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The presence of severe renal insufficiency in type 2 diabetes patients often challenges the diabetologist to prescribe a drug therapy, leading to a satisfactory glycemic balance with the minimal risk of hypoglycaemia. Diabetics with renal dysfunction present an increased risk of hypoglycemic episodes, and oral drugs are often ìcontraindications in these patients , especially if they are eliminated by the kidney. This last class of drugs requires a reduction in dosages to avoid the risk of prolonged hypoglycaemic episodes. In particular, in patients with severe renal insufficiency, metformin must be suspended in order to avoid the risk of lactic acidosis. Here we report the case of a young woman with type 2 diabetes, who quickly developed severe renal failure, unfortunately without remission. This case emphasizes the efficacy and safety of insulin-associated linagliptin for good glycemic control in patients with severe renal impairment, with marked reduction in hypoglycaemic episodes (Diabetology).