Insulin treatment: a decade of change

Insulin treatment is still heavily constrained by the problems of inappropriate absorption profiles from subcutaneous tissue, and variability of that absorption. While human insulin may be slightly disadvantageous in these respects, and its possibly lower antigenicity of little clinical consequence, it does provide assured supply. Insulin syringes remain the basis of injection therapy, but pen injectors (yet to be subjected to formal clinical trial) should increase in popularity because of patient convenience, if pens containing complexed insulin prove safe. Nevertheless insulin regimens are still dependent on the extended-acting preparations for basal insulin supply. These preparations remain too short-acting and erratically absorbed to achieve optimum blood glucose control. While insulin analogues are awaited, the promise of insulin pumps and other routes of administration, as means of overcoming these problems, looks to be unfulfilled in the near future.