Insulin is preferred as the first-line agent for glucose management of gestational diabetes mellitus and type 2 diabetes in pregnancy when nutritional and lifestyle modifications are unable to achieve pregnancy-specific glucose targets. Individual heterogeneity in defects of insulin secretion or sensitivity in liver and muscle, unique genetic influences on pregnancy glycemic regulation, and variable cultural and lifestyle behaviors that affect meal, activity, sleep, and occupational schedules necessitate a personalized approach to insulin regimens. Newer insulin preparations have been developed to mimic the physiologic release of endogenous insulin, maintaining appropriate basal levels to cover hepatic gluconeogenesis and simulate the rapid, meal-related, bolus rise of insulin. Such physiologic basal-bolus dosing of insulin can be administered safely, achieving tighter glycemic control while reducing episodes of hypoglycemia. Insulin initiation and titration require understanding the pharmacodynamics of different insulin preparations in addition to a patient's glycemic profiles, effect of variable nutritional intake and mealtimes, physical activity, stress, timing of sleep cycles, and cultural habits. Educating and empowering patients to learn how their glucose responds to insulin, portion and content of meals, and physical activity can increase personal engagement in therapy, flexibility in eating patterns, and improved glycemic control. This Clinical Expert Series article is focused on optimizing insulin management (initiation, dosing, and titration) of gestational and type 2 diabetes in pregnancy.

中文翻译：

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妊娠期和 2 型糖尿病的胰岛素管理。


当营养和生活方式的改变无法达到妊娠特异性血糖目标时，胰岛素是妊娠期糖尿病和 2 型糖尿病血糖管理的一线药物。胰岛素分泌缺陷或肝脏和肌肉敏感性的个体异质性、独特的遗传对妊娠血糖调节的影响以及影响膳食、活动、睡眠和职业时间表的可变文化和生活方式行为，都需要个性化的胰岛素治疗方案。已经开发了较新的胰岛素制剂来模拟内源性胰岛素的生理释放，维持适当的基础水平以覆盖肝脏糖异生并模拟胰岛素的快速、膳食相关、推注上升。这种生理性基础-餐时胰岛素剂量可以安全地给药，实现更严格的血糖控制，同时减少低血糖发作。胰岛素的启动和滴定需要了解不同胰岛素制剂的药效学，以及患者的血糖状况、可变营养摄入和进餐时间的影响、身体活动、压力、睡眠周期的时间和文化习惯。教育和授权患者了解他们的葡萄糖如何对胰岛素、膳食的份量和内容以及身体活动做出反应，可以提高个人对治疗的参与度、饮食模式的灵活性和改善血糖控制。本临床专家系列文章重点介绍了妊娠期和 2 型糖尿病的胰岛素管理（开始、给药和滴定）的优化。