Even as far back as 6 years ago one of his previous doctors urged him to switch to insulin because his blood sugar was far too high. He had been taking Farxiga for years and in December he was no longer qualified for it under his insurance and now he has to pay hundreds a month to get that medicine. It had been working well for him all this time but now he can't afford it, and his current doctor is urging him to switch to insulin because of his near-fatal BS levels. He's tried to keep his blood sugar down by dieting but it hasn't worked. Is switching to insulin a good idea? Or is it something he'll later regret?
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Are you familiar with Dr. Jason Fung? If not take a look. His methods might help. Not that much different from your general keto and carnivore diets, but he reminds people that when we eat more protein that is needed our body turns the excess to glucose, while certain types of fats are mostly harmless, and he recommends fasting.
https://www.sciencefocus.com/the-human-body/reverse-type-2-diabetes
Plus, is his thyroid working okay? Problems with thyroid can cause type 2 diabetes, and then just dealing with the diabetes is not going to solve the basic problem. And those problems can be subclinical, so even when the lab results for thyroid hormones fall within normal limits there might still be something going on there.
https://pmc.ncbi.nlm.nih.gov/articles/PMC6507635/