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]