A lot to unpack in your excellent response.
Let’s start with my type 2 DM history. I was diagnosed in 1992 with a fBG of 450mg/dl which caused me unable to focus correctly. At the time the health care plan we were on was basically all in-house. We, my wife and I, attended 2 or 3 classes with a CDE. I was given a binder full of information. My experience with 3 different dieticians/nutritionists who were more harmful than helpful. All 3 appeared to be anorexic with a hate for food.
I was prescribed Micronase and with the help of Dr. Bernstein I had to be weaned off as it was causing hypos. For a decade I had great control with diet and exercise and a mostly stress free life.
Then while carb restricting and exercising some 10 hours per week (bicycling) my BG began to rise, even with near zero carbs and more cycling. Also my work environment became increasingly stressful.
This was the 1st progressing of T2DM for me. I was prescribed Metformin. Over time the dose was increased to max, 2000mg daily. Then Lantus was added. This dose ended up hitting 85u.
I retired which reduced stress and was able to exercise more. This enabled me to reduce the Lantus over time to 18u. Over the last few years I had to increase Lantus to 30u.
During all this time my HbA1c was under 7%, Usually in the low to mid 6%. I have always stayed on top of my BG management.
A year ago, November, fBG and postprandial BGs were rising again. My HbA1c in January 2021 went up a full percentage point in 3 months. My PCP agreed with me that I could try MDI adding Humalog to the mix. I am using a u:carb ratio of 1u:22g and a correction factor of 1u:40mg/dl. I usually used the correction at premeal bolus. i.e. if my BG is 120mg/dl I I will add an extra 1/2 unit. I do better if I can to do a brisk walk or bike ride otherwise. When I attempted to do a correction bolus mid-meal I risk a hypo.
My HbA1cs since beginning MDI have been less than 6%.I was referred to the endo because I was enquiring about getting a T:Slim pump. My reasons were more economical than need. On Medicare the pump and insulin are covered under Part B durable medical equipment, instead of Part D drug benefit.
Now I get this surprising set of results just 2 months after my last labs.
Anyway @Eric if you waded through all this without shouting TMI! thank you, it helps to release some of the stress.
Edit - My weight has been excellent, I lost some 60 pounds after diagnosis and am currently at my trim 16-17 year old weight.