In terms of maximizing diabetes therapy for this patient, what would be an appropriate next step?

The maximum dose of glipizide is 20 mg once daily. The patient was recommended to increase glipizide from 10 to 15 mg once daily, and obtain occasional noon readings.

Counseling was provided regarding natural progression of diabetes over time, and about how it often required insulin therapy after oral diabetes medication use is exhausted.


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NPH insulin once daily or twice daily would be a more economical option versus use of insulin glargine (Lantus), along with metformin use.

Use of two sulfonylureas is not advised, and the risk of hypoglycemia on two of these agents would be high. The patient returned in three months, and with a combination of weight loss and increased glipizide, his A1c had improved to 6.6% with no hypoglycemia.