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Introduction - Hyperemesis gravidarum affects 0.3 % to 3% pregnancy. Effective treatment of hyperemesis is necessary to prevent further complication in mother and fetus. Aims and Objectives - To investigate the efficacy of intravenous insulin in the treatment of moderate to severe hyperemesis gravidarum. Material and methods - It is a hospital based, prospective, interventional study. 290 patients with gestational age 6 weeks to 14 weeks were included in the study and classified in to mild, moderate and severe hyperemesis according to PQUE scoring system. Mild and 60% moderate cases were treated by oral medicine. 40% moderate and all severe cases (42) were admitted, investigated and treated with parenteral fluids and insulin. Group I (21 patients) was treated with intravenous fluid and group II (21 patients) was treated with insulin infusion along with intravenous fluid. Patients oral feeding, 24 hours PQUE score and hospital stay was monitored. Results- out of 290 patients , 86.20% were of mild and moderate cases of hyperemesis who responded to oral medication. 14.48% (42) patients were of moderate to severe hyperemesis and treated in the hospital. Mean age of group I patients was 23.6 years while in group II 24.66 years. Most of the patients in both groups were primigravida (66.66% and 52.38%). oral feeding initiation time in group II was 8-12 hours while in group I was 24-48 hours. Hospital stay in group I was 4 days while in group II was two days. Conclusion - The addition of insulin to intravenous fluid in the treatment of hyperemesis gravidarum is effective in reducing nausea and vomiting as well as hospital stay