Micheal - its like anything else you need the right tool for the job. Pounding a nail with a screwdriver does not usually work out to well.
If you pancreas was healthy it would get you BG down after meals with a robust release of insulin which would not only blunt the spike but turn off liver glucose production. It will then continue in a phase 2 releasing moderate bursts until you BG is under 100 and then you glide back to 83, give or take in a couple hours. At that point you are back in a fasting state.
Up until recently the tool to provide that robust release and mimic first phase insulin release was not available. So about the best you could do is what Dr Bernstein has promoted since 1970, reduce the carbs, replace them with fat and eliminate the spike. Whats Dr. Bernstein say fat is not evil and that it is required for survival since much of the brain is made from fatty acids The funny thing is back in 1970 everyone was mocking that "crazy engineer" later turned doctor. The bottom line was Engineer Bernstein was working with the tools he had and he didn't have a fast enough insulin.
Now you don't need to stop the carbs you just need to deal with them like your pancreas would. Carbs no longer need to be the evil because we did not have a tool to deal with them. The tool is now available although until recently there was a lot of doubt in the community that it works as well as it does.
I was talking with a very knowledgeable PWD today who is also a CDE. Two years ago she said she would never ever touch afrezza. It doesn't work. It's no good. It will explode her lungs and a few more reasons. Sitting next to her monitor showing a Dexcom "cloud" display of a BG graph was an afrezza inhaler.
She explained to me she started using it for corrections but is now using it more and more. She said is was really hard for her as a long time PWD getting use to it because it is totally different from every other insulin she has ever used. In fact she said for all these years everyone wanted a faster insulin and now we have one but sometimes its too fast for her.
I asked her if she was still on the carb restricted diet when using afrezza which of course she was. OMG, it hit her, moderate on the carbs and lower the fat to speed up carb absorption reducing the need for follow-up dosing. No PWD following Bernstein would ever do this.
Now as far as oral T2 meds working well, that simply is not supported by the facts. If it were the ADA would not have a step program which ends with insulin. It would end with metformin, or Trulicity or one of the others. Whats the average meal time spike of a T2? No one knows, right? It doesn't matter as not one of the T2 meds could handle it anyway. What we do know is a nice walk and a diet change works twice as well as metformin. In fact metformin was no better than a placebo in preventing diabetes in a landmark study. For those that like links - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1370926/
In a few years not only PWDs but everyone will be walking around with some form of CGM with their IWatch, or Google watch or whatever. At that point who is ever going to believe an average BG of 154 (7.0 A1c) is acceptable? They are going to go crazy knowing a non-PWD never goes over 130 and they are at 135 after lunch. For those that like links -
The good news is now there is a tool to address the lunch carb spike like a healthy pancreas. We don't have 2 or 3 or 4 of these tools. If we did I would tell you about them too. There is only one today and based on what was shown at ADA 2017 there are no efforts near or long term to develop another one. It took 95 years to get the first one but its finally here.