A 56-year-old woman who is a long-time patient returns to the office for scheduled follow up of her type 2 diabetes and chronically elevated blood glucose. At her last visit 3 months ago, her HbA1C was 7.6%, where it had been for several visits. You recommended beginning treatment with insulin, which she refused because of her fear of needles. You then increased her dose of glimepiride from 4 mg to 8 mg once a day and advised her to more strictly follow her diet and exercise regimen, which she claims to be doing. Since the last visit, her home fingerstick glucose levels have ranged from 119 mg/dL to 263 mg/dL (6.6 to 14.6 mmol/L) and her weight on her home scale is unchanged at about 98 kg. She describes increased thirst and urination but denies blurry vision, nonhealing ulcers, or lethargy.
Per office protocol, a fingerstick glucose test on arrival today shows glucose level of 221mg/dL (12.27 mmol/L) and hemoglobin A1C 8.1%; urine dipstick is normal.
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