Twitching - why?

Mookie has started to have muscles twitching fits on and off for a couple hours in the afternoon and I'm quite worried.

He was on 0.5 U twice a day of Lantus and the vet switched him to 1.0 U twice a day of Prozinc a week ago. The first couple of days were ok. There was no movement in his BGs, no behaviour changes. Then last Sunday a bit of muscle twitching started in the afternoon and he had a soft stool. The next day his stool was solid. Tuesday he threw up clear liquid (approx 2" diameter) at 8pm, an hour before his PM shot. Wednesday he threw up clear liquid at 6:15 am, had muscle twitching on and off late afternoon and soft stool at 7:20pm. Thursday soft stool at 7:30pm.

Friday he threw up clear liquid at 8:20am (with hair spiked along spine) and soft stool at night before dinner. His BG after throwing up was lower than usual (13.3mmol/L, so still high) and then rose 10 points to 23.8 mmol/L an hour later - although he ate in between time, this rapid rise is very unusual - he usually only goes up 4 points at most after eating. I only gave him 0.5 U in the morning just in case. I didn't give him a PM shot.

This morning, he threw up clear liquid again. I gave him 0.5U. Since early afternoon has had muscle twitching on and off. His BG was 20.1 just after the twitching started.

All week his numbers haven't moved, in fact, his evening BGs have gone higher than when he was on Lantus at 1/2 the dose he was on this week. My vet doesn't look at the BG results that I send him (needless to say, I'm looking for a new vet).

I suspect that Mookie has an underlying dental issue that is messing with his glucose regulation. My vet doesn't think so but can't explain why he can't regulate Mookies blood sugar and why every time he increases Mookie's dosing - Lantus or Prozinc - Mookie starts having reactions like racing heart, lying in front of his water dish and then taking a long drink, throwing up, twitching, soft stool, etc...

I hope to get a dental consult this week with a vet dental specialist.

Any ideas what might be going on? Any suggestions what to do from here?

Mookie hasn't hadtypical hyperglycemic clinical symptoms since he suddenly went from being regulated to uncontrollable BGs February 9th. He urinates x2 per day (a larger qty than my non-diabetic cat) and drinks 3.5oz of water per day. His coat is shiny, his energy and appetite are good.

Until this week when he started Prozinc at double the dose of Lantus he was on, there was no twitching, throwing up or soft stool.

I haven't had a chance to convert all his BG info in US metric yet.

Here is his spreadsheet in mmol/L (with colour coding like the US metric spreadsheet):
https://docs.google.com/spreadsheets/d/18Iw-fJC-tO40CWAFF1z76Abei_BDQFJCuvw5dAAam6o/edit?usp=sharing

Any help/insights are appreciated

 

Hmmm...I wish I had some good info to offer you. So he never had this kind of reaction on Lantus? Honestly, I've never heard of this kind of reaction with a switch to ProZinc, but that doesn't mean that it can't happen. Has ANYTHING else changed for Mookie or just the insulin?

I think first things first, you want to get that possible dental issue checked out. When was the last time Mookie had a good work up at the vet? Sometimes an underlying infection of some sort can be causing the problems. So I'd bring him in and have his teeth looked at and maybe ask them to do a general checkup too if it's been awhile. See if they can't find out if some sort of infection is brewing. That will help us all determine if the BG is so high because of that or just because he needs more insulin.

Can I ask why you decided to switch insulin? ProZinc is a great insulin for cats, but so is Lantus. I don't know much about the L insulins as I never used them, but it looks like you were sticking at the same dose on it...and if it isn't enough insulin, the BG will not go down. Cats need as much insulin as they need. Even on ProZinc, you would want to up the dose until you found one that worked better...and even that can be a moving target.

My thoughts. First, do the vet to see if anything else is going on. Second, work on finding a good dose of insulin. My honest guess is that even if there's an infection going on, Mookie might have a bit of glucose toxicity (NOT as scary as it sounds...basically means he has been in high numbers for awhile and just got stuck there). With that you just have to up the insulin dose fairly frequently until you find a "breakthrough" dose...and then usually they start back down the dosing scale and settle in somewhere to a dose that gives good numbers. However, I hesitate to suggest too much with dosing because if ProZinc is really giving him a bad reaction, you might want to look into going back to Lantus...or trying Levemir. It's hard to say what to do with that...if no infection or anything is going on and nothing else has changed and he continues to be ill, I'd probably switch back and see if that helped. You are, of course, MORE than welcome here, but I hate to hear about Mookie being so ill!

 

Thank you for your thoughts Rachel I really appreciate it. I will definitely look into testing him for possible infections on top of a dental consult. The vet switched Mookie to ProZinc because he would have weird reactions to increasing the Lantus dose - recently, when he tried to increase the Lantus dose, Mookie had strange heart rate changes and within the hour of his shot would lay down or hover over his water dish and then drink for 3 minutes straight, which never happened before. He was briefly regulated on Lantus for 2.5 months before February 9th when his BG shot up and have never come back down. I even tried tight regulation myself but the higher the dose, the higher his BGs would go.

Very frustrating....mostly because our current vet is so blazé about the whole situation and dismissive of my observations, home testing and suggestion that there might be a dental issue. It's like pulling teeth to get him to do anything. The dental specialist I'm considering for a consult only deals with cats and does general veterinary cat care as well. I'm crossing my fingers that she might be a better option for us.

 

The twitching could be an episode of "feline hyperesthesia". There are a variety of triggers.

 

Thank you! I will look into it.