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Rapid, patient-led titration of basal insulin can be used to achieve tight glycaemic control in gestational diabetes mellitus with insulin resistance
  1. Isabelle Mayne1,
  2. Nicholas Thomas1,2 and
  3. Andrew McGovern1,2
  1. 1Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
  2. 2Department of Diabetes and Endocrinology, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  1. Correspondence to Isabelle Mayne; isabelle.mayne{at}


A woman with gestational diabetes mellitus (GDM) and significant insulin resistance in her third pregnancy was diagnosed with a fasting blood glucose reading of 5.7 mmol/L (103 mg/dL) at 28+1 weeks gestation and referred to our diabetes team. Using a rapid, patient-led approach to basal insulin titration this patient achieved therapeutic doses and glucose targets in the limited time available during pregnancy, without causing significant hypoglycaemia. This method of insulin titration empowers women with GDM to take control of their own management and could reduce complications in GDM pregnancies at negligible additional cost. The only additional cost being that of the higher insulin doses used.

  • diabetes
  • pregnancy
  • endocrine system

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  • Contributors AP and IKM conceived the project. AP was directly involved in the patient’s care. IKM collected the data. All authors analysed the data and drafted the manuscript. All authors read, provided feedback and approved the final manuscript. AP is the guarantor and takes responsibility for the content of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.