Ms Jones Is a 55-Year-Old Patient with New Onset Diabetes

Ms. Jones is a 55-year-old patient with new onset diabetes for 3 months and long-standing hypothyroidism that is treated with 75 mcg of levothyroxine QD. Her HbA1c at diagnosis was 7.8% and she began metformin and has titrated it to 1,000 mg twice daily. She has no family history of type 2 diabetes. Her presenting BMI is 20. She is complaining of starving herself and noting that her fasting blood glucose still runs high (120-190mg/dl) . Your next step is:

A) Add a sulfonylurea such as glimepiride
B) Order an insulin and c-peptide level
C) Order auto-antibodies (Anti-GAD 65, ICA-512)
D) Ask her to exercise in the evening to help her fasting blood glucose