72-year-old female with a 30-year history of type 2 diabetes and hypertension returns to your office for a routine visit. She is taking 20 units of insulin glargine every morning and five units of insulin aspart with meals.
She is on atorvastatin 40 mg daily. She is on no other medications. Her A1c is 6.5%, and her BP today is 145/90. The patient notes blurry vision for the past several months and a few days of dark spots in her vision. She denies headaches or nausea. What is the most appropriate next step to slow down the progression of diabetic retinopathy?
a. Increase her insulin aspart from five units to seven units with meals.
b. Increase her insulin glargine to 23 units every morning.
c. Perform a fundoscopic examination and make no changes to her regimen today.
d. Start her on a baby aspirin.
e. Start her on a calcium channel blocker.