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Diabetic albuminuria — USMLE Step 3 MCQ

Instant feedback + full explanation. One question, done properly.

HardAmbulatory Medicine / Primary CareDiabetic albuminuriaUSMLE Step 3

An 88-year-old nursing-home resident with advanced dementia, metastatic cancer, variable oral intake, and limited life expectancy receives glipizide plus basal insulin. A1c is 7.1%; several fasting values are below 70 mg/dL, while occasional postmeal values reach 240 mg/dL without symptoms. Which plan best matches current goals of care?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: C — Stop glipizide, reduce basal insulin, and check glucose for symptoms

The best answer is “Stop glipizide, reduce basal insulin, and check glucose for symptoms”. For very complex or poor-health older adults, especially near the end of life, treatment should minimize hypoglycemia and burden while preventing symptomatic hyperglycemia rather than pursue a population A1c target. Removing the sulfonylurea and simplifying basal insulin is safer than intensification, correction-only insulin, or an indiscriminate stop that could permit symptomatic hyperglycemia.

Reference: ADA Standards of Care in Diabetes—2026: Older Adults: https://diabetesjournals.org/care/article/49/Supplement_1/S277/163921/13-Older-Adults-Standards-of-Care-in-Diabetes-2026