Signs of insulinoma include general weakness, collapse, mouth-pawing,
disorientation, tremors, weight loss, vomiting, rear-end paralysis
(paresis), sluggish or depressed behavior (lethargy), drooling (ptyalism or
hypersalivation), seizures, clumsiness (ataxia), poor body condition, and
occasional hair loss (alopecia)--although the hair loss is often due to
the ferret also having adrenal disease.  Often, there is an associated
increase in the size of the spleen (splenomegaly).  These symptoms are
often infrequent (episodic) or minor, so the inital problem is often missed
by the owner until the disease becomes serious.  This delay in diagnosis
will effect the long-term survival of the ferret; in this disease, the
sooner the treatment, the better the results.  Other diseases which can
mimic the symptoms of insulinoma include starvation, systemic infections
(sepsis) and liver disease (hepatic disease).
 
Insulinoma can be diagnosed by response to treatment of hypoglycemia, blood
work (4-6 hr fasting blood sugar level and insulin level), sometimes with
ultrasound, and the direct confirmation of tumors in the pancreas during
surgery.  Since many factors can cause hypoglycemia, the blood tests may be
marginal, and the ultrasound can be inconclusive, by far the best way to
confirm a diagnosis of insulinoma is by surgery, which, coincidentally, is
also the best treatment.  The disease is caused by tumors in the pancreas,
and they usually only affect that organ, although they have been reported
to invade the liver, kidneys, spleen and lymph nodes of some animals.  The
tumors are sometimes reported to be a hyperplasia (increase of the
glandular tissue) or adenoma (benign tumor), although they are frequently
reported to be carcinomas (malignant tumors).  Because the exact cause can
only be identified in the laboratory, surgery is the only effective way of
insuring your ferret doesn't have a fatal carcinoma that can spread to
other organs.
 
Even so, insulinoma is basically uncurable and most often terminal.  Like
diabetes, this is a life-disease; one that the ferret will have the rest
of its life.  By far, the treatment of choice is surgery, but it is rarely
a permanent cure, and many times does not stop the hypoglycemia.
Non-surgical treatments only makes the symptoms tolerable to a degree;
they do not cure the condition.  Medical treatment includes drug therapy
(prednisone, diazoxide or octeotride) and diet (high-quality animal
protein).  Prednisone is usually the drug of choice.  In some cases, a
combination of prednisone and diazoxide is given.  Dietary treatment
includes the frequent feeding of high-quality animal proteins and the
exclusion of low-quality kibble-based diets, canine and feline semi-moist
diets and complex sugars (disaccharides: lactose, maltose, sucrose).  Sugar
is avoided because it stimulates the production of insulin.  Some anecdotal
evidence suggests brewer's yeast has helped, but no scientific evidence to
support this observation have been reported.  Once diagnosed, the reported
average life span of the ferret is about 10 months, but many ferrets with
minor insulinoma have lived years.
 
The only effective emergency treatment for ferret owners is to introduce
simple sugars, primarily glucose (a monosaccharide) to counteract the high
levels of insulin and offset the hypoglycemia.  This can be done with Karo
syrup or honey; use a q-tip (to minimize accidental bites during muscle
tremors or seizures) to rub it on the gums or around the tongue.  You can
also keep on hand a honey-water mixture and allow the ferret to lick it at
the initial onset of symptoms, but do not give the water mixture if the
ferret is unable to drink on its own.  In minor cases, this will reverse
the symptoms.  Remember, the problem is low blood sugar and high insulin
levels; simple sugars are the cure.  Complex sugars need to be broken
down by digestive enzymes before they can be used by the body, and so are
useless in hypoglycemic emergencies.  In moderate cases (those that take
some time to reverse) or severe cases (those that do not reverse), you
should see a vet immediately for advanced treatment.
 
What causes insulinoma?  That's the million dollar question.  Little has
been reported and there is no proven prevailing wisdom as to the cause.
Ideas include genetic predisposition, genetic mutation, diet, virus, or
some unknown environmental agent.  I reject genetic mutation (I do not
disregard a genetic predisposition, which probably exists) because the
disease tracks kibble use; that is, those countries feeding ferrets high
amounts of kibble also have high incidences of insulinoma.  While some
might argue American breeding practices have bred insulinoma, there is no
proof of that at all.  Keeping Occam's Razor in mind, the simplest answer
is environment, and the simplest environmental answer is diet because it
is the one thing that is most similar between all USA cases.  The home
environments may differ, but most use some sort of grain-heavy kibble.
So, what about kibble would cause insulinoma?
 
End of part 2. Part 3 follows. [Will probably follow tomorrow.  BIG]
 
Bob C and 19 Mo' Primary Sockivores
[Posted in FML issue 2643]