Hi Joy,

Glad to see her insulin is heading in the right direction.  Would definitely up her pergolide as it's still high and we're of course heading into the seasonal rise time of year.  Looking at your CH she was getting 6 capsules and 2 chewables so I think I'd go with 10 capsules only as we've seen the potency on the chewables is not as reliably maintained as the capsules.  You'd probably want to run just a baseline ACTH recheck (unless you're in Dr. Kellon's study) and an insulin about mid-July to see if that's keeping her ACTH in the normal range and if the insulin has come down at all with the continued diet/exercise and reduction in ACTH.