Fair point re searley being on insulin. I had forgotten that in my early hours posting. My point remains if someone is struggling despite low carb and even keto then investigating their insulin levels surely is the right thing to do before starting them on a lifelong path, because for most it IS lifelong. Regardless of cause, maybe especially if it’s unclear what the cause is
Many gp’s appear to recommend insulin for severely insulin resistant people that still have more than normal levels of production too, for whom it isn’t necessarily a good option. Because they are guessing not testing. Or simply do not know or understand other more recent options for treatment in this situation. This must change.
You're right in that if the GP's aren't recommending testing blood sugars to see what carbs the patient can tolerate, then that only option is more medication, which includes insulin. However, insulin resistance and beta cell function can be measured easily and accurately using the HOMA formula which specialist tend to do with a simple blood test of fasting glucose and insulin. C-peptide is only useful if it's off the scale low (less than 0.2 ng/mL on diagnosis which was me) which is type 1 or on diagnosis above the lab range supports insulin resistance. The normal range is not conclusive. In the lower normal range could indicate you are fasting or have eaten a lower carb meal.
My point is if not managed well most type 2's will exhaust their pancreas' beta cells, killing them, by spiking their blood sugars and running their blood sugars high. It happens over a longer period of time and many will eventually require insulin. This doesn't mean they have turned into type 1's. The HOMA formula results would be more useful here. Most will still need a specialist to calculate the results and interpret these tests.
https://www.dtu.ox.ac.uk/homacalculator/
Type 1's immune system kill off most of their beta cells on diagnosis and the remaining cells don't linger for very long in a honeymoon. I had a bet with my consultant who diagnosed me as type 1 in the first week that if I could stay off insulin for 6 years, he might consider he was wrong. Two years later, I lost the bet.
In terms of insulin, Dr Bernstein puts most of his patients on small doses of insulin on diagnosis, no matter the type, as he says it's the best treatment for elevated blood sugars. I'm no longer scared of insulin as I was initially. It certainly helped normalise my blood sugars when extreme diet and exercise had no effect. I still choose to eat LCHF.