Thank you Dr. Kellon and Martha.  I am curious if you think this trend of higher insulin, weight gain, and less glucosuria is indicating the drug is no longer working for him?  Switching to Steglatro would almost double the cost of his flozin, with the pergolide on top of that.  Is there any experience to suggest that the Steglatro would work better?  If I can't switch, is it possible that weight loss would increase his sensitivity to the Invokana?  I assume that more exercise is always an option to try to control his insulin, as long as he remains sound.  Is fasting him for some time each day too much of a risk?

I realize that these many questions may not have definitive answers.  I would appreciate any guidance as I try to determine the right course for Cadet.

Aunna
October 2018
Island County, Washington, USA
Cadet Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Cadet
Ruger Case History:  https://ecir.groups.io/g/CaseHistory/files/Aunna%20and%20Ruger

Cadet Photo Album:  https://ecir.groups.io/g/CaseHistory/album?id=84102