@MarcR if you are achieving an A1c of 43 whilst consuming around 300gr carb a day, you may find it relatively simple to reduce it a bit more, just by tweaking your diet.
The way I look at eating is I concentrated on nutritionally dense meals. I don't snack, but then again, I never have.
My meals are based around a goodly portion of protein, some above the ground veg and make up the calories with fats. For clarity, the fats aren't glugs of olive oil, or slices on butter, but often, during the week be fattier cuts of meat - like lamb, belly pork and such likes. They can be both a decent protein hit, but fats too.
These days, I can tolerate more carbs than previously and still maintain a decent A1c. I can only assume that whilst I wasn't hugely heavy, I had fat in some medically undersirable places. These days, and for the last 10 or 11 years I have a short, slight frame.
Not everyone is able, due to a plethora of factors, to reduce their A1c (or similar) tests to non-diabetic levels, but in your shoes, I'd be very hopeful.