I have been thinking that the standard advice given to suspected acro cats might be modified. Obviously, at a certain dose, we should encourage the IA/IAA test and the IGF-1 test. Next step, if any kind of treatment is contemplated, should IMHO be a switch away from super long acting insulin that builds up a depot, onto an in-and-out inulin like PZI. This would enable more confident rapid dose increases to mitigate damage before treatment without fear of overdose caused by depot. It would enable more effective dose reduction without depot interference when for e.g. cabergoline treatment was started. Same thing for after surgery. If it is eventually decided that insulin will be the only medication then switch back to a long acting insulin, and the well established protocols that have been developed.