Insulin formulations and injection devices have improved dramatically since the first insulin injection was given in 1922. Adherence to insulin therapy, however, is estimated at 62–64 % despite research indicating that good glycemic control improves patient outcomes. The challenge is to improve the rates of adherence and to intensify or progress insulin therapy as needed. Changes in insulin delivery devices, especially innovations in needle technology in combination with education and support, have the potential to improve the comfort of insulin injections and encourage patients to adhere to their insulin regimens.