hello Squirrel,
I wanted to comment on the appetite issue; my two cats had 'healthy' appetites before they were regulated. Shadoe was consuming around 24oz/day and Oliver was inhaling easily 30oz/day.
Normally, cats will be eating more food because their bodies are not getting what's needed.
Shadoe is now eating maybe 8oz/day and Oliver is down to maybe 15oz/day.
Pancreatic function
Feed Tommy what he wants to start as he may need it right now. You can track his weight gain on your ss; I have added a column for my cats to record their weight.
There are some cats that take a bit longer for their shed to fill up - always keep the shed in mind when you are increasing dose - stick to 6cyles/shots to be sure that the shed has been topped up and your cat is getting the full benefit from the dose.
Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
As with the protocol, increase Tommy's dose on the 7th cycle.
I know it's difficult to see a lack of improvement in the BG numbers, but those numbers are only a single part of the picture. Pay close attention to Tommy, how he is acting and changing. How is his coat? Make a note of changes and improvements with his coat, and habits, old and new. Watch for the amount of urine, as it may lessen as he approaches regulation. Also, his water drinking may change too.
Food is very important. You want to ensure that Tommy is getting NO dry food, including any dry treats or seemingly harmless treats.... read the ingredients as many will have some form of sugar in them. Even the pill pockets that so many use for giving meds to their animals .... they have sugar in the ingredients - all flavors except the Duck and Pea flavor for allergies, which has no sugar/corn syrups. I mention the dry foods because if my Shadoe gets just a single mouthful of even 3 or 4 pieces, her BG will shoot to the 400s.
Because Tommy will eat all the food left out, you can try what works for many by using a timed feeder. You can ration out equal portions and he can't get the food till the feeder turns.
Petsafe 5-meal Auto Feeder
You mentioned a switch to another insulin. If any switch is made, I would suggest switching from Lantus to Levemir as it is a bit gentler than Lantus and just as long lasting. I use Lev for both mine, and did find that Shadoe was improved in all ways when I switched from Lantus to Lev.... she relaxed more, had less urine issues, and better BG numbers. While PZI may be fine for some cats, it's not as long lasting as Lantus or Lev, so I don't think it would be a good option for Tommy.
I know you may be discouraged by a lack of improvement, but maybe Tommy just needs more insulin than other cats. There have been others who were at higher doses and did eventually go OTJ - I think of Randi/Max who was at a higher dose but is OTJ today and it's been almost a year too, I think!
So just stick to the protocol, feed Tommy what he wants and record the amount in ounces on his ss to track the total, plus track his weight gain. I just weigh myself while holding a cat, then set the cat down and weigh myself again, then subtract. Easy peasy and more convenient than going into the vet office all the time!
Finally, if at all possible, get at least a before-bed BG test in the pm cycle because many cats go lower overnite and then are high in the morning at amps. It may not be the case here with Tommy but without the number to prove it, you don't know for sure.
There are 3 absolute most important BG tests to take: amps, pmps, and the before bed test. Aside from those 3, you can save strips by getting tests at +6 and then if able +3 and +9 are good. See below - it's not the same for all cats, but it's a good starting guideline.
Also, you can move around your test times between shots - one day get 3, 6, 9, and the next day, get 4, 8. With staggered test numbers, you may be able to pinpoint Tommy's nadir and save strips at the same time.
When people are at work, they can't do any testing, so don't worry about getting lots of tests, just get the ones that will tell you something most useful.
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.
As you get closer to the dose that Tommy needs, you will start to see the signs in his mannerisms and attitude. In time, you will start to see the old Tommy back.
It will happen.