What is the recommended adjustment for Martina's diabetes management given her current A1C level of 7.4%?

When considering management adjustments for a patient like Martina, whose A1C level is at 7.4%, it's important to recognize that this level indicates her diabetes is not adequately controlled. Recommendations for adjusting diabetes treatment often depend on the current medication regimen, patient preferences, potential side effects, and overall health status.

Introducing a thiazolidinedione could be a viable option depending on numerous factors such as Martina’s heart health and weight management goals. Thiazolidinediones can improve insulin sensitivity and help lower blood glucose levels. However, they also come with certain risks, including weight gain and potential heart failure, which must be considered based on the patient's overall condition.

While increasing metformin is a common strategy when blood glucose targets are not achieved, the option presented suggests a significant increase to a total of 4,000 mg per day, which exceeds the recommended daily dose and could increase the risk of side effects, such as gastrointestinal issues. Therefore, it's essential to consider if Martina is currently taking metformin and whether such a drastic increase is advisable.

Insulin therapy is often considered when oral medications do not achieve the desired control and it may be more appropriate for patients with significantly higher A1C levels or those with symptoms of hyperglycemia. However