Problem
Mr. Arman is a 69-year-old diabetes type II patient who presents to your clinic for a routine follow-up appointment. Past medical history includes hypertension and hypothyroidism; intact cognitive function and functional status. Diabetic medication regimen includes: Detemir 15 units every morning, metformin 1000mg PO BID, and glipizide 5mg PO BID. His fasting lab results from today are as follows: Glucose 136 mg/dL, SCr 2.69 mg/dL, eGFR 23 mL/min/1.73 m2, A1C 7.3%; all other labs within normal limits. Which option is the most appropriate for this patient based on this lab results?
i. Increase insulin detemir to achieve a better A1C goal.
ii. Discontinue glipizide due to decrease on renal function.
iii. No changes on regimen are necessary.
iv. Discontinue metformin due to decrease on renal function.