35-year-old patient with type 2 diabetes
History of present illness: A 35-year-old female with Type 2 diabetes presents for medication management. She was first diagnosed two years ago. She exercises regularly, has a BMI of 19 and has never been overweight. She has been taking metformin for twelve months. Despite taking her medication with food, this patient reports that she continues to experience gastrointestinal distress every day and is seeking advice or a solution. Her symptoms vacillate between nausea, severe constipation, and diarrhea. She's very interested in whether she can make any lifestyle changes to improve her condition; this patient wants to know if changing her diet further, adding in supplements, or making any other similar alterations could help her diabetes. She was told that her diabetes was not severe, and so she is hoping she can eventually get off her medication altogether.
Social history: Patient denies ilicit drug, tobacco, and alcohol use. She is single and lives with her cat. She works as a financial analyst for a local business.
Past medical history: Diabetes (diagnosed in 2018).
1. How would you suggest the patient's medication regimen be altered?
2. What lifestyle considerations (if any) would you bring up with this patient?