Recent advances in insulin research open new avenues for treatment, both, for type 1 and type 2 diabetes. In developed countries, standardized "ultra-rapid-acting insulins" are now also used in addition to rapid-acting insulins. First- and second-generation basal analogs are available. Third generation basal analogs, which only need to be applied once a week, are in the pipeline. Second-generation "ultra-rapid-acting insulins" insulins with faster onset and offset of action may be particularly useful for multiple daily injection and automated insulin delivery systems. An improved time-action profile of bolus insulin would be able to cover the rapid increase in glucose after meals with a rapid fall thereafter to avoid postprandial hypoglycaemia. The third-generation basal insulins allowing once-weekly dosing made major steps towards becoming a clinical reality. However, issues with insulin affordability and availability remain problematic even in more affluent countries. Biosimilar insulins products can provide people with additional safe, high-quality, and potentially cost-effective options for treating diabetes. Particularly in lower-middle income countries insulin therapy is facing issues not only of access but also storage, lack of diabetes education and stigma. Key massage: With the new bolus insulins, the physiological insulin secretion pattern can be mimicked better and better and hypoglycemia can be avoided. With the ever longer pharmacokinetic action profiles of the basal analogs, the injection frequency is reduced, which leads to better adherence and quality of life. The potential of using once weekly insulins as a remedy against premature death compared to the current standard of care under these circumstances should be evaluated in pilot studies. The changing paradigms of insulin delivery reinforce the need for international efforts with different stakeholders to ensure the appropriate products of the life-saving drug are available for everyone who needs it worldwide.