Newer insulins and easier blood glucose monitoring have greatly improved the ability to obtain excellent control of blood glucose levels with less risk of hypoglycemia. In type 1 diabetes, insulin pump therapy remains the optimal approach with the most flexibility, especially with the ultra-fast-acting analogs lispro or aspart. Otherwise, once- or twice-daily dosing with the long-acting analog glargine provides excellent basal coverage, and lispro or aspart at meals provides bolus coverage, all in the attempt to mimic physiological insulin secretion. For type 2 diabetes, although oral agents continue to be a mainstay of therapy, it is clear that many patients require insulin to attain the goal A1c of < 6.5%. Once-daily glargine is now used more commonly after 1-2 oral agents have failed, and it typically takes the place of sulfonylureas. The future will likely have better systems for continuous glucose monitoring and novel therapies to control glucose through agents that affect gut hormones.
Right now, continuous glucose monitoring really doesn’t seem feasible, even in the very near future. It’s also expensive!
This is a good article reviewing the state of technology though. I will say, as a Type 2 diabetic, I STILL hate any of the longer acting insulin. Their release just isn’t as perdictable as the fast acting in a pump. Plus, if you get up and you end up running around the room all day, the only way to deal with the excess insulin is eating, thus incurring weight gain.