Cass, I hope Dr Kellon has some advice for you.  You certainly now have mastered the dosing via syringe of Metformin!  I think you should share that with the group when you have time... 

The only suggestions I have are can you get her ACTH into the mid-teens (as others have found to be beneficial), and can you increase exercise (right now I think your CH indicates she is sedentary?).  Thank goodness she is not in pain, if you can increase exercise it might be a good time to start?  (I'm not sure what the smoke situation is there right now though)

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Kirsten and Shaku (IR) - 2019
Kitimat, BC, Canada
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