Hello Pip,
Diabetes care in Japan is reasonably good and I get a monthly clinic visit on the Japanese NHS (pays 80% of costs) where they take a blood sample to test my HbA1c and meet with the doctor who usually gives me a rundown on my monthly bloodwork. Of course, being doctors, they are very pharmaceutical oriented but the doctor I see trained in the US and is more open to questions from me, partly because I have training in the biological sciences and I'm always asking him questions about the biochemistry. I developed diabetes at the age of 44 but was watching for it because both my grandmother and mother were diabetics, so I have a strong genetic tendency for diabetes. In the early days, it wasn't too bad and I was able to control it reasonably well by eating carefully plus fairly low doses of Metformin and little exercise, but it worsened as I got older and the last time I really "fell off the wagon" was 4 years ago when I was under a lot of work stress and my A1c shot up to 10. They put me on semaglutide self-injections, which made me feel awful plus caused a lot of bruising to the abdomen, so I stopped and thought about finding another way. I didn't really modify my diet very much other than cut out most flour and sugar-containing products (processed foods) but I did start walking gently every day for at least 7000 steps or about 5 km and it became very clear from the monthly A1c that my diabetes was drastically improving and dropped to the high 6 region, which I had never been able to achieve using Metformin and GLP-1 medications. At that point, I "bit the bullet" cost-wise and started wearing a CGM so I could monitor (as a scientist, I am very data oriented) which foods were pushing up my BG levels moment-to-moment and when I did see a rise I went for an extra walk of 30 minutes or so to push it back down. That strategy has seemed to work and now I am regularly hitting 5.8 to 5.9 at monthly A1c tests while using no medication. I'd say that it is the CGM giving me knowledge about what foods rapidly increase my BG that has helped solve the problem. Unfortunately, I can't get a CGM on the Japanese NHS unless I'm an insuling-injecting diabetic so using a CGM is quite expensive but I figure that once I've trialed every food I generally eat, I'll know what to avoid and if I can't avoid it, I'll know what to do in terms of walking to lessen the impact and then won't need a CGM all the time. As a recent example, I'd always believed the marketing BS that sugarfree muesli is a healthy breakfast for diabetics due to the higher fibre and low GI, but it is NOT in my case and causes a very steep large BG rise requiring 1.5 hours of walking after eating to return to normal levels, so no more muesli breakfasts for me! In summary, I suppose CGM gives me the knowledge I need to understand what foods I shouldn't eat and if I do, what I must do to quickly reduce the impact.