Insulinoma,Pancreatic Tumors & Hypoglycemia

by L. Vanessa Gruden

Insulinoma. Your vet may call it by a different name such as pancreatic tumors, hypoglycemia, or low blood sugar. But by any name, its symptoms include one or more of the following: “Staring” into space; staggering; drooling; deep, fainting spells; clenched teeth and “locked” jaws; moaning or crying aloud; or, in advanced seizure, screaming.

First: These symptoms are serious and require the attention of a veterinarian! This is not a condition you can treat without medical assistance and support. Nor will insulinoma go away. At best you can help manage it and postpone the worst effects. However, it is through careful management that we have had the best success maintaining an active, quality life for the shelter ferrets who have been diagnosed with this disease. It is not an imminent death sentence, however, it requires commitment and knowledge on your part.

Before talking treatment, it helps if you have a general understanding of how the disease operates. In it’s simplest sense, insulinoma is the reverse of diabetes. In diabetes, the body underproduces insulin. Treatment involves replacement with insulin injections.

Insulinoma is caused by tumors which grow attached to the pancreas – the organ that produces insulin. Those tumors interfere with the pancreas’ ability to regulate the insulin it produces and insulin is overproduced.

Excess insulin causes what are referred to as seizures. In the mildest form, it may appear as if your ferret is standing for several seconds staring, glassy-eyed, into space. Afterwards, everything appears normal again. As the disease advances, or as the blood sugar level drops, the severity of the symptoms progress. From “staring” to drooling, accompanied by a “spaced-out” look; to, in more advanced stages, a full-fledged seizure when you find the ferret stiff, and “lock-jawed.” In severely advanced cases (death is imminent without treatment), the ferret will be screaming and convulsing.

Normally, the body produces insulin as a response to the ingestion of sugar. Introduce sugar in your blood stream (a candy bar), and your body will respond with a shot of insulin into the blood stream to metabolize (use) the sugar. Insulin needs sugar and vice versa. If there is more insulin than is needed to deal with the sugar in the blood, it goes looking for more. The brain is a high energy user; there is always sugar there. If the amount of insulin is out of balance with the sugar in the bloodstream, it attacks the brain’s supply.

Now, do you think that if you kept your fuzzy on a sugar diet, the insulin would be taken care of? WRONG! The pancreas releases insulin in RESPONSE to sugar flooding the blood stream. So, overloading on sugar will cause the pancreas to overload the body with insulin. The result is a spiral, first flying up (like that sugar buzz you get after the candy), then crashing down. So, the trick is to keep a low, steady level of sugar in the system to keep that insulin busy.
Let’s next talk about sugar. Sugar is available from a number of food sources. There’s the old fashioned refined sugar. This is the easiest to digest and use. There’s dextrose, sucrose, fructose (fruit-based sugar) and many other “–oses.” You can find simple sugar in corn syrup which can be used to take a ferret out of an insulinoma seizure. Because it’s easy to digest, it works FAST. And with a seizure, you want to get that excess insulin working on the sugar you introduce into your ferret as quickly as possible. (We’ll talk about HOW a bit later). Other sugar-based products, like honey or molasses – the latter is an ingredient in NutriCal or FerretVite – are also easy-to-digest sugars.
So: If your ferret is seizuring you want to get them sugar quickly. That’s where you use corn syrup, honey or molasses and rub it into their gums (Do not FORCE food into an unconscious or semi-conscious animal!! They can choke!!). NOTE: If the ferret is in a screaming seizure, get to a vet ASAP and do not try to self-treat.

I would use no more than 1/4 to 3/8 teaspoon of syrup. That’s not a lot – much of it will smear the counter, the ferret’s chin, and you. But that’s about the maximum that will makes it down their throat. If the ferret is not completely out of it, dilute a bit with warm water and allow a few drops to dribble down their throats from a syringe.

It may take anywhere from 5 minutes to upwards of 45 minutes to work. Don’t keep forcing sugar. Give it a chance to work before you give more because you don’t want to cause a “crash” after they’ve recovered. Spiking their system up and down is dangerous—it causes the pancreas to work even harder to try to regulate the errant sugar in the body.

Now, to help AVOID a seizure once you know your pet has problems, you want to keep the insulin busy for as long a period as possible, never giving it a chance to go shooting into the brain. You accomplish that by feeding high quality, protein snacks.

Back to the food lesson: You can get protein from vegetable matter (an economical source is corn or soybean) or from MEAT. A ferret’s short digestive system does not utilize vegetable protein efficiently. This is why you are urged to feed your ferret high QUALITY protein from a meat, not vegetable source. For ferrets with insulinoma, pet foods with cornmeal as the first ingredient on the label are a poor choice to help control insulinoma.

It takes longer for the body to metabolize sugar derived from protein, which is bad if your ferret is in seizure. But which is good if you want a long-lasting, stable sugar in the body.

We have found many ferrets, as they age, either have gum problems or may forget to eat. They may not have full-blown insulinoma; rather, you are seeing the symptoms of low blood sugar (hypoglycemia). These animals may need a supplement to make sure they’ve eaten. Those with severe insulinoma should eat every 3 to 4 hours. The less severe the symptoms, the longer the ferret can go without an extra meal; you may only need to supplement once or twice a day.
For our shelter ferrets with insulinoma as well as for the old-timers who may not eat well, we supplement their usual food with “gruel” (sometimes called “duck soup”). Other options are chopped liver, cooked plain chicken, or the more palatable 1st or 2nd stage chicken human baby food. Warm it to room temperature, but be aware it could cause diarrhea.

The good news is that insulinoma can be controlled in many ferrets with food supplementation for quite a while. My attitude towards medications is to avoid them when possible. The cortosteroids used in treating insulinoma cause liver damage. When the animal needs the steroids to control the disease you have no choice, but however long you can reasonably delay their use, the better.

There are several drugs used to treat insulinoma. One treatment is with Prednisilone or with a dilution of liquid azium in distilled water. Our vet prescribes Azium (2 mg to 10 cc of water) which works well for us. We dose every twelve hours. They start with one drop and can go to three drops or more per dose.

The other drug that can be used is Proglycem (a human medication). It isn’t cheap; depending on your vet’s sources, it can cost up to $150 a bottle. But a bottle can last 2 to 3 months depending on the dose required to keep your ferret stabilized.
Part of the treatment problem with insulinoma is it’s random progression. Like any tumor, pancreatic tumors grow and react differently in each ferret. The only assurance you have is that it will progress. Which brings me to another alternative – surgery.

We’ve had poor luck with surgery. There is no denying that it works – for a time. But it is not a cure. The pancreatic tumors are very tiny. Surgery removes the visible tumors but microscopic ones remain and almost always grow to replace those removed. To my knowledge, no one has found a way to ensure all of the tumors are removed.

In most cases, insulinoma is diagnosed in older ferrets. Often, other medical conditions are also present in the ferret, making it very hard to justify the expenditure and risks of surgery.
Each animal and each person’s ability to provide care, along with your veterinarian’s advice, need to be factored into treatment decisions. Whatever the result may be, we hope this information will help you make informed decisions about your ferret’s care.

Simple Gruel Recipe:

  • Crush your pet’s regular dry kibble (a coffee grinder works great).
  • Add twice as much water, then microwave for 1-2 minutes, depending on quantity. Consistency should be like that of thick soup.
  • Allow to cool to comfortable temperature, but not too cold (test with finger).
  • Feed from syringe or off finger initially; ferrets normally learn to like it—a lot!
  • 2 oz. is a full meal for a ferret. This is equivalent to about 4 tablespoons or the small sauce cup you get in restaurants.
  • Refrigerate unused portions for reheating.