Insulinomas are functional endocrine tumors of beta cells in the pancreas secreting increased/inappropriate amounts of insulin leading to low blood sugar.
Patients may show lethargy, ataxia, weakness, tachycardia, disorientation or behavior changes, hypersalivation, weight loss, and muscle wasting. In patients with dangerously low blood sugar, they may tremor or have seizures, collapse, or even lapse into a coma. Animals with these more severe signs should seek veterinary care immediately as an emergency.
Low blood sugar may be caused by excessive fasting, liver disease, Addison’s Disease, or sepsis. Generalized weakness may result from a heart arrhythmia, metabolic disease, anemia, neurologic disease, or gastrointestinal illness. True seizures may be caused by epilepsy, toxin exposure, or masses within the brain, however, it’s not uncommon for fainting spells caused by heart disease known as syncope to resemble seizures.
A blood glucose after a 3-hour fast with a result less than 60 mg/dl with clinical signs is highly suggestive of insulinomas in ferrets. From there, your veterinarian will recommend full blood testing including a complete blood count and serum biochemistry panel. Ultrasound may be recommended to identify tumors within the pancreas, especially in patients where surgery is a treatment option. Tumors removed surgically should be submitted to the pathologist for testing.
Ferrets who are actively seizing should be seen as an emergency as prolonged seizure activity can result in overheating to the point of heat stroke and damage to the brain. Patients who present with seizures may require hospitalization for stabilization. Stable patients are treated either medically or surgically.
Surgery may be an option for some ferrets and is recommended for otherwise healthy ferrets under 6 years of age. In some cases, it improves the response to medical management and can cause temporary remission. In other cases, the tumor may have spread to other organs and surgery provides no advantage to medical therapy.
Medical treatment is not curative and aims towards temporarily improving your pet’s quality of life and minimizing symptoms. Your vet will prescribe a steroid, typically Prednisone, to help increase sugar production from the liver. Administer the prednisone as close to 12 hours apart as possible. As the disease progresses they may add on a second medication called Diazoxide.
You will be instructed to feed 4 to 6 small meals a day and always have food available throughout the day. We recommend feeding grain-free diets, such as Wysong Epigen 90 Digestive Support, which will help regulate your ferret's blood sugar throughout the day. Do not use semi-moist foods as they are high in simple sugars. You may need to transition to a different diet slowly since ferrets can be stubborn about changing diets and you do not want your ferret to miss a meal as that can make things worse. If you would like to discuss other diet options for your ferret, please let us know.
If the patient is drooling, seems nonresponsive or slow to wake up, or is trembling or twitching, immediately apply high sugar syrup (such as Karo corn syrup or honey) to the gums followed by a small high protein meal of 5 - 6 ml of chicken baby food, Carnivore Care or Emeraid Carnivore diets. If your pet does not improve or if they go on to seizure, this is a medical emergency and your pet needs to be seen by a veterinarian immediately. If we are not open, please go immediately to the emergency clinic.
Your pet may need to go on a second medication, Diazoxide, when changes in the diet and the prednisone are no longer working as well.
Once your pet’s blood sugar levels are controlled, recheck exams and blood tests are needed monthly to make sure they are doing well.
Insulinomas are rarely cured but can be managed with a good quality of life. Survival times are highly variable from 5-504 days with medical therapy, 93-1002 days with medical and surgical therapy.
It is recommended that you recheck immediately if clinical signs return: if emergent, owners should apply a small amount of sugar syrup to gums at home and immediately seek veterinary care. Otherwise, your veterinarian will recommend checking blood sugar levels at initiation of medical therapy, 7 days later, then only as needed if stable dosing is achieved. After that, we recommend a recheck exam and blood glucose every 3 months for chronic management.
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