Yes, his hands were shaking after TP II but that didn't prevent Israel from launching their attack on Iran, did it?
You may disagree with me, but the eventual, inevitable step of this escalation ladder, if it's not stopped, is to hit vital infrastructure of each other and when we get there, Israel will be destroyed due to her size. It is an existential threat to them. Will they use their nukes then?
We know that they're genocidal and the US has given them a free pass to commit genocide. Not only that, the entire media of the Western world try to paint them as poor Jewish people fighting for survival among rogue Muslim states that want to destroy and devour them. So, I'd say that Israel is very likely to use at least tactical nukes in that scenario.