The issue of planning the timing and dosing of insulin in relation to food is one of the most difficult issues confronting people with diabetes. Recent focus on improving quality of life in this area has focused on developing different modes of administration of insulin thereby avoiding subcutaneous injections and developing new analogues of insulin. Both inhalational and buccal administration technologies have been developed, and have essentially overcome some of the difficult pharmacokinetic issues regarding large peptide molecules, however there remain some clinical problems. Advances in the practicalities of treating insulin have occurred, such as more accurate and less expensive glucometers, new administration alternatives such as implantable pumps, with further developments in the pipeline including islet and gene replacement for Type I disease. However all of these newer options have limitations and currently subcutaneous administration is the only real option for most people. Insulin analogues have so far been relatively disappointing in terms of improvement in mortality and morbidity although for some patients the ability to alter the dosage of insulin depending on the planned meal size or reduction of between meal snacks has been helpful. Furthermore there is a yet unknown question around long term safety. This review will discuss the major clinical issues surrounding the new insulin analogues as they relate to efficacy and side effects.