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 Prednisone to treat Insulinoma led to Diabetes
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BinderGang

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Prednisone to treat Insulinoma led to Diabetes - Friday, September 04, 2009 2:44 PM
Hi all,

This is my first time posting on any Ferret forum. I felt I needed to hear if this has happened to anyone else and what did you do.

First off, I found a great Ferret vet in Long Island. The beggining of the month, my ferret went into one of those low-blood sugar shocks, drooling, mouth open and I rushed him in to the vet. He was diagnosed with Insulinoma and given Lupron shots and I was to give him Prednisone twice a day. We arrived home and that day he was back to normal. Everything was great.

Fast forward about 3 weeks and I notice he's losing a bit of weight, not eating as much and acting weak. So this past Tuesday I took him back to the vet.

The treatment for the Insulinoma brought his blood sugar up back to normal...and than way past it. He no longer had low blood sugar, but very high blood sugar. He has become diabetic. He lost a good deal of weight. The tumors, however, did shrink due to the Insulinoma.

The vet suggested not to give up yet and we're weening him off the Prednisone (1/4 of what he had previously per day, every other day) and feeding him a high protein diet. This, hopefully, is supposed to bring everything back down to normal.

He's eating now (not yet on his own, but licks it up while we feed him), but he's still very weak. I'm nervous because I'm in the same mind frame where after that first vet visit he was back in action that afternoon, where as this time around it's 3 days later and not too much has changed.

I've searched online and the only thing I could find is how diabetes is a 'rare' side effect in ferrets being treated for Insulinoma. Not many people talking about an actual happening. I would love to hear from any of you if you have experience. Thanks!
Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Friday, September 04, 2009 3:45 PM
diabetes is rare in ferrets...
 
Do you know why the vet gave lupron?  Lupron is used to treat adrenal disease, not insulinoma.
 
What was the BG at the time of the first visit? what was it at the second visit?  What doseage of pred are you giving?
 
Are you sure it was insulinoma the first time?  BG can read low for many reasons.  If they are sick, dehydrated, catch a bug, havent' eaten.  Was the episode a complete surprise?  Was he fine one day, and having a seizure the next?
BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Friday, September 04, 2009 3:59 PM
Snapper13


diabetes is rare in ferrets...

Do you know why the vet gave lupron?  Lupron is used to treat adrenal disease, not insulinoma.

What was the BG at the time of the first visit? what was it at the second visit?  What doseage of pred are you giving?

Are you sure it was insulinoma the first time?  BG can read low for many reasons.  If they are sick, dehydrated, catch a bug, havent' eaten.  Was the episode a complete surprise?  Was he fine one day, and having a seizure the next?


I'm not sure about the Lupron. Or the BG. I know the second time, it was VERY high. Around 4 times higher than the norm.

The dosage of Pred was 1ML twice a day, every day. He had that for a month. Now it's .5 once a day, every other day, just to ween him off and than stop it all together.

The episode was a complete surprise and he was fine one day and having a seizure the next. However, the x-ray's showed tumors on the pancrease. After the first time treatment (Lupron shot and Prednisone), he was doing great for the first few weeks. War dance, running around like it never happened. The prednisone even shrunk the tumors.

I really, really appreciate your interest and any help or encouraging words you have to offer.
Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Friday, September 04, 2009 5:49 PM
are you sure you are giving 1ml twice a day?  Or is it 0.1ml(cc) twice a day.
 
On the weaker pred (1mg/ml) amount, we've never given more than 0.35cc twice a day.  When we moved to the higher strength (5mg/ml) we were giving 0.07cc twice a day.  (yes, I wrote that right, 0.07cc twice  day)
 
1cc is a HUGE dose.  even 0.5cc is a large amount.
 
I somehow wonder if the large dose is what is causing his diabetes.
BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Friday, September 04, 2009 6:39 PM
Snapper13


are you sure you are giving 1ml twice a day?  Or is it 0.1ml(cc) twice a day.

On the weaker pred (1mg/ml) amount, we've never given more than 0.35cc twice a day.  When we moved to the higher strength (5mg/ml) we were giving 0.07cc twice a day.  (yes, I wrote that right, 0.07cc twice  day)

1cc is a HUGE dose.  even 0.5cc is a large amount.

I somehow wonder if the large dose is what is causing his diabetes.



I am positive, I'm even reading it off the Prednisone bottle to even double check. It was 1.0cc twice daily. Now it's .50cc once a day, every other day.

The bottle of Prednisone says Prednisone Solution 15 mL.
Ferrets4

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Re:Prednisone to treat Insulinoma led to Diabetes - Friday, September 04, 2009 10:57 PM
Unfortunately steroids can cause temporary (usually) diabetes, it happens in ferrets and cats a lot. Usually insulinoma and adrenal problems go hand in hand  so possibly thats why he was treated with lupron. I have a spontaneous diabetic ferret, no steroid use, no tumors that could be found although I suspect a glucogonoma which is also a tumor of the pancreas but of the beta cells instead of the alpha cells as is seen in insulinoma. They can happen concurrently, a ferret can have both, one tumor excretes excess insulin and the other excretes glucogon which dramatically raises the blood glucose.
I hope the diabetes corrects itself once the steroid use is over, its very possible, they also can have transcient diabetes after pancreatic surgeries for insulinoma, all in all a complicated and serious problem.
Pippin has been seriously diabetic now since January and we are trying to control it with insulin and diet,  make sure no carbs are in the diet, protein only meals such as chicken soup and as few carbs in the kibble as you can manage, carbs are the enemy of both conditions.

    
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BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Friday, September 04, 2009 11:25 PM
Ferrets4


Unfortunately steroids can cause temporary (usually) diabetes, it happens in ferrets and cats a lot. Usually insulinoma and adrenal problems go hand in hand  so possibly thats why he was treated with lupron. I have a spontaneous diabetic ferret, no steroid use, no tumors that could be found although I suspect a glucogonoma which is also a tumor of the pancreas but of the beta cells instead of the alpha cells as is seen in insulinoma. They can happen concurrently, a ferret can have both, one tumor excretes excess insulin and the other excretes glucogon which dramatically raises the blood glucose.
I hope the diabetes corrects itself once the steroid use is over, its very possible, they also can have transcient diabetes after pancreatic surgeries for insulinoma, all in all a complicated and serious problem.
Pippin has been seriously diabetic now since January and we are trying to control it with insulin and diet,  make sure no carbs are in the diet, protein only meals such as chicken soup and as few carbs in the kibble as you can manage, carbs are the enemy of both conditions.



Thank you so much for your response. He has not had any pancreatic surgery. He was too old by the time he had the issue for any surgical procedure.

Have you had any experience with the weakness related to this and how long (usually) it would take to get back to "as close as normal" as possible?

In terms of food we've been feeding him canned food the vet had given called "Hill's Prescription Diet: a/d" mixed with water so it goes through the feeder we feed him with.
Ferrets4

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Re:Prednisone to treat Insulinoma led to Diabetes - Saturday, September 05, 2009 1:42 AM
A/D is good, and contains what he needs, ideally finding something he will eat on his own would be best, so you wouldnt have to force feed. I am so thankful I had gotten Pippin used to eating soup before he got sick, it made such a difference to him when he needed to eat it to survive, he digs in every single time I offer it and thats a blessing.
Try offering the A/D on your finger, most ferrets love being finger fed and it gets them started enjoying it on their own too. I also offer a mix of oil in small amounts, I mix 1/3 ferretone, 1/3 sunflower oil and 1/3 virgin olive oil,  fats dont affect their blood glucose but do add calories and are good for the coat and digestion ( it will give some loose stools in larger quantities).
Diabetes causes dehydration as well as the body tries to excrete the excess glucose in the urine so make sure he gets lots of fluids orally, as much as he will take. I dilute Pips soup with water every meal so he gets as much as I can get in him. Warming the food slightly makes it smell and taste much more appetizing as well.
If the high BG continues you might consider discussing with his vet about starting him on small doses of insulin to keep it down below the renal threshold until his pancreas begins to function again. Insulin use requires constant monitoring though but can help them feel much better.
    
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Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Saturday, September 05, 2009 11:21 AM
If you have access to it, look into canned feline EVO, too.  I feel the ingredients and guaranteed analysis are better than A/D  (but that's just me)
 
I'm still blown away by the 1cc of pred twice a day.  what is the strength of pred?  15ml is how much is in the bottle.  It should say something like 1mg/ml, or 5mg/ml.
BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Saturday, September 05, 2009 11:47 AM
Snapper13


If you have access to it, look into canned feline EVO, too.  I feel the ingredients and guaranteed analysis are better than A/D  (but that's just me)

I'm still blown away by the 1cc of pred twice a day.  what is the strength of pred?  15ml is how much is in the bottle.  It should say something like 1mg/ml, or 5mg/ml.



The vet's bottle doesn't say. But, I did get a refill from the local Pharmacy that the vet called in and that says 6.7 MG / 5 ML.
Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Saturday, September 05, 2009 12:03 PM
At first I thought I read 5mg/ml.  phew!!!!  Now I re-read it and it's basically it bit strong than 1mg/ml strength.
 
1cc is still WAY too high.  5mg is also very high, considering he's in the beginning stage of insulinoma.  Sammy was at 0.35 near the end of the disease, and that was with a BG level in the 30's.  And there was no doubt at that time he had insulinoma.
 
I still think that 0.5 is way too high.
 
My petie is on .25, twice a day.  he weighs over 1000g.  And he's been insulinomic for close to 9 months, now.
 
I wonder if your vet read the ferret manual (the one every exotic vet has on hand to assist with dosing based on weight, I think it's the blue book) and saw 1cc and thought it shoudl be 1cc twice a day, as opposed to 1cc per day.  I got confused once, when I questioned the amount of pred Petie would be on, because the vet said 0.4cc.  And my jaw dropped, because we had NEVER had a ferret receive that high of a doseage.  Not ever.  Never ever.  But then she clarified, saying it was 0.4 for the day, so broken down would be 0.2 twice a day.  Which was more of the standard amount for when we were just starting treatment and the BG was low, but not horribly low.
 
I'd definately verify that amount.  That pred dose seems way too high.
 
Is there another vet you can call for consultation?  Have your ferret's weight and BG reading handy.  as well as the strength of the pred, and the doseage. 
BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Saturday, September 05, 2009 3:14 PM
I will definitely ask the vet when I see her for the checkup on Tuesday. I'll also see about getting a second consultation from another one.

However, the main problem now is still that he's weak from the blood sugar being too HIGH.

He also has been having trouble when going to the bathroom. He does go, but it's a struggle. There's also a few "false alarms" where he goes to the corner to go and just nothing comes out.
Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Sunday, September 06, 2009 8:54 AM
How old is your ferret?
 
I don't know too much about diabetes, but difficulty to urinate is a symptom of adrenal disease.  He received a lupron shot though.  Some of ours get flutamide along with the lupron, if the lupron didn't help the urination issues.
 
I'd cut the pred back to .25 twice a day. 
 
Cut out all treats.  He's on A/D.  Try some meat-only baby food (like gerbers stage 2, or beechnut stage one). 
BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Sunday, September 06, 2009 1:06 PM
Snapper13


How old is your ferret?

I don't know too much about diabetes, but difficulty to urinate is a symptom of adrenal disease.  He received a lupron shot though.  Some of ours get flutamide along with the lupron, if the lupron didn't help the urination issues.

I'd cut the pred back to .25 twice a day. 

Cut out all treats.  He's on A/D.  Try some meat-only baby food (like gerbers stage 2, or beechnut stage one). 



Unfortunately, I don't know his exact age. When I got him back in October of 2005, the previous owner said he was 1. However, she also thought he was a girl. So, he's at least going on 5 next month.

Yeah, I stopped with the treats. I'm going to get some baby food.

He got the Lupron shot on the first vet visit (1st of August), but not at the last.

The odd thing is though, that he never had a problem peeing or pooing until he started to weaken from the diabetes.

I told my vet about the bathroom problem. She believes the location of the tumors is causing the struggle. However, he didn't have bathroom problems until 2-3 weeks after treatment for the Insulinoma...and the vet said the tumors shrunk a bit due to the Prednisone. I don't really understand that.
<message edited by BinderGang on Sunday, September 06, 2009 1:11 PM>
Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Sunday, September 06, 2009 10:34 PM
Yeah, I don't know about shrinking pancreatic tumors either....
BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Sunday, September 06, 2009 10:43 PM
An update for today.

I don't want to count my chickens before they hatch...but he was acting more, I guess you can say "lively" today. It definitely gave me hope that he can get better.

He paid attention to his surroundings instead of just looking tired or sleeping. He wanted to leave his cage on his own and got my attention to do so. He started pawing at his bag of kibble (which I haven't fed him in almost a week now, as I've been feeding him the a/b wet food). I gave him a piece and while I'm not sure he ate it, he went over, on his own, to his hiding spot under my bed and came back out pawing at the bag again. Even if all he did was hide the food...for the past week he didn't even want to touch it.

Still struggling to go to the bathroom though, but one step at a time I guess? Back to the vet on Tuesday. Fingers crossed. Thank you all so much so far for your help, it means a lot to me. I will keep you updated as I know these threads and posts can be help for others too later on.
Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Sunday, September 06, 2009 10:52 PM
You said the lupron was given Aug 1.
 
We give our lupron once a month, but htere are 4 month depots available, too.  You may want to check what kind was given.  If your ferret is about 5 years old, it is very likely that he has insulinoma and adrenal.
 
Pred, as you've discovered is the medication of choice for insulinoma, and it isn't that expensive.  (However, we are quesitoning the amount you are giving)
 
For adrenal, if you decide to treat medically, you can either use melatonin or lupron.  I use lupron.  But you should give it regularly, on schedule.  he may be due for another shot, if he has AD.  And if he is having difficulty urinating, you may want to look into flutamide (which is what i use) or propecia (which Wenmister has used)
 
I'm glad he showing signs of his old self, though.  Hiding food, and wanting to be let out of the cage are good signs!
BinderGang

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Re:Prednisone to treat Insulinoma led to Diabetes - Tuesday, September 08, 2009 6:47 PM
So, we took him back to the vet today.

His blood sugar level dropped very little and he lost a little more weight even though we've been feeding him with the syringe.

On the positive side of things, the vet said the keytones that were at very high levels the last time around, have completely gone.

And the reason the prednisone levels are so high: We're not just battling insulinoma. We're battling lymphoma. Last time I really don't remember her saying it was definitely that, just that from the X-Ray it could be.

Blood tests work and such was never done because simply, I can't afford all of it and I'm doing some reading to try and understand.

Is it possibly that adrenal can be mistaken for lymphoma? I'm reading the symptoms of adrenal and except for the fact that my ferret hasn't lost his hair, this really does sound like it could be what he has.
Snapper13

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Re:Prednisone to treat Insulinoma led to Diabetes - Wednesday, September 09, 2009 8:00 AM
ahhhh - lymphoma.

Without bloodwork, it is possible the two could be mistaken for each other.  And that might explain the pancreatic tumors as well.
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Re:Prednisone to treat Insulinoma led to Diabetes - Saturday, November 07, 2009 7:06 AM
Are you able to advise the outcome of your ferret having diabetes due to Prednisone?  I am current experiencing identical problem but with my dog - and from what i hear and read this very rare.  My guy was diagnosed with Insulinoma, i gave him Pred and like you fast track several weeks and i have a diabetic dog on my hands.  would appreciate an update. t hanks,

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