For a 68-year-old woman with Type 2 Diabetes and poor renal function, what is the most appropriate pharmacological management?

In the context of managing Type 2 Diabetes in a 68-year-old woman with poor renal function, insulin is the most appropriate pharmacological option. Insulin therapy can be adjusted according to the patient's blood glucose levels and can be safely used in patients with renal impairments, as it does not rely on renal clearance for excretion.

Biguanides, such as metformin, are contraindicated in patients with significantly impaired renal function due to the risk of lactic acidosis. Sulfonylureas may lead to prolonged hypoglycemia in patients with renal issues, as their metabolism and clearance can be adversely affected. Glitazones, while not contraindicated, may have concerns related to fluid retention and cardiovascular risk, particularly in older adults with underlying health conditions.

Thus, insulin is a safe and flexible option for controlling blood glucose without the risks associated with those other medications in the context of poor renal function.