For those who with success in reducing A1C, feedback please

JayAmerican said:

I finally started seeing results with fasting levels. It took patience being on a strict diet (and by diet I don't mean calorie counting, I mean staying away from bad carbs and keeping it as keto as I can). After 5 straight weeks of patience, and persistence, my morning levels and in-between meal levels are going down. My (unscientific) feeling is that the body needs to: get rid of fat & glucose storage around the liver and be "trained" that it is OK for it to not dump which I think it does because it is being triggered by excess insulin. Once the insulin needs drop, the insulin resistance alleviates and the liver starts learning that it doesn't need to keep dumping glucose to keep you from dying in your sleep or between meals. It won't happen with 1 meal change or even a few days. It will take weeks.

This doesn't mean that carbs wont' spike your levels anymore when you have them, that will still probably happen, but the point is to get to a safe level and stay there. Like someone with allergies - those allergies will never go away on their own (technically, I'm sure some people have managed to somehow "cure" their allergies) so you have to treat diabetes as always-present. Once at normal levels you can probably cheat every now & then, also to "test" your body to see how it reacts (hopefully only partial spike and then quickly back to normal) but you will never be able to get back to the same eating habits as before.

Before I fully succeeded in bringing my fasting levels down, I told my theory to the endocrinologist and she said "that's now how it works [regarding the liver]". Welp, I don't know if it is or isn't, I just know that I think like an engineer and my body is a machine and I am doing what seems to be working.

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I wish I could have given your post more than just one emoji rating, LOL. You're talkin' my language!
I do think in my case you hit the nail on the head with "training" the liver that I'm not going to die of low blood sugar between meals. If I've been experiencing reactive hypoglycemia for years (most likely), my poor liver doesn't trust that it won't be facing that kind of dangerous scenario. When I'm eating low-carb, my set point is remarkably stable yet higher than a metabolically healthy person. I'm absolutely convinced that my liver has a set-point and needs to be convinced/retrained. So then the question is how best to retrain it? The obvious solution is low-carb, although I recognize that super careful mixed meals might work for some people. Seems like LOTS more margin for error with that, though. In fact, I don't know how it could be done reliably without a CGM, because the goal is to stay within a narrow range without fail for weeks and weeks. One mistake and you might trigger a reactive hypoglycemia event, which could potentially undo all the "calming" of the liver. Maybe I'll start thinking of my liver as a skittish puppy that needs to be coaxed and shown that I'm predictable and it's safe to relax. Oh, dang - that makes me realize that my adrenal glands need to calm down, too and stop prompting the liver to pump out more sugar.
I've also begun a week long experiment where I am going to eat a large low-carb breakfast, and attempt to skip lunch (with some back up low-carb light foods so I don't melt down at work if this doesn't go according to plan) and then eat a light(ish) low-carb early dinner. I am hoping this might bring down my fasting blood glucose. Previously, I was skipping breakfast except for coffee/cream, maybe a hard-boiled egg.
I am totally into this experiment for the foreseeable future.
Thank you so much for your reply and your creative (engineer) thinking for me.