Mrs. S. returns for follow up 2 years after the initial visit and diagnosis of Type 2 diabetes and despite continued adherence to her diet and exercise plan she has gained 25 lbs in weight and her HbA1c is 9. She has followed up with the nutritionist who feels she is compliant with her diet. Six months ago you started her on Glipizide and gradually increased the dosage, she is currently taking the maximum dosage. She is reluctant to use insulin. Would you now? 

1. Have her see the nutritionist and diabetes educator for further lifestyle intervention

2. Switch to another oral agent such as metformin.

3. Add another oral agent such as metformin.

4. Consider adding long acting insulin before bedtime (BIDS therapy)

 

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