|Understanding Insulinoma||Dealing with a Seizure|
|Diet to Avoid Seizures||Treatment Options & (See note above)|
Nothing is surer to cause terror in the heart of a ferret owner than the diagnosis: 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 almost always 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 and foremost! Any of these symptoms are serious and require the attention of a veterinarian! Insulinoma is not a condition you can treat without medical assistance and support. Nor will insulinoma go away. It has never shown itself to be curable, either. At best you can help manage it and postpone the worst of its effects. However, it is through careful management that we have had the greatest of luck in maintaining a prolonged and active, quality life for the shelter fosters who have been diagnosed with this disease. So, do not consider it an imminent death sentence! It will, however, require effort and understanding on your part and a consistent commitment.
Before talking treatment, though, it helps if you have a general understanding of the disease and how it operates. This will be overly simplistic and naive, but I think it helps convey what you and the ferret are dealing with.
In it's simplest sense, insulinoma is the REVERSE of diabetes. In diabetes (human, or ferret), the body underproduces insulin. Treatment involves insulin replacement therapy - that is, 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. When insulin is produced, it is OVERPRODUCED. It is the excess of insulin which causes what are referred to as seizures. In the mildest form, it may appear as if your ferret is standing or sitting in suspended animation for several seconds staring, glassy-eyed into space. After those few moments, everything appears normal again. As the disease advances, or as the blood sugar level drops, the severity of the symptoms progress. From "staring" to slight or prolific drooling accompanied by a "spaced-out" look; to, in it's more advanced stages, a full-fledged seizure when you find the ferret cold, stiff, and "lock-jawed." In rarer, but severely advanced -- death is imminent without treatment -- cases, the ferret will be screaming or convulsively twitching.
Normally, the body produces insulin as a response the ingestion of sugar. Introduce sugar in your blood stream (the late afternoon 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, it goes "looking" for sugar. The brain is a high energy user. There is always sugar there. If the amount of insulin is out of balance to deal with the sugar just eaten, it "attacks" the brain's sugar supply. That's why if your ferret hasn't eaten, it can experience a "seizure."
Now, just reading that you'd 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 (high levels of activity - just like the slight, sugar "buzz" you get after eating a candy bar), then crashing down - which is what happens if you overdose on sugar - some people almost experience the equivalent of a hangover!
So - the trick is to keep a low, steady level of "sugar" in the system. In other words, let's keep that insulin busy! Let's next talk about "sugar."
Sugar is available from a number of food sources. There's the good, old fashioned, right out of the sugar bowl, refined, sugar. This is the easiest to digest and use sugar. There's dextrose, sucrose, fructose (fruit-based sugar) and many other "--oses." You can find simple sugar in corn syrup which is the "standard" prescribed treatment to take a ferret out of an insulinoma seizure. And with good reason. 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 to give them the syrup a bit later). Other sugar-based products, like honey or molasses - the later is an ingredient in NutriCal or NutriStat - are also easy-to-digest sugars.
There are other kinds of sugar that have various levels of digestibility - how easy or hard it is for the body to metabolize. Your body can metabolize sugar from PROTEIN. But it takes longer for the body to use sugar taken from protein, which is bad if your ferret is in seizure. But which is good if you want the sugar to last as long as possible.
So - to tie the food discussion together.
If your ferret is seizuring - from the blank stare kind of seizure to the very serious clenched teeth or screaming seizure - 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!!). But you don't want to use TOO much, or you will spike them as they come out of seizure.
I would use no more than 1/4 - 3/8 teaspoon of syrup. That doesn't sound like a lot, and I've gooed the counter and the ferret's chin with far more than that! But that is the maximum that ever makes it down their throat. Normally, I will dilute it with warm water, and then rub into the gums or, if the ferret is NOT completely out of it, I will allow a few drops to dribble down their throats from a plastic syringe.
It takes awhile for it to work. With some ferrets it can take just 4 or 5 minutes - with others in deep seizure, I've seen it take upwards of 45 minutes. Don't keep forcing sugar. Give it a chance to work before you give more because you don't want to cause them to "crash" after they've recovered.
Spiking their system up and down it not good for them and only causes the pancreas to work even harder to try to regulate the errant sugar in the body. Resist the temptation to overdo it!
Now, to help AVOID a seizure, what you want is to keep the insulin busy for as long a period as possible, never giving it a chance to go shooting into the brain to run riot. You keep the insulin "busy" by feeding high quality, protein snacks. Back to the food lesson.
You can get protein from vegetable matter (an economical source is corn or the infamous soybean); or from MEAT. Ferret's short little digestive system is not evolved enough (nor is food in them long enough) to utilize vegetable protein efficiently or very well. So, it basically goes in one end and out the other not very well broken down. This is why you are urged to feed your ferret high QUALITY protein - from a meat, not a vegetable source.
For ferrets with insulinoma, the pet foods with corn (in any form) as the first ingredient on the label, is a poor choice to help control insulinoma. They may even do harm as many inexpensive foods add sugar to encourage pets to eat them (as we all know, ferrets are infamous sugar-junkies!) Few of us have ferrets that will eat a little chopped liver or cooked chicken, however, many will grow accustomed to the taste (and texture) of chicken formulated for human babies with some patient pampering. First or second stage formulas, warmed to above room temperature and made soupy with water (or unsalted chicken broth) seem to work best.
What we have found is that many ferrets, as they age, either have gum problems (how many of you brush your ferret's teeth?), or are sometimes too tired (lazy, bored) to get up and walk over to their food bowl. Occasionally, these ferrets may not have "full-blown" insulinoma. Rather, you are seeing the symptoms of low blood sugar brought on because they "forgot" to eat. Or, as in one case I experienced, the ferret got stuck in a closet for 8 hours, and did not have access to it's food bowl. She experienced a mild seizure, and, while on watch for further signs of insulinoma, has thus far been symptom-free for the past six months (though I feel like a heel!)
Ideally, they should be fed every 3 to 4 hours. However, as most of us have to work daily, more realistically, they can be fed every 6 to 8 (or 10) hours. The less severe the symptoms, usually the longer the ferret can go without their "snack."
For the shelter ferrets with insulinoma, as well as for the old-timers who are notorious about not eating well, we supplement their usual food with "gruel" (sometimes called, "duck soup"). This is the nuked (microwaved), ground food with a touch of Sustacal or Ensure for flavor discussed in earlier issues of Paw Printz. For severe insulinoma cases like our former foster-son and club mascot, Put-Put, we fed jarred, human baby chicken with warm water and a small shot of Ensure. (yes, the food supplements have sugar, but no one would eat their food without something sweet in it). We "tricked" them but starting them on a higher percentage of the Sustacal/Ensure in their food and slowly cut back to their lowest tolerance level. (We feed at 5 a.m.; 8:30 a.m.; 5 p.m.; and 10:30 p.m. weekdays. Weekends, we are able to feed later in the morning or early afternoon.)
The really good news is that the disease can be controlled in many ferrets for varying amounts of time with no medication! Some have gone for a few weeks, while others have gone for several months without medication being required.
My attitude towards medications is to avoid them when possible. The cortosteroids used in treating insulinoma cause liver damage. Unfortunately, when the animal needs the steroids to control the disease, you have no choice. However, however long you can reasonably delay their use, the better.
Now, what about medications? Not everyone will be able to feed their ferret every 6 to 8 hours. Or, diet alone may no longer work.
There are several drugs used to treat insulinoma. The early treatment is with Prednisone (usually as PediaPred - a children's liquid version of the drug which is FAR EASIER to dose than in pill form!); or, with a dilution of liquid azium in distilled water. Our vet prescribes azium (2 mg to 10 cc of distilled water) which works well for us. It works quicker than pred, though it may not be as tolerant of delays. We dose twice a day - every twelve hours. They start with one drop and can go to three drops per dose.
The other drug that can be used is Proglycem. The problem for many people with this
medication is its price. Depending on your vet's sources, it can cost anywhere from $110 to $150 a bottle. The price keeps increasing (apparently, while known in humans, insulinomas are rarer in humans than diabetes, thus the high price of the drug.). While expensive, a bottle lasts 2 to 3 months depending on the dose required to keep your ferret stabilized.
Part of the treatment problem with insulinoma, in our experience, is it's randomness in progressing. There is no set pattern that says - well, your ferret has one month or ten months after diagnosis. 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 the other alternative - surgery.
To be honest, we've had poor luck with this alternative. (See note above) There is no denying that it works - for a time. But, again, it is not a cure. So you are faced, like with the food and medication, with treating the symptoms, not curing the disease. The tumors are very tiny. Surgically, the visible tumors are removed. The problem is that microscopic tumors remain and almost always grow - in varying amounts of time, to replace the removed tumors. So far, to my knowledge, no one has found a way to ensure all of the tumors are removed.
In many cases, insulinoma in the shelter ferrets has been diagnosed at the age of 5 or 6 years. It is very hard for us to justify the expenditure for surgery for the roughly 10 animals we get each year who are eventually diagnosed with the disease while they are fostered with FACT. Not when the other alternatives (food and medication) exist and seem to work so well for us.
We have, thus far, only lost one ferret in the shelter to the ravages of the disease itself (she went into a seizure that could not be brought under control). The others died of other illnesses (usually kidney or liver failure) before the insulinoma progressed to the point of fatality. That may just be our experience, and I'd welcome other shelter's sharing their experiences.
So far I have been spared facing insulinoma with one of our personal ferrets. But the law of averages will eventually get to me, I know. And I do not know what my reaction will be. I suspect the ferret's age and general health will have to be factored in to my treatment decisions along with the advice of our vet.