"In brief, the insulin titration protocol involves initiating nighttime basal insulin for all women with fasting blood glucose >5.3 mmol/L despite dietary and lifestyle advice, starting at an initial dose of 14 units daily and subsequently titrated daily by patients according to their fasting capillary glucose values. Women are advised to increase their basal dose by 4 units each day following a fasting glucose reading above target ≥5.0 mmol/L. They are advised to reduce their insulin dose if their fasting glucose was <4.0 mmol/L with hypoglycemic symptoms. If fasting glucose targets are achieved, then women are advised to keep their insulin dose the same until it goes out of range again, at which point they can continue dose titration in the same way. This insulin management algorithm works in a manner very similar to a physiological homeostatic system, and its use provides a unique opportunity in GDM to understand the insulin requirements of women throughout pregnancy."