New aspects of insulin therapy in type 1 and type 2 diabetes.

Tight control of the blood glucose level decreases the frequency of complications of both type 1 and type 2 diabetes mellitus. Until recently, the available short, intermediate, and long-acting forms of insulin could not readily be used to achieve tight glycemic control without introducing an unacceptably high risk of hypoglycemia or demanding an impracticably rigid lifestyle. With the introduction of faster-acting insulin analogues, lispro and aspart, and a peakless long-acting insulin analogue, glargine, the goal of safe and effective tight glycemic control may now be within reach for many patients. The use of these new insulins allows the clinician and patient an expanded range of options for achieving good control of fasting and postprandial blood glucose levels.