I think you are possibly needing to push, no, state to your vet that you want to have Tigger tested for acromegaly and IAA. I know all about having to fight with a vet to get the tests done.
I wasn't expecting to get in today so I wasn't totally prepared, but had a nice long visit with the vet. She did a complete blood check including the thyroid.
She doesn't think its thyroid or Acro but she is checking the thyroid for sure, not sure about the Acro. He doesn't have the signs of that by what she was saying.
To say a cat does not have the signs is not a good enough reason to refuse the tests. Not all acros 'look' acro.
I had Shadoe up to 9u BID Lantus before I finally was able to 'convince' my vet to draw blood to ship for testing. I had to take the info to the vet to show what tests I wanted and to tell where the tests had to be done. For weeks, the vet kept saying she does not look acro- she was a cute little grey kitty, tiny head, fine featured, only 6yrs old, female, tiny paws, no belly, so why would I want to waste my money on the tests?
I replied 'Because she is MY cat, and it is MY money. I can always go to another vet, so make the call and find out what you need to know about the tests getting done.'
They grudgingly had her tested and were shocked when the results came back positive for acromegaly. Seriously, getting to a dose of 8u and higher when being fed low carb wet food and all other tests cannot explain the resistance, it's time to test for a few resistance conditions.
The tests are important because you will want to know if Tigger has a functional pancreas or not. If Tigger goes low, you will need to feed a whole can of high carb, not just a spoonful, because his pancreas works fine and may just go lower with more food.
You won't do much different for Tigger if the tests are positive, but you will want to avoid BG under 100 as it is harder to bring up some acro's BG with high carb when they go low.
Let Tigger eat what he needs as his body may not be at a point where it can utilize the food well. Before they were regulated, my two acros ate huge amounts of food. Oliver was around 30oz a day and Shadoe inhaled close to 24oz. Now, they are much better - Oliver ate maybe 10oz yesterday and Shadoe ate close to 6oz.
I don't know if it's been mentioned yet, but you should consider picking up some R insulin to add to your tool box. When BG are very high, you can give a small amount of R to pull down the BG to a range where your Lantus can work better.
As well, from Tigger's ss, it looks like you are holding his dose longer than you need to hold it. If a dose is not show any improvement by 6cycles, you may as well increase the dose. By day 3, if you are seeing the same high 300s, it is time to up the dose. You need to find Tigger's good dose that will get him under 250.
One thing I should mention about the 2 tests - if Tigger has any issues with lipemia on his previous bloodwork results, you will need to fast him before the draw for the tests. Shadoe has issues with lipemia on most of her b/w, so she needed to be fasted from the nite before.
Here are the links to the 2 test sheets you can take to your vet; I don't know if the sheets have been revised recently, but should be good
IAA Test
IGF-1 (Acro) Test
Best of luck with your vet and getting the tests done.
ETA:
Oliver tested positive for acromegaly(325) and IAA(60%) - current dose 22.5u BID Levemir
Shadoe tested positive for acromegaly(120) and IAA negative(7%) - current dose 12.5u BID Levemir