OBJECTIVE: To analyze emerging trends in effective utilization of insulin in the treatment of type 2 diabetes. METHODS: A systematic management plan and requirements for successful insulin therapy in patients with type 2 diabetes are outlined. RESULTS: The key to successful management of type 2 diabetes with insulin therapy is the use of adequate amounts of insulin and a bolus-to-basal insulin ratio of 1:1. Patient education about the progressive nature of the disease and the importance of self-monitoring of blood glucose is essential. The most effective method of sustaining normal blood glucose levels is to mimic the physiologic response to intake of food and thereby control postprandial glycemic excursions. Rapid-acting insulin lispro is useful in this effort. In the development of effective insulin regimens, one option is use of an insulin sensitizer in combination with bedtime NPH insulin. CONCLUSION: Because of deteriorating beta cell function, insulin deficiency results and usually necessitates administration of exogenous insulin in patients with type 2 diabetes. The goal of insulin treatment of type 2 diabetes is to achieve near-normal glycemic control. The insulin secretory defect progresses over time; thus, therapy must be continually matched to the underlying pathophysiologic defects.