Managing Insulinoma

Over the past few years of working with dozens of ferrets suffering from insulinoma, we have learned much about how to help our critters manage this disease. Medication is important, but so is a devoted owner who's ever vigilant and knows what to do when critter has ups and downs, which we've learned are to be expected with this dastardly illness. This article is designed to compliment the clinical information that is readily available about the disease, focusing more on daily management.

The photo isn't a critter with insulinoma...hee's actually a camera mistake, but we think it's fairly representative of how a critter with insulinoma can feel kind of foggy  :)

Insulinoma causes too much insulin to be released periodically into the body. The disease is the opposite of diabetes and instead is more akin to hyperglycemia. Symptoms include lethargy, instability, drooling, nausea, seizure or even coma. Detecting the early symptoms can be tricky, since the milder symptoms are often similar to the aging process: critter starts sleeping more, playing less, etc. Because insulinoma can appear suddenly and cause all sorts of trouble, we recommend screening critters at least twice a year, starting at age 3. Screening is a simple blood test to measure the glucose level, done after a 4 hour fast. Your vet can test, or you can test with a home glucometer - although we recommend a visit to your vet or to the shelter for some help with the first time you try testing yourself. :)

If your ferret fails the screening test for insulinoma, he or she should be started on prednisolone, which is a steroid. We only use the brand name, Pedia-Pred, which is made for children so it's fruit flavored! Dr. Fear of Parkview Animal Hospital tells us that he's used other types of "pred," but has found that the Pedia-Pred is the best tolerated and most effective with the smallest dose. Be careful with generic versions of "pred." Pills are more difficult to give and generic liquids may contain alcohol.

Medication is the essential treatment for critters with insulinoma. But while meds are critical to help critter's body keep insulin levels in check, we have found that nutritional support is also an important component of successful disease management. Frequent incoming meals are the body's natural way to battle the ups and downs of the illness. In other words, if a ferret with insulinoma skips a meal or two (or more) for any reason, he or she can get into serious trouble very quickly, being already put upon by the disease.

When a ferret begins showing symptoms of insulinoma, the showing of symptoms often means the disease has progressed to a level that critter is not able to manage on his/her own. In other words, critter might start having trouble keeping things on an even keel, so that's why you were able to notice. Starting a critter on meds should certainly help, but if critter has started to have trouble keeping everything regular and level, critter might well need additional support around the time of diagnosis. So if critter starts acting funny and you suspect insulinoma, a visit to the vet for a diagnosis and, if confirmed, a prescription for steroids is critical, but your immediate support for the critter is also very important to helping him get back to "normal."

We feel the most important thing to remember about insulinoma is that critter is going to have ups and downs as the disease progresses. Sometimes these "down spells" as we call them can be mild, but sometimes the spells can be quite severe and require lots of help from the hooman beans to get critter back up to speed! Here's our theory on what frequently causes a down spell for critter who's living a happy, regular life. Let's say critter wakes up in the morning and does his thing, but when it comes time for breakfast, he's feeling a bit tired and skips breakfast. No biggie for you and me, but for Mr. Insulinoma, he needs that food as fuel to help his body stay on the level. Then at lunchtime, our friend wakes up again. Now he's really tired, having skipped breakfast, so he decides not to get up at all. By dinnertime, critter is really feeling puny. But Mom's home, time to get up and say hello. In other words, you might not notice that critter has been skipping meals and getting himself into a down spell. Overnight, critter continues to be too sleepy to bother eating, so by morning he's really in trouble. Now add in another possible complication: enough skipped meals and critters can easily develop ulcers, which could make them REALLY not want to eat! But regardless if critter gets into ulcer trouble, simply skipping enough meals means there won't be enough fuel in the critter to keep glucose levels where they should be. Thus, by the middle of the next day, critter is having an episode and you're left thinking "where did all this trouble come from?" It's important to remember that down spells will happen even if critter is on meds and everything else in his life is normal. Also remember that meds will need to increase over time, as the disease progresses. So being prepared for a down spell is critical to helping critter manage this disease well.

If you find your critter in a serious down spell, you need to rouse him enough to start getting in some food. Rarely is kibble successful; rather, try some mushed kibble, plain chicken baby food with Nutrical or chicken gravy. If you've helped critter appreciate a mushie when he was healthy and fit so he thinks it's a treat, you should be in good shape. TLC is the way to help get a critter to eat when there are reasons he doesn't naturally want to. In the extreme, you'll need to force feed critter (see "Supportive Care: Feeding the Sick Ferret in the Health section of our web site). But most often you can help critter with tender loving care. Remember that some mushie is oh-so-much better from Momma's finger than from a bowl - and better still if Mom is singing to critter during the delivery! HA! You know what we mean. Getting enough nutrition into a critter who's gone into a down spell can take some time, so be patient. Remember that he's now in a deficit, so a few cc's of mushie isn't going to cut it. Shoot for frequent feedings, no matter how you cajole critter into eating. And it can take several days for critter to get back on his feet!

Don't forget that ferrets with insulinoma should not have any sugary treats. This includes fruits, cereals and most commercial treats. You don't want to give anything to the ferret that would cause the body to naturally release insulin to balance incoming sugar. High quality kibble, with high protein levels, is what a critter needs - going in regularly every few hours. Giving critter a raisin is invites the body to release insulin to balance the incoming sugar, which could lead to a dangerous drop in critters' glucose level. If you have a critter with a 5 raisin per day habit, consider switching him to a healthier snack using trickery! We started making "treat kibble" some years ago (see inset). Take some raisins and mix in a dish with a like amount of kibble. Close the dish and let stew for a few days. Then, instead of giving the raisin, give the pieces of kibble that have been hanging out with the raisins, soaking up the aroma. Viola, raisin scented kibble! Your critter might give you a funny look the first time you offer, but keep at it! J

If ever you're worried that your ferret has insulinoma, take critter to see an experienced ferret veterinarian right away. Better yet, don't wait until you're worried - start screening your critter(s) at age 3! We are definitely of the opinion that most ferrets will eventually develop at least a touch of insulinoma, not unlike the fact that if a hooman bean lives long enough, he will develop heart disease. Then as you help critter manage the disease, if ever he gets into a worrisome spell, do not hesitate to contact the shelter for help. We have quite the arsenal of support here at our place, since we have so many different critters to please!