Much discussion of late has been around this topic. Some of it a bit contentious.
Yet, pondering it, I realized that pretty much only pills, and in this the only D-drug I'm on other than insulin is metformin, do I follow instructions faithfully.
Insulin? No way. I'm all over the map doing stuff with it that is most definitely "off-label" from the standpoint of standard D prescription. Same with my G4 CGM.
Here's what I do "off-label" to manage my Diabetes:
- Intramuscular injections -- 2-3 a week to bring down highs. I even do this for moderate (<150) stubborn highs, just because it's so much faster (2x). I do this even though I'm wearing a pod and could bolus that way.
- Manage IOB on two devices -- pump and/or smartphone -- as needed due to insulin administration outside pump delivery. It's not hard, but it's more complicated.
- Make bolus decisions based on my CGM. I have so much experience with the thing now, how it plays with my system, when it's going to be significantly off, etc., that what risk is there is minor in my opinion, and my experience. Since the new firmware flash last fall, it's become even way more accurate. I can rely on the readings usually well into a calibration cycle even, within constraints (sensor not too old, BG stable, some other conditions).
- The pre-bolus game. I try to time my boluses so that insulin peaks when carb digestion begins (i.e. glucose entering the blood) if I'm starting from normal (70-90), or peak when I take first bite (starting a bit high, 100-130). It's a game of chicken, and I've had to pre-empt hypos now and then with a few skittles. However, it's a strategy that allows me to still have 40-60 carbs at a meal an still stay under 140 peaking, then landing back in the 80s 4 hours later.
- If I miss a met dose (1000mg 2x a day) I'll take 1 1/2 on the next dose. Works really well.
There are others that I'll post as I think of them.
The biggest takeaway here is this: I'd never be able to achieve an a1c of 6% if I didn't "go rogue" like this. I firmly believe I can get down to my goal of 5.5% with these same tools if I work more agressively at treating highs and cutting out late night snacking, my demon.
I know I can get there easily with a tool like Afrezza added to my arsenal, which of course I'll be administering in all sorts of off-label ways.