I have had ferrets that have had good quality life with insulinoma for 3 to 5 years. Generally, we wait for a year or so after the initial diagnosis before doing the first surgery. We monitor blood glucose levels at home with a glucometer (like diabetics use) during that time. Symptoms usually go into remission for a year or so after surgery. When symptoms recur we begin medication and we again wait for months before resorting to another surgery, IF the ferret is still a good surgical candidate at that time. (If adrenal tumor symptoms crop up, however, surgery is done immediately, as long as the ferret is otherwise medically stable. Insulinoma tumors are removed during the adrenal surgery.) The reason for waiting before surgery is that often, in the initial stages of insulinoma, many of the tumors on the pancreas are still microscopic and can't be seen to be removed. Even after months of waiting, there can still be microscopic tumors that will not be removed and will shorten the length of time that the ferret can go without daily medication. There's simply no way to know, and there's no way the vet can tell if they've all been removed. Insulinoma is not curable, but it IS very manageable. The number one, most critical issue is diet. The ferret MUST eat regularly, and the food MUST contain a high ANIMAL BASED protein. My recommendation for this is kibble & water soup or chicken baby food. (Kibble MUST be high in animal based protein. I recommend Totally Ferret, Superior Choice, or Eukanuba Kitten foods. There are no other ferret or cat foods that I recommend for insulinoma ferrets... and I've read just about every label of all the rest on the market. Other foods may be adequate for your other ferrets, but with insulinoma, every bite of food counts. The SOURCE of the protein percentage is what matters... NOT how high the number is! FERRETS CANNOT METABOLIZE VEGETABLE BASED PROTEINS like corn or soy.) If your vet has prescribed Carafate for your ferret, the vet very likely suspects the presence of stomach ulcers. For this ferret, I would feed a 100% diet of chicken baby food, not A/D (A/D is simply the veterinarian standard "sick critter" food). Baby food is more easily digested and very gentle on the stomach and MOST IMPORTANTLY; it is MORE of what a FERRET needs. A liquid vitamin could also be added to this. I would not give Ferretvite type vitamins due to the sugar content per dosage. Mix warmed chicken baby food with a little water until it's just watery enough to drop from a dropper. 10ml (or 10cc) every 3 hours is the absolute minimum amount. 15ml to 20ml is good. If you can't (or it's too stressful for the ferret) to get 10ml at once, give 5ml, then wait 10 to 15 minutes and give 5ml more. ALWAYS feed before leaving for work/school or bedtime. With a ferret on Carafate, I give the Carafate 15 minutes before feeding soup. In some cases I add 1/8th tablet of Zantac crushed in 0.5ml of water (or pedialyte) 30 minutes BEFORE the Carafate and feeding. Carafate must have an acidic stomach to work, so any antacid must be given at least 30 minutes before or after Carafate. This protocol covers both "upset stomach" bases and in many cases encourages the ferret to eat more. As long as the ferret is on Carafate I would not coax or allow more than 15ml at a time. Smaller and more frequent feedings will produce better and quicker results. Soup feedings can be reduced to morning and night AFTER the ferret has returned to normal eating routine of dry food. Ferrets with upset stomachs (low blood sugar symptom) or stomach pain (stomach ulcer symptom) will not eat voluntarily... especially when you're not there. When they don't eat enough animal based protein, blood glucose levels drop even farther. A 12-hour fast for these ferrets can induce seizures that can be fatal or can cause damage to other organs, eventually causing fatal organ failure. ALWAYS make sure they don't go longer than 8 hours without a 10ml feeding immediately before and after that 8-hour time span. With very weak ferrets, I get up once in the night for a small feeding. Seizures are to be avoided at all costs. They are most likely to occur after a prolonged period of not eating. Should you noticing drooling, stumbling, limpness, twitching, or jerking, immediately give no more than a teaspoon of watered syrup or honey. BE SURE the ferret is swallowing. Watch for the throat muscles to move slightly. If he won't swallow rub undiluted syrup on his gums, smearing between teeth. As soon as the ferret looks "almost" normal, give baby food soup or egg yolk. It is IMPERATIVE to follow the syrup with the protein food. The syrup elevates blood sugar quickly, usually within 10 to 15 minutes, but it will let blood sugar levels "crash" even lower if the "immediate" sugar (from the syrup) is not replaced with sugar metabolized from an animal protein food. As soon as you've given the protein food, call your vet. Don't waste critical time calling the vet before giving syrup. Don't second guess yourself with questions like "Is this really a seizure or episode?" Better safe than sorry. A dose of unnecessary sugar won't kill your ferret... hypoglycemic shock will. Seconds count. The sooner the hypoglycemic shock episode is stopped, the less damage is done to the ferret's organs. THERE'S NOTHING THE VET CAN TELL YOU THAT WILL HELP MORE THAN THE SYRUP! You can't get to the vet's office soon enough to help MORE than giving the syrup. That's the number one thing you've GOT to keep telling yourself while you're having a panic attack. SYRUP FIRST... everything else will wait. Normally, diet and medication WILL prevent seizures. Ferrets tolerate steroids (like Pred) much better than humans. Don't be afraid to increase the dosage (no more than 0.25ml increments for a week at a time) if activity level and appetite is not improving toward normal. Pred dosage for insulinoma ferrets is NOT an exact science. It's far, far better to give too much than too little. Once good activity, appetite and stable blood glucose levels are attained for two months, you can try lowering the dosage (again in increments of no more than 0.25ml for at least a week at a time) to see if activity, appetite, and glucose levels will remain stable with a lowered dosage. But FIRST get her stable & stronger with the higher dosage. Later on in the progress of the illness and when surgery is no longer a viable option, it's sometimes necessary to add Proglycem to the pred to maintain prevention of symptoms and good quality of life. A few more DONT'S specific to insulinoma ferrets ONLY: Don't give Brewer's Yeast or Chromium, or feed foods containing it. Avoid anything with ingredients ending in "ose" (dextrose, lactose, etc.) "ose" = sugar. Don't overlook "unusually sleepy" behavior. It's usually an advance sign of an episode. Feel free to print this out and discuss it with your vet. Your vet may want to modify dosage recommendations or issue additional cautions due to factors that I am not aware of. This advice is NOT a substitute for veterinary care. Please see the article on supportive care for help with feeding techniques and diet care for insulinoma ferrets at http://www.geocities.com/ferretsfirst/feeding.html Debi Christy Ferrets First Foster Home Practical & easy training, care, & maintenance articles available at http://www.geocities.com/ferretsfirst/ [Posted in FML issue 3671]