The recognition of the importance of good glucose control and new insights into the pathophysiology of type 2 diabetes have led to a renewed focus on the role of insulin therapy in patients with type 2 diabetes. Current approaches to insulin therapy in type 2 diabetes include various combinations of oral agents and insulin and various forms of insulin monotherapy. Combinations of oral agents and insulin have been expanded to include both basal and prandial forms of insulin. New insulin analogs and new methods of insulin delivery have also expanded the potential for various types of insulin monotherapy. Further studies are needed to determine the role of intensified insulin therapy in helping patients with type 2 diabetes reach their glucose goals.