A blood glucose level of 20 is extremely low, and a very powerful indication of insulinoma. Insulinoma is caused by a tumor (or tumors) on the pancreas, which causes an over production of insulin. The results can be deadly. The best treatment so far, is to surgically remove the tumors and a portion of the pancreas as well. We just had one who had 1/3 of the pancreas removed during a second operation for insulinoma. One-third was also removed during the first operation. It is usually not a complete cure. The surgery will prolong the life and the quality of life. I believe the average life is over 420 days or so (with medication) after the surgery; but I know of ferrets alive after 2 years. Treating the disease strictly with medication such as pedipred, will relieve the symptoms for a while, but surgery is usually the very best option. Dick B. - not a vet [Posted in FML issue 2112]