Test Your Knowledge Issue 441

This Week’s Question #441 - Diabetes In Control.com Newsletter

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. 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:

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

E. A and B