This article originally posted 04 November, 2008 and appeared in Issue 441
Test Your Knowledge Issue 441
A 55-year-old woman who has had type 2 diabetes for 15 years is evaluated to review her blood glucose levels and adjust her medication. She currently takes metformin 1000 mg twice daily, glimepiride 4 mg/day, pioglitazone 30 mg/day, and insulin detemir 30 U at bedtime.
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She has no known microvascular or macrovascular complications of diabetes. Physical examination is remarkable for trace edema only. Her hemoglobin A1C value is 7.5%. Her home blood glucose log for the past week is as follows:
BLOOD GLUCOSE VALUE, mg/dL
Breakfast
Lunch
Dinner
Day
Pre
Post
Pre
Post
Pre
Post
Bedtime
Sun
136
—
84
—
178
275
185
Mon
172
—
167
—
203
—
175
Tue
124
279
118
214
—
—
167
Wed
103
—
154
—
186
223
174
Thu
92
—
129
—
175
261
198
Fri
118
251
132
—
174
—
184
Sat
87
—
97
—
134
—
171
Pre = preprandial; post = 2-hour postprandial.
Which of the following is the most appropriate treatment option for this patient now?
A. Increase insulin detemir dosage by 4 U
B. Increase glimepiride dosage to 8 mg/day
C. Increase pioglitazone dosage to 45 mg/day
D. Stop glimepiride and add pre-meal rapid-acting insulin
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