Cat Started Twitching After DM Diagnosis & Severe Hypoglycemic Episode?

[Mazi's Mom]

Hello! Mr. Mazi (Maserati) and I are new and have only been members here since late March when Mazi was diagnosed with DKA and Diabetes.

Mazi was brought to the Emergency Vetinarian Hospital mid March with a diagnosis of DKA and a BG in the 600's.

The hospital treated Mazi and sent him back home not even 24 hours after admission. He presented with lethargy, weight loss, acetone breath, increased urination, nausea, vomiting and wasn't eating.

When we went to pick him up around dinner time his glucose was in the 300s and he had only ate once for the emergency vetinarian. They suggested a diabetic diet, home monitoring, which I 1000% supported and understood the importance (Insulin is a dangerous drug) and that we follow up with his primary vetinarian. They didn't send us home with home with any anti nausea medication or an appetite stimulant, only Lantus 1U BID and assured us that his status improved. When I expressed my concern that the Alphatrak monitor I ordered wouldn't be delivered for two days and I wasn't comfortable not testing him before giving him his insulin, they told me Mazi would be fine till the meter arrived and he was on a very tiny dose. I brought up getting a human meter for the time being, and they told me that they were not accurate and it wouldn't be useful.

Thinking that these professionals had Mazi's best interest in mind, I trusted what they said and we took Mazi home think we would be okay.

We fed Mazi dinner, but he only ate about a quarter to a little less than 1/2 of a 5.5oz can of food. We gave him his shot and I made sure he stayed close to me that night.

He still seemed lethargic and off all night. I stayed awake that entire night to monitor him because I was so uncomfortable not being able to test his BG's. He stayed up all night, followed me around while walking slow. He appeared to be staring off into space and was drooling (nausous). I figured he was still not feeling well due to the ketones in his blood.

Breakfast time came, and he only ate more than a 1/4 but less than 1/2 of his can of pate. Because he was still eating something, I went ahead and gave him his 2nd dose of insulin.

2 hours later, I noticed his legs were wobbly, as he staggered to his litter box. I followed him and as he was in his box he collapsed.

I immediately picked him up, put him in his carrier, called the vetinarian hospital, explained to them his symptoms and told them I was on my way to the hospital with Mazi.

On the way to the hospital his breathing became labored and he was panting and crying. I was so afraid he was going to have a seizure in the car on the way to the hospital. I was by myself.

When we got to the hospital, they were waiting for us, they took him back into a room. As they were placing an IV and checking his sugar the vet said he had began to seize. His seizure only lasted for a few seconds because they had just got BG and were ready to administrator a high dose of dextrose. According to the vet once they delivered the dextrose Mazi immediately came to and was looking around the room. When the vet came back to brief me, they told me his blood sugar was 23. He said they would have to monitor him closely for 12 hours, but he suspected Mazi's prognosis would be good due to him responding right away to the dextrose.

Mazi spent 4 days in the ICU and these geniuses finally thought placing an NG tube, administering an Appetite Stimulant, anti nausea meds, and monitoring him for a few days were just now appropriate.

Flash forward, Mazi recovered. However, he has had some neurological changes since then. Mazi now twitches a few times a day. They're mostly in his face or his front legs. They only last approximately 2 or 3 seconds and are hard to document on my phone to show my vet. They don't seem to bother him, they are not triggered by anything, they just come and go.

My primary vet isn't even sure what happened. He suspects its related to the diabetes or the hypoglycemic episode. He suggested it could be Neuropathy or when his brain was deprived of glucose he could have gotten an injury to his cerebellum that controls your motor movements. He said doing an MRI is expensive & would be a waste of money because if it is brain damage there is no treatment for it. So he suggested since it doesn't bother him, continue to monitor it, try to get the episodes on video, and if it gets worse to call him.

At the very least, I hope Mazi's story stresses the importance on why home monitoring is so important and is the only way you can keep your diabetic kitty safe.

I hope my story is a reminder, that medical professionals are not always giving you the best advice. If your gut tells you what your vet, physician, or whoever is instructing you to do something, feels unsafe or wrong, listen to your instinct.

Why they sent me home with a diabetic cat who needed insulin who wasn't eating well, with no medication beside insulin, I'll never know. I wish I would have advocated more for Mazi and had the hospital keep him till I could home monitor. In the end, it would have been cheaper, Mazi wouldn't have been injured and I wouldn't have guilt and trauma because I ALMOST killed my cat by overdosing him on insulin.

Also, remember to do your own homework and don't just listen or trust medical/vetinarian professionals when things don't feel right. There were many red flags that I should have seen. If I would have spent 5 mins on Google, I would have known that I could monitor a cats blood sugar using a human meter that I could have picked up at Walmart for less than $20.

I was wondering if anyone else has experienced this or heard/seen/ has any knowledge about neurological twitches in a cat after a diabetes diagnosis, with Neuropathy, or after an episode of severe hypoglycemia?

Thank you in advance for any feedback!

 

[Wendy&Neko]

The only time I've seen neurological twitches after a diabetes diagnosis (and no severe hypo) has been in a cat that has another condition. One example is acromegaly (hypersomatotropism) - which is a benign pituitary tumour that can get large enough to press on the rest of the brain.

Would you call the twitches seizures? I remember seizures in a cat that was unfortunately given the wrong dose (20 units instead of 2units) for a period fo time.

 

[Mazi's Mom]

I dont think I would call the twitches seizures. When his mouth of cheeks twitch its only about 3 or 4 twitches and they stop. The leg twitches are usually just one movement more like a twitch and not a jerk and no rigidity in his jaw or leg muscles.

The leg twitch is almost like the same thing we do when we catch ourselves falling asleep and we twitch our legs and wake up.

The twitches don't appear to be triggered by anything they happen when he is awake and relaxed.

No abnormal behavior before the twitches come on like disorientation, meowing, aggression, or staring off into space. No loss of bladder or bowel control, no loss of consciousness, no drooling.

Mazi can just be laying on my lap awake, alert and relaxed and his leg will just twitch once or twice out of no where. Or he'll be relaxed and ill see a minor tremor or twitch near his mouth or checks.

The reason his primary thinks its related to the diabetes or the hypoglycemic event is because I said I never noticed it till after his diagnosis.

Its definitely neurological related or related to nerve function.

I was reading that twitching in a diabetic cat that isn't caused by hypoglycemia can be caused by the same neuropathy that is responsible for plantigrade gate. He has no muscle weakness, his balance and coordination is normal. He jumps on the furniture with no problems, he walks normally on his tip toes.

The only thing the doctor said during his follow up that he noticed was that he lost some muscle mass near his shoulders which could have been caused from the DKA and he was showing slight signs of arthritis and for only being 9 yrs old is kinda young to be developing arthritis.

I'm thinking its not caused due to damage to the cerebellum because he can loft his head up high, no problems with balance and coordination, his gait is normal, limb movement is coordinated.

All this leads me to think it is related to Neuropathy due to his diabetes.

In all honesty, I have no idea how long he was experiencing diabetic symptoms. He had 2 or 3 incidents well over a year ago that he peed outside his litter box. We have 2 cats and my significant other is the one who changes the litter box so I dont know how long he was experiencing increased urination. Both cats share the same water bowl so its hard to track how much one cat is drinking. However, in hind site I do remember thinking I was filling the dish more than I used to. And over the past, I would say 1.5 yrs Mazi started begging for people food and that was a change from his normal baseline, but I didn't think much of it besides that he had a change of preference In food because Mazi has always been dramatic his entire life when it came to food and would always act like he was starving when he was getting fed three meals a day so my spoiled mazi was never starving, just dramatic and liked food, but he never showed interest for human food until the last 1 or 2 yrs.

In hindsight I can see the diabetic symptoms developing, but with him they developed slowly over a period of a year or two.

So I'm wondering if his blood sugars have been elevated for 1 or 2 years before he went in full blown DKA and was finally diagnosed. And over the past year or two he developed twitching a Neuropathy and maybe i didnt notice it until just recently because when he brought him home from the ICU, I was watching like a hawk for Hypoglycemic symptoms and finally noticed the twitches.

So his pancreas wasn't making enough insulin to prevent diabetes symptoms, but it made enough to prevent DKA until it finally couldn't anymore.

I've been thinking of trying the methyl B12 and see if it helps diminish his symptoms.

 

[JL and Chip]

Has Mazi had his thyroid checked recently? The last value I see on the Labs tab is from 2021. It’s probably a long shot, but hyperthyroidism can sometimes cause twitching (and definitely excessive hunger and thirst). Might be worth ruling that out for good measure.

 

[Mazi's Mom]

@JL and Chip ill have to check his labs that were taken in March of this year when he was diagnosed with DM and DKA to see if the hospital checked his thyroid hormone. I ill call this week and ask them to email me all his labs. I actually called last week and they were suppose to email me them, but go figure they never did.