Diabetes affects approximately 18 million adults in the United States. Diabetes increases the risk of microvascular and macrovascular complications, such as nerve neuropathy, retinopathy, nephropathy, and cardiovascular disease. Intensive diabetes management reduces the risk of complications but presents numerous challenges in clinical practice. In the natural course of type 2 diabetes beta cell function declines over time and may necessitate frequent medication adjustment. Oral antihyperglycemic medications may lose efficacy over time and may induce intolerable adverse events. Some medications for diabetes can cause weight gain, even if patients exercise and watch their food intake. Furthermore, patients with type 1 diabetes may experience frequent blood glucose fluctuations despite optimizing their use of insulin. Hypoglycemia is a common adverse effect of intensive diabetes management. Pramlintide as an adjunct to insulin therapy is useful for treating both type 1 and type 2 diabetes to improve control of postprandial glucose. To ensure maximal efficacy of pramlintide with minimal adverse events, it is extremely important that diabetes educators thoroughly understand pramlintide's mode of action, indications, appropriate patient selection, required insulin dose adjustments, and provide careful patient instruction.