What he hasn't disclosed is that he's on Metformin and an insulin pump. It's not him doing the legwork; it's medication doing the legwork. That's how he gets away with so little change. Guaranteed, if you took away both of those things, but especially the insulin pump, his A1C would spike to hell and back, and his diabetes would be uncontrolled even with the Metformin. He's non-compliant with the dietary changes.
I will admit that I was wrong about Lou being prescribed a CGM. They're increasingly handing them out to Type IIs on Medicaid, but I thought that Lou's refusal to meet with diabetic educators, being fired by his doctor, making a big deal about not checking his blood glucose, his external locus of control and the complete absence of
grifting for accessories meant that he was just using a meter.
However,
there is no way Lou is using an insulin pump:
To have a pump prescribed, you
have to be documented as able to learn and specifically able to count carbohydrates.
A PCP is unlikely to have the time, knowlege and resources for all the education and paperwork required for insulin pump initiation. That'd be an endocrinologist, with dietician and educators to boot.
If Lou had a pump, he'd have the Dexcom data-push CGM not a Freestyle or anything else that he can't be bothered to read manually. The whole point of CGM+pump, these days, is that they've hit FDA standards for safety and now newer pumps can make limited decisions from CGM data (adjust basal for high/low, small boluses).
Once you're on a pump, it's possible to go off the rails/become noncompliant and have the endocrinologist keep filling DME prescriptions out of harm reduction, at least for a while, but someone like Lou isn't going to waltz in and do his "not even going to do my meds today" moping without big red flags.
He's also a relatively "new" diabetic; they're going to try orals and an insulin pen first. A pump for Type II comes after everything else has been documented as failing.
Finally, back to the primary source, I'm pretty sure I remember Lou posting about injections, and that he "shot up" for the day and wasn't going to eat anything, please clap your hands if you believe in Lou.
