? Seizures at time of insulin injection (NOT HYPO)

Hi everyone!

It's been a while since I've last been here. Moby has been regulated quite nicely for two years now, but we've recently encountered an issue that has stumped two general practice veterinarians and two feline internists.

Moby's been on Lantus (0.25 unit, twice a day) and other than a rocky start in 2015, he's been regulated ever since and living a happy life. He's also been receiving fluids due to CKD, but we've been managing both diseases quite competently for about a year.

However, starting a couple months ago, we began to notice these twitchy episodes that have gotten progressively worse. It began as slight twitches/drooling anywhere from 30 - 120 minutes after the insulin injection, but in the last month, the twitches have turned to seizures and have occurred as soon as three minutes after injection.

We have tried 0.5 units, once a day, and while that has managed the seizures after the injection, he has not been regulated and has been feeling quite ill because of it. He only has these seizures when we give him the insulin both morning and evening. He never has had a seizure when we do a once-a-day dose. Also, he is always at the top of his curve when these seizures happen, he is nowhere near to hypo; he tests anywhere between 225-500 after an occurrence.

My husband caught his most recent episode on his phone last night around 11:30pm. It's a long story, but I made the executive decision to gave him a hair's breadth of insulin, and he began seizing three minutes after.

Watch the video, I'm actually on the phone with an overnight vet when it happened

Anyway, we're switching him to Prozinc (my next stop tonight is the Prozinc board), but one of the internists basically said today they are just throwing (excuse my language) **** at the wall and seeing what sticks.

His fructosamine was good, his urine was fine, all his blood checked out fine and the CKD markers even improved from his last panel. He's peeing, pooping, and eating and drinking more, but that's to be expected with the recent attempt at the once-a-day dosing.

Could this have been just bad insulin? The insulin was NOT expired and clear, kept refrigerated, but probably open for 60 days.

Does anyone have any experience with this? I'm so stumped. He needs insulin twice a day, but at this expense? I am so at the end of my rope with ideas and going from vet to vet to vet and finding no help at all. Thanks for reading my post and for any ideas or wisdom. I am grateful for this community!

 

You poor thing. Poor Moby. That video was hard to watch, broke my heart.
I do wonder about about the insulin because you said your insulin was about 60 days old, and the twitching/seizures started a couple months ago. Did this start when you started this batch of insulin? Do you use vials or pens?
I really have no idea, but if it were me, I know it's expensive, but I would try a different batch of Lantus. If you use pens, don't just use a new pen from the same lot, get a different lot # completely and try that first. Then you will at least know if it's the Lantus itself or just that batch, and know definitely whether to switch insulins.
If you use a vial, make sure it's a different lot# too. I had problems with the vials a couple months ago myself, white floaties in the bottles. I went through 3 vials in a couple months. The last vial I purchased I could see the floaties in it before I even opened it. It was still sealed. Pharmacy gave me a hard time, manufacturer gave me a hard time (because it was being used on a cat, off label use, so they wouldnt replace).
I switched pharmacies and switched to pens.

 

Are you home testing or relying on the fructosamine tests?

 

@Woodsywife, we test every single day and are super vigilant about his glucose levels.

 

@katiesmom Those are good ideas. And that's something I wish I figured out to do before I just bought the Prozinc to try, which I just did tonight. We're actually on a tight budget right now anyway, so if he does well on the Prozinc, at least I've found it to be more affordable than the Lantus. I actually did call the Pharmacist on the Lantus and tried to find out the lot # or at least when it was made and he kept repeating that since the insulin pen was open more than 28 days, that was the issue and he wouldn't help me further. GRRR!

 

Aweeee you poor momma bean that was scary to watch. I can't help but give you hug...much luck to you and your furbaby.

 

So sorry to see your sweet kitty having such a scary thing happen to him!!

Just something to consider if he doesn't do well on the ProZinc and you decide to return to Lantus.....If you buy Lantus from Canada (where most of us are now since it's 1/3rd the cost) you can get 5 pens for about $175 including shipping costs (that's 1500 units)...so it ends up costing about .12 cents per unit. Here's the information on where most of us are buying our Lantus from now

ProZinc is a U40 insulin, so you only get 400 units in a 10ml vial....and it runs about $100....so that's .25 cents per unit

 

@Chris & China Ah, I hadn't even considered the math yet! We did buy the Lantus 5-pen pack previously to this. But I didn't know about the Canadian option. I will definitely use that in case we need to go back! Thank you!

 

Do you usually inject him in the scruff? Have you tried another site, flank, maybe? Just a thought. It's got to be awful to have to watch him seize like that every day; it's got to be pretty awful for him, too, I guess.

 

I feel so bad for you and your poor kitteh. That is so traumatic to watch. Yes, I would suspect bad insulin and at least try a single dose from another batch. Please tell us if the switch to Prozinc helps. Also make sure you use U40 syringes with the Prozinc, or you have to calculate the dose conversion to U100. I really feel bad for you. I hope you find the issue. Poor Moby kitty.

 

If you still have the pen, the lot number w/ expiry date should be printed on it. Did you already throw it away?

 

Could your sweet Moby be allergic to the Lantus or an ingredient in it? It does have a strain of E-coli bacteria in it.

 

I hope the Prozinc works. Strange thing regarding the Lantus, I wonder if it's an allergic reaction.

 

* I have a cat that has seizures, too. He's had them since a kitten.

I wanted to give you some insight into what might be going on. My kitty has feline hyperestesia seizures and possible spinal reflex seizures related to him being a manx. When we got him, before the diabetes, he was having 5-15 second seizures more than 5 times a day. We worked on reducing triggers and are down to a few a week.

Some cats are prone to these, and they often begin as just skin rolling, twitching, tail flicking, and running from things that aren't there. This is the hyperestesia. For some cats, when they have hyperestesia, any additional stimulaton to their back or scruff area can lead to full seizures. Mostly fleas are the cause, but lantus can sting this area for hours as it's acidic. My cat really had issues with lantus. Levemir, a similar insulin does not sting and does not cause the symptoms and won't lead to seizures.

Most vets won't treat the initial hyperestesia as it's considered a "benign" problem. The issue is these behaviors gradually get worse in some cats, like mine, and if you treat the lesser symptoms you can prevent the full blown seizures. Typically, phenobarbital is used, and it can make them groggy for a few weeks until the dose gets to the right point. I've had enough success reducing triggers, we haven't had to start on any medications. Short seizures look scary, but they won't do much damage, the real risk is safety -- cat falling off things or biting himself. My cat fell down our stairs twice : (

Also, make sure you check your cat for signs of fleas, mites, or other skin conditions. These need to be treated to reduce seizures as well.

 

Thanks Meya14. This info is very interesting. My experience with seizures is not really relevant here (grand mal,brain tumour, phenobarb), although the seizures did start with twitching in response to sharp noises. The only thing I would point out is that professional advice about seizures in general is not to try and restrain the animal - use pillows or other soft items to keep safe from hazards.

 

I also wondered about hypersethesia; I have a cat with who has mild hyperesthesia, thankfully no seizures yet! That's what made me wonder if she tried shooting in a different area, like the flank or side, if that would make a difference. I didn't think about the Lantus sting itself actually triggering it, good information!

 

Actually, this is a good reminder - any new onset seizures in an adult cat without a history should be investigated. Hyperestesia usually has a long history of other behaviors prior to the seizures. Sudden onset grand mal seizures can often be other things like tumors, electrolyte issues, major illness, etc.

And shooting lantus in the flank did help at lower doses for us, but we got up to 7 units twice a day, and the skin rolling and biting was almost constant. Poor kitty. I don't know they pH of other insulins (prozinc, etc.) so I don't know if they sting too, but levemir does not.

 

@Meya14, Oh my god, thank you so much for your insight! I'm on my lunch wolfing down a salad and just read your post. I already have a few questions about Moby's episodes and how it compares to yours, so I will write those down throughout the day to ask later tonight if that's ok with you. I think my main question right now is that the episodes have gradually grown stronger and closer to the time of injection, which sounds in line with how hyperesthesia progresses?

 

I'm just following along , but did want to mention the same as the poster above about restraining. I know it's so scary and your reflex is to try and restrain , but plz don't. Just make sure he won't roll into anything & his surroundings are safe .At least that's what I was taught at the veterinarian hospital that I worked at

 

So my kitty isn't quite the "typical" hyperestesia kitty in that he has other neurological issues in addition because he is a manx. He has a shortened spine, no tail, and has an altered walk due to issues with the nerves in his spine. Some of his seizures are due to the fact that he has spinal reflex issues. He's had these seizures since birth.

The hyperestesia, however was really bad when we got him. This problem is almost like a positive-feedback loop, the more they engage in the behaviors, the more their brain must misfire. We worked hard to eliminate the things triggering (touching his back in certain places) as well as distracting him when I noticed he was doing the behaviors. If I can get him to "walk it off" it seems to cut the feedback loop and shorten the spells. His main behavior is licking his low back area, skin rolling, and biting his foot. If he has a bad week, I do notice the spells increasing in frequency and he will have more of the grand-mal type seizures like you saw. The behaviors are often mistaken for cat grooming or normal activity, so watch your cat closely and see if you notice other things during the day that seem unusual. This video looks a lot like what happens to my cat (minus the tail of course):

 

After watching this video now I have a question, I've always thought it was kind of odd that one of my cats does this weird thing. He will be walking along and then he'll act like he ran into like an invisible spiderweb or air has suddenly blown across the floor because he'll take one ear and tuck it under and then kind of like duck his head as if he had ran into something. And the other day he was sleeping started hissing jumped up turned around and then laid back down , it was very odd to see. Honestly I thought he was just a weird cat but do you think that this stuff has been happening to him ? I don't know if it matters but he has always had a small limp and his tail looks like it stopped growing too soon, like his tail is stunted.

 

OMGosh! After watching the video right above my post my cat skittles does this exact same thing all the time. I had no idea that this was a medical condition. So now what do I do,He also has diabetes. And the post above this one I also described him what I thought was weird things that his brother does. So can both of them have something wrong, when I say brothers I mean real brothers as in littermates .
I'm sorry to be a hijacking this thread, and I can't get a link to work if somebody wants to link my two post and start a new thread for me on this issue so I can ask and learn about it

 

Serrib: If the symptoms are mild, and they don't appear to distress either cat, the most common vet advice is to do nothing, just monitor. In most cats, it waxes and wanes, but never progresses into seizures. Also, make sure that your cats do not have fleas, mites, or other skin conditions, as these can cause it to become much worse. If the symptoms are distressing to the cat, or are progressing then vets usually treat with the lowest dose of phenobarbital that will control the symptoms.

 

Moby update: been on Prozinc for two days, we're still learning and testing to find the appropriate dose, but we're injecting in his flank and so far, so good!

 

Thank you , they seem fine other then when skittles will suddenly lick/ chew his back legs which makes me think that he might have a little bit of pain since he hadn't neuropathy back in 2015.

Does anyone know if this is hereditary, since both of them act like this once in a while . They are 2 out of 4 born in theirs mothers last litter and I am friends with the other person who got their 2 brothers and one of their brothers died. My friends had left to go to lunch on a Sunday afternoon and everything was Absolutely fine when I left, but when they came back a couple hours later they walked in to a very unwelcomed surprise ... their kitty laying there dead . So every time something seems out of the ordinary and I automatically think of their brother and wonder if something is going on with them