3 years old - Insulinoma

Hi All, 

seems one of my ferrets has Insulinoma, he is only 3 yrs 10 months and has been suffering with lethargy for a month or two and the past few weeks with weakness in back legs. Vet has done full blood tests and pretty much confirms it. 

They also saw some kind of lump next to adrenal glad, but unsure if its anything unless they do surgery. 

My questions are, should we go for surgery with the chance of not seeing anything (Vet wont just remove a section of pancreas for no reason), or go on medication until it comes back then do surgery?

Also wether or not we go for surgery, he and his mate have been on a good high quality Kibble from birth, but should i change to something else? I do have easy access to raw food but read that high quality cat food is much better for them?

Look forward to some wise words of advice ;)

Thx

Hello and Welcome to the forum! I never opt for surgery for adrenal or insulinoma. I treat adrenal with melatonin from Walmart and either monthly or every three month lupron. For insulinoma I give pred am and pm. Plus give soupy 3x a day to help keep their BG up. I have had many through the years with both. I have 2 adrenal boys now and one was recently diagnosed with insulinoma. I almost lost him. Both diseases can be treated with meds. For me, surgery is to invasive and they usually end up on meds anyway. I've had friends lose their babies after surgery for insulinoma. The only surgeries I agree to is if its the only way to save their lives. 
I hope this helps.

 
Fuzzbutts Rule!

Hi and welcome to the forum.
I go along with bandit99.  Surgery is a]only a temprorary solution.  In both adrenal disease and insulinoma the tumors are almost sure to come back.  

Look into Suprelorin F implants for adrenal disease.  They are a bit expensive, but cheaper than lupron in the long run, as they are good for up to a year.  If lupron works, the Suprelorin should as well.

http://www.virbacferretsusa.com/about-suprelorinf-implant

THE DOOKS OF HAZARD

Thanks both of you for your advice.

He at this stage does not have any diagnosis of adrenal disease, so I am focusing on his Insulinoma.
I was told he is fairly early on in the disease, so that is a good thing I guess.

Of course the main question is surgery or not - with surgery yes it has a risk but with a youngish ferret in 
a fit state for surgery (so vet informs me from his tests), many others suggest to give him the chance that it may work or at least delay the need for meds by perhaps 6-12 months.

OR bring him home and try the very best for him in the way of meds and other treatment.

I know some of you have suggested some solutions, I am in the UK so perhaps some of the things mentioned are not easily available, perhaps alternatives? 

If he is at the early stage of Insulinoma and I go for meds treatment, what can I expect to happen?
I would appreciate any further advice on the stages of the problem and how to react and treat it.

Finally if it a meds treatment we go for, what life expectancy should we realistically expect?

Thanks again ;)

The prednisolone along with either a soupy or 1st stage chicken baby food will help keep his blood glucose up. Whatever dose my vet prescribes I break it up into 2 doses, am an pm. That way it's in their system continually. Right now Casper is on 0.2ml, am and pm. (He was diagnosed a month ago) I caught his fairly early too. Casper is 6 1/2. He gets soupy 3x a day. Most of my babies with insulinoma have lived another 18 months or more after diagnosis. But mine have all been older at onset of the disease and had not had proper care before coming to me. One of my babies was diagnosed with adrenal, insulinoma and lymphoma all in the same month. He lived another 18 months. Unfortunately there's no way to give an exact length of time. Every case is different. But I have had very good results with meds. Eventually the dosage is increased as the disease progresses. 

 
Fuzzbutts Rule!

Great thanks for the advice.

I am collecting him today so hope to start him on the right course straight away.

I have read so many duck soup cocktails, but what are the more simple options?
Is it right to buy chicken legs and boil them, then blend and add some kibble (blended) with water?

or are there some better options.

I do like your ideas, especially as your guys have lived such long lives so far and in the past!

Soupy can be as easy as diluted baby food. The soupy I make is easy. My batch last about 2weeks for 4 fuzzies. The night before I soften some kibble. The next day I put it in a blender or food processor. Add water, egg, I add a little pure pumpkin to help with hairballs, and about a Tbsp of heaving whipping cream. The whipping cream helps add weight.  
As you mentioned you can also boil either chicken pieces or a whole chicken. No seasonings. Use the broth instead of water. Then add the other ingredients I mentioned. Even the kibble if you want. Add the broth to make the soup the consistency you want. If you have to feed him with a syringe at first make it thin enough to go in the syringe. Try rubbing some on his gums first to see if he'll eat it on his own though. Some act like you're feeding them poison at first but then usually  will eat it. All of my 4 do. 

 
Fuzzbutts Rule!

Thanks

Just got him home and have ben given some Prednidale mix in water, and told to give him 0.1ml twice a day.
I am still waiting for the insulin results, but can I assume Im ok to continue using this med?

Will get the chicken all blended up tomorrow so hope to get him back to normal soon.

Even after 48 hours of the Vet giving him his Med, I see some improvement at home with him, having more energy
and slightly better on his legs..

The pred usually starts working fairly quickly. It will also help his appetite. Be sure he eats when taking the pred because it can be rough on the tummy. And yes keep giving the pred. 

 
Fuzzbutts Rule!

you can see if he'll eat the chicken raw, as well.  let it warm to room temp.  if he doesn't take to it you can still boil it.  Some ferts go straight for it and some have to be coaxed.  

THE DOOKS OF HAZARD

Thanks for the tips,

I will be trying boiled chicken with skin possibly with soften kibble, then blend.

Have tried raw/boiled eggs but he and none of my ferrets like it ;(
Doesn't the whipped cream give the opposite effect for a ferret that shouldn't have any sugar?

Hello All,

Well 3 weeks after our return from vet and little Yogi is doing ok. Been really trying to give him regular small and often meals of mainly either blended up cooked chicken and kibble with a bit of water, dry kibble and some very small bits of raw chicken which he seems to respond well too. 

I am sticking with the pred medication 0.1ml twice daily, but he does still wobble at certain times during the day so not sure if Im doing anything wrong. He loves a little walk in the garden with his mate, so all seems ok. 

Any other tips on diet or other that I should consider?

BTW - the results came back and showed a positive insulin level, and nothing abnormal, is that normal ? 
Even though his blood glucose levels were low.

Thx all!

insulin and glucose are supposed to balance each other.  Insulinoma screws with that balance.  If you can check his glucose once or twice a week, you may find that his pred dose needs to be increased.  You can check it yourself.  We use a Tru2Go meter that we get at walgreen for $10.  If you want help with it, I can give some tips.

THE DOOKS OF HAZARD

Thanks, I don't think they sell them here in the UK but will search ;) 

Would this link be what I need? http://www.storkz.com/true-21292002961.html

How do I get the sample? I can't imagine trying to stick a needle in to get blood :(

Thanks

http://www.storkz.com/true-21292002961.html

That's what we use.  And we use the same technique as when we trim nails.  A little ferretone or favorite oil on the belly to distract them.  The meter comes with instructions and a lancet for getting blood.  We use the deepest setting because of the tough skin on the toes.  We shave the side of a toe with a personal groomer and lance the side.  Have the meter set up and on before lancing. The ferret doesn't even feel it.  At least not enough to stop licking oil.  It takes one small drop of blood, but it has to be a drop so the test strip can absorb it.

THE DOOKS OF HAZARD

Hello All,

Thought Id give you an update and maybe get some more advice...

My little cutie is ok, feeding him quite a lot of raw chicken and a soup mix of cooked chicken and kibble.

He's doing ok but I am finding recently that after he gets his meds (preds), then a bit of food, he claws at his mouth with some saliva. He is still flopping about a bit each day at certain times with weakness in his back legs, so should I increase his 0.1ml twice a day to a bit more?

I would increase it.  When is the last time his BG was tested?  It sounds like he's having seizures.  You may want to double it and get his BG tested asap.

THE DOOKS OF HAZARD

> then a bit of food, he claws at his mouth with some saliva

Pred can be upsetting his tummy.  Just be careful of ulcers.



http://kristenmcdonald.com/portfolio/web/ferretfacts/www.ferretfacts.com/gastriculcers.html




How are you giving his preds to him?  I usually give the preds in their soup.


I hope this helps

Thanks for the advice,

I usually give it to him on some blended/cooked chicken mixed with kibble. And then followed by more if he wants or some raw chicken breast. 

I did increase his meds x 2, and he has shown some improvement, with only a few times showing a quick spout of clawing at his mouth with saliva. So I would hope it has made him feel a bit better. 

I didn't get the Glucose machine yet, so need to order that online this weekend. Is it something that will help us ?

I will of course at some stage soon need to take him to the Vet for a check up and possibly look at surgery, but lets see how things go...

I would also like to try new foods that may improve him, so any other ideas would be appriciated 

Thx!

You can get a glucose meter at walgreen for $10 with 10 test strips.  I can give you some tips for getting blood, but no guarantees  

THE DOOKS OF HAZARD

Hello :)

I just ordered one online from Amazon - as i live in London England these True2Go and strips are only available online and take a few weeks to arrive.

But once it does I hope to have it help me with monitoring him and any future ferrets we get.

Well, I didn't realize where you lived.  I'm sure there similar models available where you are.  Be advised that ths strips are good for a year.  You should test every 2 weeks for a couple months, then monthly.  That'll give you time to shop for one.  

THE DOOKS OF HAZARD

Hi all,

I just wanted to discuss the Pred meds my furry mate is on.

As discussed, we increased his meds to 0.2ml twice a day, as he was having some issues and what appeared to be mini fits (clawing at mouth etc).

However after several days of being on double dose, he just was not right. After each dose, and food together he was acting very strangely - flopping about, almost in a daze.

So the past few days I decided to actually reduce he does to lower than originally done. And I must say he has not shown any of the worrying symptoms he has especially on double does (0.2ml twice a day). 

I am also trying to fill his tummy before giving any meds, and although he is not any where near back to his former self, he is stable.

Question - would he have been on too much to begin with? or am I guessing. 
I am waiting for  my Glucose machine to arrive from the States, so I assume that will help me judge.
Also will this machine (True2Go), be accurate enough?




Thx

Usually you want to start with a lower dose so it can be increased later, and because pred does have side effects you want to delay them as long as possible.  
We've used the Tru2Go for years.  We checked it against our vet's reading and it was very close, +/- .1mg/dL.  The meter comes with a small bottle of test solution.  Follow the directions to test the meter.  If it is off, you'll know how much.  
We found a site in amazon.com where the test strips are like 1/4 the price as in the stores.  

THE DOOKS OF HAZARD

Yes True2Go is on its way - shame it takes so long to get here from States :(

Will ask for advise when it arrives !

OK finally my True2Go and sticks arrived :)

So I now need advice on using git on my little boy - look forward to all the tips.
What settings to use, where best to take samples etc.

Thx

here comes the fun bit.

hopefully you've got your fuzz accustomed to some sort of oil or ferretone. we use ferretone.  a few drops on the belly is enough to distract them while we clip claws.  using that trick works for getting blood.  


insert the test strip into the meter, but not all the way so it turns on, just so it's ready.  shave the fur from the side of a toe (we try the back ones first, or you could put a thin coat of petrolatum on the toe to keep the fur from absorbing the blood.  Set the lancet on 5, the deepest setting (ferret skin is tough)

when you are ready to use the lancet, massage the toe to get some color in it.  push the test strip in all the way so the meter turns on.  Lance the toe (we find the side of the toe works best) wait fora bead of blood to form then put the test strip in the blood until the open end of the strip is full.  You only have about 1 minute from the time the meter turns on to get a reading or you will get an error.  

you could try it on yourself to practice.  Good luck.

THE DOOKS OF HAZARD

Thank you, I will try that tonight.

I dont have ferretone but will try an take his attention another way!

He has started struggling with his hing legs the morning, he has all the energy he normally has but his legs just done work?

How would we compare the reading? I assume if we use the same as you, then I can tell you when it is.
I assume then we can increase meds...?

Tris

Hello All,

Well we tried and tried tonight to get  sample of blood, and after 5-6 times still no luck.

We tried on the side of his claw, his tail, his paw on setting 5.
His side of claw did show signs of red ness but no sample

Any advice :(?

it may sound silly, but did you put a needle in the lancet?  Did you get any blood at all, or just not enough?

This is a pretty g0od article on the procedure.  
http://www.ferret-universe.com/health/home_glucose.asp

normal values are 80-120 mg/dL  (4.95 Mmol/L - 6.88 Mmol/L).  If you still have trouble with it, it might help to get you vet to show you how to do it.

THE DOOKS OF HAZARD

Yes I did put a needle in :)

He in the past week gotten worse with his back legs not really working.

It is sad and frustrating as we can get the meter to work after waiting so long, but I will be taking him to the vet next week
and asking their advice.

It does always seem that shortly after medication, he does sometimes seem lifeless and sometimes claw at his mouth.
Is this something common, I would have assumed that the meds would help.

Perhaps the dosage is not enough or not going in to his system well enough?

What are my other options to know re: meds, for when I go the vet?

Thx :)

it could be the dosage is too low.   A ferret can tolerate quite a lot of pred.  You could probably safely double the dose again but call the vet and ask, if you can't get there that for that long.  

That said, he's still young and doesn't need to be on high doses of pred indefinitely.  There could be other issues as well.  I would get back to the vet. Keep notes of any important signs and behaviors.  We have older one who has had multiple strokes.  Yours could have some neurological issue too.

THE DOOKS OF HAZARD

Yes he was checked again at the vet and they noticed a large Cyst on one of his Kidneys. They did drain it for tests and didn't see any sign of cancer in and around that organ. His Blood glucose was on the low side but all other tests proved fairly inconclusive. 

I was given some slightly different meds (prednisolone), which we are giving half a tablet twice a day. He has shown some signs of improvement, most clearly he has stopped clawing at his mouth with saliva. And he does have some improvements with his energy levels (but not that much). 

I will take him back next week, but the vet did say we could increase in the dosage by 50% (1.5 tablets per day).

I can only assume it is just trying to find the right dosage for him to improve. But then again is it because of a large Cyst which was not completely removed that is causing discomfort?

Would be interested in your thoughts. But on our next visit, i will be taking my blood glucose machine for the vet to show me what to do :)

Prednisone is converted to prednisolone by the liver, so prednisolone is actually better because it's easier on the liver and kidneys.
HOw are you giving it?  We crush the tabs, dissolve in a small amount of water, then add a few drops of ferretone and mix.  Usually they will lick it right out of a bowl but they may get tired of it after a while.  That's when you have to use a syringe.  
You might be able to get stronger tablets so you can give smaller bits of tablet per dose.  
It may take a couple adjustments to find the right dose.  It seems like fuzzies are different. Some will adapt to lower BG levels and others will seize and/or die with no prior signs.  Our Kahlua lived 2 years until over 8 years old on pred and her BG never recovered above the mid-40s.  

The other med used for treatment is Proglycem/diazoxide. It's primarily used to treat high blood pressure, but as a side effect it inhibits insulin production which increases glucose levels.  It is usually added later when the pred starts to lose effectiveness.

THE DOOKS OF HAZARD

Hi,

Hes had another set of tests and his Blood glucose is at around 45 Mol....
We have him on 1mg tablet twice a day at the moment (up from 1/2 twice a day), and he is showing improvement.

Out of interest, what is the max per day these little furries can safely handle before we need to think about other treatments?

Thanks :)

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