes continued even after sulfonylurea was with drawn. Endogenous hypoglycemia was confirmed with an insulin glucose ratio of 0.39 and 4 on two occasions. Imaging of the pancreas was normal. On exploratory laparotomy, the tail of pancreas felt tough and bulky. Intraoperative ultrasound showed heterogenous lesion in the tail of pancreas. Distal pancreatectomy was done. In the post operative period diabetes again developed and required Glimeperide for control.