My grandmother, 75 yrs of age, is a diabetic for past 15-20 years, taking metformin (2g daily) plus insulin (40+35). Where I am from we don't usually give a basal bolus regimen, just 70/30 in morning and evening. She also has history of IHD one year back.
Recently, her renal function tests revealed a creatinine of 2.0 (178micromole/L). Her GFR according to MDRD equation is less than 30. This clearly means metformin should be stopped.
However, when I stopped her metformin, she developed high blood glucose (9.7 fasting), so now I am not sure what to do? Are oral agents really needed with insulin for glucose control? And if not, how many units am I to increase her morning/evening insulin dose on each adjustment? How frequently to monitor? I myself am a doctor, so I know to always get the patient checked before any modification in treatment, but I just thought to also obtain the view of any experienced doctor over the internet as well. Any help would he appreciated.