Whether you have many ferrets, or just a few, I believe you will find
it worthwhile to acquire a blood glucose (bg) monitoring system.
Insulinoma is found in ferrets as young as two years of age, according
to one veterinary website. The meters are usually pretty affordable
(Freestyle is $39.00 + tax after a $40.00 rebate at Walgreen's),
however, it is the strips you use with them that will be the ongoing
expense. Freestyle strips come in a vial of 50 usually for under $1.00
per strip. Both meters and strips are sold on eBay. Shop around for the
best buy.

There is a meter available that is designed for animal use, and can be
ordered from your vet, however I have never used one, and do not know
anything about them.

Knowing how to use your own meter makes it affordable to check the
progression of Insulinoma, and how your ferret is reacting to his meds.
I suggest you purchase a good meter, them familiarize yourself with it
and learn to use it by carefully reading the manual. Practice on
yourself.

Next, take your ferrets -and your meter- to the vet for a blood glucose
check. Get a good reliable baseline, so you can safely monitor them
between vet visits. This way, you can compare readings on your meter to
your veterinarian's equipment. Adjust your reading by that difference
when recording your readings.

The goal is not to replace vet care, but to further monitor you
ferret's care. I take my meter with me when my ferrets see the vet.
Whenever a blood sample is drawn, I check my meter against my vet's
equipment. My meter consistently reads about 10 points below my vet's
equipment. Therefore, I add 10 points to any reading I get. Perfect?
Maybe not, but a lot better than knowing nothing.

Many of my ferrets get bg checks late in the day or during the weekend
when a vet isn't available (usually when I have the most time or one
is symptomatic), and if you know what their blood sugar level is,
additional meds can be administered -or withheld- in an emergency until
a phone consultation is available. Ask your vet what he would want you
to do in such a situation, and write it in your ferret's file. If you
get a reading that is unusually high or low, wipe the pad clean and
re-test. (could they have stepped in something sweet?) If you need to
make an emergency adjustment, call your vet once the office opens.
Every ferret should have their own file with their medical history
documented in it!

There are many sites available that explain Insulinoma so well, I'm not
going to go into that here. The Miamiferret website (link below) has
several good sources of information listed under the Insulinoma pages.
Please pay particular attention to the comments by Dr. Williams below
the recipe on the Insulinoma Elixir page.

http://www.miamiferret.org/fhc/

This web page has a good write up on Insulinoma. Bear in mind,
different resources may state different cut off levels to diagnose
insulinoma. That isn't as important as getting your ferret checked by
a vet, and treating them accordingly. One ferret may drool at 75 but
another might not drool until its blood glucose level is dangerously
low, in the 30's. If I see symptoms, we treat the ferret accordingly.

http://www.ferretfacts.com/insulinoma1.html

One rather interesting site is below, and also shows surgery images of
a pancreatic nodule. If you find these images troublesome, you can read
the information and skip the surgery photos. The site has taken that
into consideration. I will say, I don't agree with giving ferrets
Nutrical as a treat to distract when they take a blood sample since
I highly suspect it contains sugar. Other similar supplements do.
Other than that, the site has some good, basic information.

http://www.lbah.com/ferrets/insulinoma.htm

There are a number of sites that give excellent instructions for
testing your ferret's blood glucose level. Here are a couple that
are available:

http://www.unc.edu/~pjdutche/bloodsugar/

http://www.ferret-universe.com/health/home_glucose.asp

Some extra tips that have helped me over the years include:

* keep a record of each ferret's bg readings and the date taken. I also
note what dose of prednisilone or prednisone (pred) the ferret was on
at that time.

* fasting blood glucose numbers are lower than non-fasting. When you
record your reading, note if it was fasting or non-fasting. You may
later need this information to help your vet provide the best medical
care for your ferret.

* be sure to keep enough Ferretone on their belly to distract them.
Never use a sugar based treat as sugar will enter their bloodstream
rapidly, artificially raising your reading.

* you can increase blood flow to the foot/pad you are going to take
your sample from by gently rubbing the foot.

* I have a fresh lancet in the holder and ready to use, and a fresh
strip in the meter ready to finish pushing it in for use. I get the
ferret out, lay him on a small blanket on my lap, give their treat and
prick the pad. I then push the strip in to start the meter. I then
re-focus on the pricked pad, gently squeezing the toe to help working
with the bead until I can touch the meter to the drop of blood.

* if I want a fasting bg, I try to pull the ferret out of it's sleepy
sack after a long nap. Personally, if it has been three hours since an
insulinomic ferret has eaten, I consider it a fasting glucose. Pulling
them out of their sleepy sack also assures warm feet which will give up
a drop of blood better. If they are asleep in a hammock, their feet can
still be chilly -lay a little blanket over them the last hour before
you want to take them out. Don't attempt to get a bg reading after the
ferret has been running around. Those little paws are just too cold to
give up a drop of blood!

* if you fear your ferret is in a crisis, administer the honey, Karo,
or whatever you use, to their gums. A Q-tip works well to keep from
being injured. Stabilize your ferret first. If you need to get a sample
of blood to check, but the ferret has cold feet, you can hold the
ferret's leg/paw you intend to get your sample from under very warm tap
water about a minute to help blood flow. Be sure it's not hot enough to
be uncomfortable for the ferret. Dry the leg/paw and proceed to check
its blood sugar level.

* you can increase blood flow to the foot/pad you are going to take
your sample from by gently rubbing the foot.

* If you are having trouble getting a sample, you can increase the
depth the lancet will puncture by lifting the lancet higher in the
holder and putting the cap back on. The cap will only let the lancet
go out 'just so far'. Paw pads can be very thick, and you need to
pierce through the callous. I have found some ferrets need to have a
deeper puncture to get a sample than others. Their pad won't bleed
uncontrollably by doing so. I have also very gently filed some of the
callous from the pad with an Emery board. Be sure not to file too much
off. You can tell when the pad is severely calloused by the rough, dry,
yellow, dead appearance of the skin versus the soft pinkish color a
ferret's paw pads will normally be.

* another thing that can make getting a sample easier is to use the
trick Pam mentions, using a thin coating of Vaseline on the pad to help
the blood bead better. Be sure to wipe off any excess. I have also
found, with some ferrets, trimming longer fur away around the toe will
prevent it from breaking the bead's surface tension thus losing the
sample. Finger nail or embroidery scissors work well for this. (Use a
distraction. They won't care.)

* if your ferret is consistently exhibiting low blood glucose symptoms
before their next dose of pred, ask your vet about switching to an 8
hour dosing schedule versus twice a day. This has helped give a lot of
ferrets additional quality time. Ferrets metabolize various medications
at different rates than other species. Some meds are metabolized
faster, like PercortenV which is used to prevent Addison's, but aspirin
is metabolized more slowly and needs to be carefully given under a
vet's care to prevent accidental overdose.

* it will be more difficult to get a sample if your ferret is
dehydrated. Make sure the ferret has had enough fluids (subQ if
necessary). If the ferret will accept soup, you can get more fluids
into them by watering their food down a bit for the feeding prior to
when you want to check their blood sugar. One of my ferrets is on
furosemide (Lasix) for an enlarged heart. My vet prescribed a small
dose of furosemide to reduce blood volume, hopefully relieving some of
the strain on his heart, and decreasing pressure on his trachea. (it
worked for about a month before he developed a wet cough) If furosemide
reduces blood volume, and your ferret is on this drug for heart issues,
it might be beneficial to try to test his blood glucose just prior to
his next dosing so there is more blood volume.

* prednisilone/prednisone is not a good drug to be used for ferrets
diagnosed with Cardiomyopathy, however, it must be given to control
Insulinoma using the lowest dose possible. Pred can cause fluid
retention, so the addition of or adjustment to your ferret's furosemide
(Lasix) dose may be necessary to help rid their body of additional
retained fluid. Consult your vet. However, somewhere I read that
uncontrolled Insulinoma may cause or worsen heart conditions. Both can
be treated and controlled under the guidance of your vet. When multiple
disease processes are present, it becomes a balancing act. Each day is
a gift.

* ferrets have a higher packed cell volume (more red blood cells in a
volume of blood) than humans. These bg meters are designed for human
blood. If your ferrets blood is too thick, the strip may have trouble
pulling the sample into the meter. Dehydration can make this problem
worse.

* sometimes, if it takes too long for a bead of blood to raise, a
'skin' will form on the bead, making it impossible for the strip to
pull the sample in. Hospitals will swipe the puncture with alcohol to
get the area to bleed (on a baby's heel) then continue to squeeze to
take the sample. Since they were collecting blood for a glucose test, I
can only assume this would work for a ferret, too. I admit I have not
tried this myself for a ferret blood glucose test.

* ferrets with kidney failure battle dehydration. They take in plenty
of fluids, but the kidneys have lost the ability to retain it and it's
just flushed right out. They will have very wet litter boxes. It may be
more difficult to get a sample from a ferret in kidney failure. Work
closely with your vet.

* there is a difference between Prednisone and Prednisilone.
Prednisilone is gentler on the liver and would be my preferred
medication. The generic liquid form is very affordable and simple
to adjust doses with. Pills can be crushed and mixed with water.

If you monitor your ferret's blood sugar routinely, and take them to
the vet when you see they need a medication adjustment, you may never
find your ferret in a low blood sugar crisis. What 'routinely' means,
can be different for each ferret.

New, improved blood glucose meters are introduced all the time. If you
have a friend or relative that is diabetic and uses a meter, let them
know that you could use their older meter if they get a new one and
plan to discard the meter they currently use. Tell them why you want
one, and why it is so important. Any diabetic is well aware of the
danger of a low blood sugar episode and will likely be happy to pass
their older model on to help you. Make sure it doesn't require too
large of a sample to function.

My personal favorite has been the Freestyle. It takes a very small
sample size, and the Freestyle Flash requires even less. I can get a
blood glucose reading with a bead of blood the size of a pin head on a
paw pad -I've had no success with the tail. I've used this meter for
probably six years now, with little to no problems with it. Read the
manual for whatever meter you get and understand calibration and the
need to set it to the right lot number on each new vial of strips. I
don't have much knowledge of other systems. Maybe those using other
systems could offer some help for their brand of meter.

Finally, remember, Insulinoma is a progressive illness. For some
ferrets, it will progress rapidly. For others, they may seldom need an
adjustment in medication. The key is knowing exactly what each ferret
needs, and providing it. I advocate surgery early in the disease
process as it's believed there is a greater likelihood of developing
diabetes when surgery is done on a ferret that has had long standing
Insulinoma. I have seen this, myself, although my surgically induced
diabetes cases resolved within days to weeks. Not all ferrets are so
lucky.

Thank you to Linda Iroff for jogging my brain and Kim Fox for her
questions. I hope I have answered most of them.

Julie

Julie Fossa 
West Central Ohio Ferret Shelter
http://www.wcofs.org
International Ferret Congress
http://ferretcongress.org/

[Posted in FML 5509]