I know you say that you target 30g carbs per meal, but have you tried a very low carb diet (< 30-50g/day)?
I have in the past but @ the time did not stop growing resistance and/or beta destruction as BS would stall for a while then continue to worsen.
I believe that reducing insulin and trying the Protein-sparing modified fast might get the body set up to be in a position for future insulin reduction as you have both mentioned.
Plan on trying this and seeing where I am at when I visit the Drs in 6 weeks at the Mayo Clinic.
Have you had tests to make sure you don't have ongoing infections? Do you have any dental problems?
Do you have any ongoing inflammations? Do you have sleep apnea?
This year I have racked up quite a bit of dental infections etc. all of which I am currently dealing with and all of the tooth and gum issues have been attributed to Diabetes by the perio etc.
Have you had an appropriate battery of tests to test for infection and inflammation (i.e. blood cell counts and CRP)?
I have regular blood work done on average every 2 months but not more specific tests like the ones you have mentioned... planning on getting better worked up in MO in 6 weeks.
Are you still taking insulin sensitizers (like metformin and Actos)?
Metformin ER 2000 mg/day.
Do you still drink alcohol?
No. Never a big drinker but since learning of the LD .... none.
What actions have you take to address your NASH? Some research suggests that a protein sparing starvation diet can dramatically improve NASH.
Local GI dx NASH a few years ago by way of ultrasound et al. but no biopsy and stated nothing could be done specifically for NASH scarring but to help halt escalation rear in blood sugar control. Looking forward to GI/Hep at Mayo to confirm NASH or other LD, explain the relationship with Diabetes or the insulin resistance and come up with a game plan.
How many calories a day do you typically eat, on average?
Recently way too many as the insulin has been reaching some sort of clinical benefits, b/c I am consuming much more to correct or avoid hypos.
How many grams of carbs?
I am going to try the diet mentioned above.
Are you keeping tight, accurate accounting of carbs and calories, despite the difficulties in applying carb-counting info to administering U500?
Prior to beg. the U500 I was much better with carb record keeping, however I was not getting anywhere doing it.
What is your dosing pattern/strategy? I.e., timing relative to first bite of food, etc.?
I begin eating anywhere from 5-20 minutes after injecting (I was told to eat within 30 minutes but nothing more specific strategy wise... as well there is not an abundance of literature on 500... most of what is out there is redundant.
What happens to your BG when you're fasting (i.e. >3h after eating), and you have no active insulin? I.e. does it slowly rise, fall, or stay flat? What is the behavior under different BG conditions (i.e. hyperglycemic, or near target)?
Overnight it is now slowly falling without stopping or leveling off ... (the same at other fasting times); although not what I would like this is a nice change as since Dx prior to beg. U500 I would usually wake up with higher BS than I went to bed with.