Michelle
I'm sorry he is still so high. It could be NDW. I know you want to get him down from where he is. When he was initially on insulin, his breakthrough dose was 1.75u but we've learned that cats can sometimes look a little different their second time around.
If you study Alex's SS for 2009, which Jill referenced and I have looked at many, many times, she held the initial dose for four cycles as you did and then she started raising every six cycles until Alex got into normal numbers. When Alex came out of remission, Jill started her at 0.5u. She made an interesting comment on the SS that IF she had used the formula we use for initial starting dose for newly diagnosed cats following TR, (.25u/kg of ideal weight), the starting dose would have been 1.375u. Alex reached her breakthrough dose at 1.5u.
I think taking him up again after four cycles is very aggressive. We don't know at what dose he will hit the breakthrough so the question is, how aggressive are you comfortable being? You've done this before but it's been a while. Do you think you could deal with quickly dropping numbers that might get quite low if the aggressive approach really works and he starts down? Can you stay up and monitor him if you increase him tomorrow morning and by tomorrow night he's turning out some low numbers?
I think there is not a right or wrong answer. It boils down to whether you feel equipped to handle a possible very active cycle so soon back into the FD dance or whether you need just a bit more time to feel comfortable with it all. You've already taken one good aggressive move and I applaud you doing so.
If he stays in these high, flat numbers, I would not let him go any more than six cycles and I'd be testing for ketones. Also, if you decide to go the very aggressive route and take him up .25u tomorrow, I would then stick with increasing every six cycles if you do not see any downward movement; in other words, I wouldn't use that more aggressive technique again. If he starts to get into blue numbers, start holding the dose a little longer...between 6 and 10 cycles.
