More than ever before in the history of diabetes therapy, patients and health care providers have the necessary pharmacologic tools available to achieve near-normal blood glucose control. Achievement of this goal, however, requires an in-depth knowledge of the pharmacology and limitations of the currently available insulins. A willingness to try new strategies combined with a creative approach to each patient will result in optimal diabetes management. Continued advances in the development of insulin analogues and investigation into alternative routes of insulin delivery are likely to expand therapeutic options in the near future. Such developments will continue to improve the quality of life and health of patients with diabetes.