A third of the world’s population currently has no guaranteed access to essential medicines. Attention has focused on the issue of access to medicines for HIV/AIDS, TB and malaria, but not on access to essential medicines for noncommunicable diseases, including insulin. Insulin has been widely available in the Western world since its discovery in 1921, but in resource-poor settings access to insulin is still problematic due to international and national barriers to access. Solutions proposed have mainly focused on increasing availability and lowering cost. However, insulin alone is not enough for proper diabetes care. In order to improve the lives of people with diabetes, access to medicines needs to be addressed in parallel to creating a health system able to manage all aspects of diabetes care.