Insulinoma
One of the most common and most devastating of ferret diseases is cancer of the insulin-producing cells called an insulinoma. Other names for this tumor are beta-cell carcinoma or pancreatic endocrine carcinoma. This cancer occurs when the cells of the pancreas that produce insulin (beta-cells) grow out of control. The disease in the ferret caused by this cancer is not caused by the cancer growing into a large tumor and thereby disrupting the surrounding tissues or organs (as is often the case with cancer), rather, it is due to the effects of the over production of the hormone insulin by the cancerous tissue.
As with any major disease problem in the ferret, insulinoma is a problem that should be addressed by a veterinarian familiar with ferrets, their diseases and with significant experience performing surgery on ferrets. This common problem of ferrets is very rare in dogs, cats, or other small animals.
Significant anatomy and physiology
The pancreas is a large glandular organ located at the upper end of the digestive tract, where the stomach empties into the small intestine. This large gland has two functions, one, called “exocrine” (meaning the gland secretes material outward or out of the body), and the other called “endocrine” (meaning that the gland secretes into the body or into the blood stream). The exocrine function involves the production and secretion of the digestive enzymes used to digest food, primarily proteins and sugars in the diet. The endocrine function involves regulation of the level of sugar in the blood stream. Two substances, or hormones, are involved in this process, insulin and glucagon. After eating a meal that contains sugar or carbohydrates, blood sugar levels rise in the blood. This rise in blood sugar causes the pancreatic beta cells to release insulin. The insulin acts on body tissues to actively absorb the sugar from the blood stream and lower the level in the blood.
When an insulinoma is present, too much insulin is released into the blood and the body’s tissues absorb too much glucose. This causes blood sugar levels to drop too low for the brain to function normally, resulting in the signs we see in the ferret.
Occurrence of insulinoma
It is safe to say that most ferrets that “die of old age” die of cancer. The cause of this truism is not clear, but unlike most animals that die of organ failure (liver failure, kidney failure, heart failure, etc.), ferrets die of a variety of unusual forms of cancer. Insulinoma is reported to be the second most common cancer of ferrets, second only to adrenal cancer. As many as 25% of all ferrets may develop this form of cancer. They occur in both male and female ferrets, as young as two years of age up to “old age,” five to eight years. Early spay or castration has not been shown to increase a ferret’s chances of having this form of cancer, nor has diet.
Symptoms
A ferret with early stages of insulinoma may show very subtle signs. The ferret may stare into space as if it is in a trance. It may seem tired or may lack energy. As the disease progresses the ferret acts increasingly weak. It may drag it’s back legs or be too weak to climb. The ferret may retch or paw at it’s mouth as if nauseous. With advanced disease the ferret may become unconscious or have seizures caused by very low blood sugar levels. Other signs that may occur with insulinoma include vomiting, and black, tar-like diarrhea. If left untreated signs may progress to coma and the death of the ferret.
Diagnosis
Insulinoma is tentatively diagnosed on the basis of history, physical signs and tests that show low blood sugar levels. The disease is confirmed by tests showing high blood insulin levels and evaluation of cancer tissue removed at surgery. These tests must be performed by a veterinarian and there is some interpretation of results required. There are times when a ferret with an insulinoma may have normal blood sugar and normal insulin levels. The tests are best performed following a two to three hour fast. Longer fasts may give a falsely low blood sugar reading. Tests taken when blood sugar is very low, especially if it has been low for some period of time, may give a falsely low blood insulin level.
Treatment
Insulinoma is treated with a combination of medical and surgical therapy and, in some cases dietary changes. Medical treatment consists a steroid, prednisone, and in difficult to control cases, an insulin blocking drug, diazoxide. The prednisone acts to change the way the ferret’s body uses sugar. This greatly reduces the high and low sugar levels responsible for the symptoms caused by the tumor. Diazoxide helps to block the effect the insulin has on body tissues. Prednisone is very inexpensive and comes in both small dosage pill and liquid forms. Diazoxide is very expensive and comes as a liquid and a pill, however the pill form is difficult to reduce to a small ferret dosage.
Once stable, surgery may be recommended. The goal of surgery is to slow the progress of the disease. Insulinoma tumors metastasize or spread to other locations in the ferret’s body very early in the disease. This makes a surgical cure highly unlikely. However, removal of the primary tumors appears to significantly slow the progress of the disease.
Surgery is most often recommended after two to three weeks of medical treatment has been completed and the ferret has become medically stable and stopped showing signs of low blood sugar. In the author’s practice, ferrets undergoing surgery for insulinoma spend two to three days in the hospital. The surgery is performed on the first day. The ferret is prepared for surgery early in the day. An catheter is placed in a vein in the front leg and the ferret is started on a constant infusion of fluids including glucose (sugar). This reduces the risks of anesthesia and surgery in these patients.
Isoflurane, an inhaled gas anesthesia, is administered, first by a mask and then through a tube placed in the patient’s airway. The abdomen of the ferret is shaved from the middle of it’s chest to the inside of it’s thighs and the skin of it’s abdomen is washed and sterilized. An incision is made from just below the umbilicus (the belly-button) to the zyphoid process (the point at the bottom of the sternum). The tumor (or tumors) are located in the pancreas and the abdomen is examined for other forms of cancer and other problems. A common finding at surgery is the presence of a large spleen or adrenal cancer. If present, these problems would be addressed at the same time. The abdomen is closed with three layers of sutures and surgical staples.
Pain medication is given prior to the time the ferret awakens from the anesthetic and repeated in the evening. Further pain medication is usually not required. Intravenous fluids are continued until the patient is eating on it’s own.
Experimental treatments
The author has experimented with chemotherapy aimed at killing the cancer tissue. Two drugs have been used to treat insulinoma in other species and hold promise for treating the disease in ferrets. These drugs are highly toxic to insulin producing cells and have been used in medical research to produce diabetic animal models (animals that can not make insulin). This research is in very early stages and their routine use of these drugs is many months to years away.
Prevention
At this time there is no known way to prevent this disease. Some authors recommend not feeding sugary treats and keeping your ferret physically fit. Good diet and husbandry are always recommended.
Conclusion
In summary, insulinoma is a very common cancer of ferrets. Signs of the disease may include trance-like staring, lack of energy, loss of attention, weakness, nausea, and convulsions. It is caused by cancer of the insulin producing cells of the pancreas. The disease is significant and ferrets showing signs of insulinoma should be attended by a veterinarian familiar with ferrets and experienced in the surgery to correct this disease. The disease is diagnosed with a combination of history, physical signs and lab tests. Treatment consists of both medical and surgical treatment and, someday, may include a chemotherapy protocol aimed at killing the tumor cells. Treatment is not curative but will greatly enhance the quality and in most cases quantity of life, especially when initiated early in the course of the disease.
Signs of insulinoma
(In order of progression)
- Trance-like Staring
- Lack of energy
- Weakness
- Hind leg paralysis
- Nausea / Pawing at mouth
- Muscle tremors
- Seizures
- Coma
- Death
Article by Jeffrey R. Jenkins, D.V.M
About Dr. Jenkins
I recently took my male ferret to a vet. his hind legs “fall over” when he runs or walks, he’s having trouble climbing, he makes a horrible sound like someone stepped on him from time to time, and he is eating less. The vet didn’t do any blood tests at all just squeezed his middle and lower areas and then told us he has cancer. Is this normal? Should the vet have done blood tests or can cancer be found just by physical touch?
The signs you describe are common signs of weakness. Insulinoma would be one cause, but there are many other problems that may present similarly. The masses or tumor of insulinoma are very small, most often only a few millimeters in diameter and would typically not be felt by palpation (feeling from outside his body). There is a chance that your veterinarian felt a large tumor (most likely not an insulinoma).
In most cases some testing, and possibly radiographs, would be taken to diagnose insulinoma. Blood glucose levels being the most common test.
My male ferret Echo just turned one in march and for the past few days he’s been laying down out of nowhere. Now, I know that’s normal, but he does it every few minutes and lays there for anywhere from 30 seconds to over a minute. I’m currently enrolled in school to be a vet tech and I plan on taking him to our school clinic to have bloodwork done. I just wanna know if insulinoma is a possibility or is he just worn out?
Kelly
It would be unusual for a one year old ferret to have an insulinoma. Still the signs you describe are not normal behavior for a young ferret as well. It is more likely that your friend has eaten something that he shouldn’t. Young ferrets have a strong attraction to things made out of latex, rubber and foam.
Best if you have Echo seen by a veterinarian familiar with ferrets as soon as possible.
Good luck! Dr. J
Hello, my name is Crickett and I have 4 wonderful little Ferret friends. I love them very much so it just crushed me when one of them, came down with “what appears to be Insulinoma”. My lil friend Freakers went into screaming siezures a few days ago. It took meds from his doc and 24hrs to get them to stop. Im still waiting for test results and final diagnosis, but it’s real clear what is ailing him. He’s unable to walk or move around on his own. He has to be force fed, but once he gets started at times is eager to eat. He act like he’s a bit confused most of the time, when he’s looking around. He’s approx 7yrs old, but was very active before the symptoms started. It’s been a week now and the most he can do is lift his head and it seems the lights are on and no one is home. It’s breaking my heart to see him this way! I do NOT want him to suffer. What are the chances of him “with proper treatment” recovering from this? Is there anyway for me to help my other little friends from getting Insulinoma, too? C.L
It’s difficult to tell you if your ferret has an insulin producing tumor or not, but his signs do sound consistent with the disease.
I am surprised, however, that he is not doing better if he has been under the care of your veterinarian. If his blood glucose levels were low and he has signs suggestive with insulinoma, most veterinarians would start treatment with prednisolone and most ferrets would improve significantly.
I think it’s time you had a talk with your veterinarian!
Thank you so much for your quick reply. I will do that right away! Im very happy to hear that with proper treatment my ferret should do well. God Bless
I just went through a horrifying experience with my little girl ferret last night, she is 4. I’ve researched a lot on this particular subject, and I am most positive this is what she has. It breaks my heart that she had to go through what she did.
I came in, around 4 am and saw her laying stretched out at the bottom of her cage. She usually likes to be in her tent with her blanket, covered, so I noticed that was weird. When I walk in the room, her eyes usually light up and she starts climbing to the top of her cage wanting out. She just looked up, tried moving, and fell right on her face.
I panicked. I got her out, held her. She was foaming, drooling, breathing really funny. I thought I was about to lose her. All I had was in common instinct was to make her comfortable and try to talk to her to keep her responsive.
She would look at me when I called her name, but would go back into a trance of staring at nothing, or her eyes would close. I tried playing with her legs, usually she pulls them back from me, but she was lathargic. When I put her on my bed to run around after she kinda woke up, she wanted to walk around, get under the covers, play, but sadly her little legs, weren’t letting her. It was as if she was drunk, or her leg was broken.
Finally, after researching this, I found the Karo syrup deal, didn’t have any so I used corn syrup. Not 10 mins later she was responsive, hoping around, playing. Still having trouble walking, but after I put her in her cage, she ate, drank, curled up and went to sleep.
I got her out this morning and she was walking fine, eating fine, being her silly self. The vet I use for my dogs, would rather not work with ferrets, I live in Memphis, TN and would love to help her as much as I can. I’m going to get some baby food, chicken to get some protien in her as soon as I wake up. She’s my baby, and I just don’t want to lose her. I’ve seen that it is not 100% curable, and that breaks my heart. Name anything and everything I can do to help prevent her from going through that ever again.
Ashley
Most ferrets with insulin producing tumors respond well to treatment with prednisolone and some are cured with surgery.
You have an Exotic Animal Speciality Practice in Memphis. I’ve known Dr. Hannon for some time. He has a good reputation and, I am certain, will help your ferret get back to health.
Best of luck! Dr. J
I have just lost my ferret today to pancreatic insulonoma. I am heartbroken. It started a year ago, when he wouldnt eat, or poo or drink. Vet did blood test an said it was this. he started him on diazoxide twicce a day. every six weeks he would have a relapse. I found a liquid cat food called liquivite which was the only thing that gave him a jump start, so every couple of weeks he would have this. He was losing weight and i took him back to the vets august 2011 and he was prescibed steroids (prednisolone) as well as diazoxide. I gave him these tablets crushed and in chicken soup in a syringe twice a day. He continued to lose weight and he sadly lost his fight today.
Karen
Sorry about your loss. Also that it took you till now to find our web sight.
WE would have recommended your friend start prednisolone on day one and talked about doing an exloratory surgery as soon as he was stable. Many of these ferrets do well, some even cured, with surgery to remove the tumor(s).
Thank you so much, do you know anything about their price range? I have never even heard of the place til you mentioned it.
No but I am certain it would be worth the initial exam and consultation to find out their thoughts and costs.
Best of luck, Dr. J
I have a 3 year old female ferret who has tumors in her digestive tract. When first diagnosed, she was put on prednisone (pill form). The tumors shrunk within a matter of weeks. Recently (3 months later) the tumors have rapidly increased in size. Larger than before. I had the prednisone filled as a liquid to ensure she is ingesting the right amount. Has the tumor built up a toleration and the prednisone is no longer effective? If so, would increasing the dosage be appropriate? Originally, the vet told us surgery would be too difficult as the tumors are thoughout the tract. I do feel small little bumps in a couple places, but I feel one extremely large (quarter size) in one spot. Would the removal of the largest tumor relieve her and prolong her life? As of this week, she has a lot of trouble walking and barely wants to move. Her muscles in her arms and back are almost non existent. Any input and advice would be greatly appreciated. I understand this disease is somewhat unstoppable, but I am wondering would the best thing to do is in order to relieve her and make her comfortable. Thank you so very much.
It is difficult to give a very specific answer without knowing more about the tumor, however, I can make a good assumption that this is a form of lymphoma (because it responded to prednisone). If that is the case there is a good chance that a more aggressive course of chemotherapy (typically a 3-4 drugs given in concert with each other) will bring the tumor back under control. We typically would start with one of these “chemotherapy cocktails.”
I think you need to get a biopsy or aspirate of one or more mass so that you know what you are up against and how to proceed.
Let us know if we can help. Good luck!!!
Dr. J
Hello Dr J
I have a 8 year old ferret. Last May she had a seziure. Come to find out she has cancer. She is now on predisone. It doesn’t seem to be working anymore for her. I have had it raised to help with the blood sugar. She has good days and bad days. The question I have is, as long as she is on the meds will she have another seziure? And also how long is to long for me to hold on to her? I don’t want her to be in pain like the first time she had a seziure.
Laura
As the tumor(s) grow in size and mass it will be more difficult for the prednisolone to control her blood glucose (sugar). More (prednisolone) will work for a time but not for ever. How long depends on the number and size of the tumor(s).
Another option is to do an exploratory surgery to remove / debulk the tumor mass. This works on MOST ferrets and some are even cured by the surgery. We perform insulinoma surgery regularly (averaging more than one per week).
You should find a veterinarian with a busy ferret practice that performs this surgery often (at least 6-8 times a year). It is not uncommon to find adrenal tumors during these surgeries. These can be removed at the same surgery.
Until you have her surgery done / If you choose not to do surgery, you should make an effort to get your ferret to eat often. Wake her up and encourage her to eat every time you come or go, your meal times or anytime you think about it. As anyone who has owned a ferret knows, ferrets eat many times during the day. This gives them a constant source of blood sugars made from the fats and proteins in her food. Her insulinoma will cause her blood sugar to drop and that makes it hard for her to wake up and eat. If she goes to long between meals her blood glucose (sugar) can get too low and lead to a seizure.
I found my ferret this morning at 6 and he was laying on his stomach face in the litter he was still warm but stiff and there was no symptoms he was fine the day before please help
Lisa
Sorry to take so long to get back to you. I hope your friend is OK!
Email me via the web site if you are still having problems.
Dr. J
My ferret is a 3 year old male I found my ferret this morning at 6 and he was laying on his stomach face in the litter he was still warm but stiff and there was no symptoms he was fine the day before please help
Hi there, I have a 7 and a half year old female ferret who has just been dianosed with strongly suspected insulinoma. She had laid down, seeming really sleepy, so I took her to the vet. Her blood sugar was 2.8 and later (after glucose) 3.7. I’m trying to work out whether to risk surgery (strikes me as either a very good or very bad outcome) or just to use the steroids (which I believe will help her for a few months, so possibly to the end of her natural life, though possibly not). The added problems are that she has been found to have a very slow heart rate (60 beats per minute). The vet is not sure why this is but is thinking it might be due to the low sugar levels – I’m not sure how much this affects her chances under the knife. Also, the vet found a little fluid around her heart, not too much but a bit. Liver & kidney tests seem OK. Can you offer any assistance on my decision? I’m not sure if her age and other symptoms should put me off surgery (which seems like the action of choice) or not. Many thanks.
Most ferrets that are diagnosed with insulinoma are in bad shape at the time they are first presented and most of them improve enough with prednisolone that we can do their surgery or maintain them for significant periods. I’ have you see how she does over the next couple weeks and then make your decision about surgery.
Hello,
My ferret is around 7 yrs old and she was just diagnosed with moderate insulinoma. I took her in when I noticed she wasn’t using her back legs. She’s on steroids now and I have nutrical for emergencies. Unfortunately it took 2 hours for her to be seen after the incident. Will she regain use of her legs and walk again?
Thanks!
Justin
Her hind leg weakness is due to low blood sugar (not brain trauma, etc.). That means that the dose of prednisolone / prednisone is not enough to get her sugar levels up OR that she needs to have her tumor removed or reduced in mass so that the prednisolone can do its job.
Best of luck! Dr. J
Hi, my little buddy Albus just had surgery to remove a mass near his right adrenal gland. The vet said it is one of the largest he has seen. My question is two fold: A- The vet said he noticed a dark red area on the pancreas and was going to take it out and biopsy, But after getting the adrenal gland and the tumor he went back and couldn’t find it…do you think that could be the early stages of insolinoma? B- Albus has been rubbing his chin on the floor after eating since his surgery (6 days ago)…do you think he could have stomach ulcers?
Thank you for you help! The fuzzbutt are lucky to have you.
Sorry for the slow reply. Your question got lost in the pile !!!
I’m hoping Albus is doing well and that you have histopathology back and an answer to what the mass was.
Very often the pancreas will bruise when being handled. Insulinomas are small firm tissue that, if anything, are lighter in color than the surrounding pancreas.
The chin rubbing could be a sign of nausea and could be a sign of gastritis or gastric ulcers. If he continues he should be treated as if he has ulcers.
This is a bit insane to think. but, i have a male ferret. only one yr. old. but, last night i was holding him in my arms, and i picked him up and he just fell again. but, he had had a very very long play day. so i think he was just tired, because today i let him down, and he was as happy as could be. since he is not in the age range for insulinoma, what can i do to try and prevent it from happening, and give him a fulll, happy life? please, i just want to make sure my baby boy is okay. and, i’m also new to a new state, and i’m not so sure where the nearest veterinarian is if i ever need one in case of emergency. i love in Pensacola, FL. can you help me?
Hi my feret passed away this past Sunday. He woke me up at about 4 am scratching the carpet. He somehow got out of his cage. I got up and put him(Timmy) back inside his cage. Then I had to look for the other little guy(Pancho) well I did find him under the sofa. I put them both back inside. They seemed ok. But later that day I looked at Timmy and he was laying on his stomach face first into the litter box. He was cold so I tried to wake him up but he was dead. But it’s been 1 day and Pancho is doing fine. Any idea what could have killed him over night? And also do you think Pancho will feel sad being by himself? Should I buy another feret to keep him company?
There are lots of possibilities. Young ferrets (<2 years) love to eat rubbery things or thing made of foam. If Timmy found and ate something that totally blocked the outflow from his stomach he could progress rapidly. They will also eat things that they should not (cleaning products, etc.) but I’d expect those thing to show signs right off and take longer to progress to death.
If you still have Timmy you should have a veterinarian or local/state veterinary lab perform a necropsy. That is the only way to get the true answer.
Thanks for your time. Im also worried about Pancho feeling lonely. Is it a good idea to get him another friend or is it best just to let him be by himself? Thanks
Ferrets do OK alone but are happier if they have company.
Cheers, Dr. J
I have a ferret who was diagnosed with insulinoma about a year ago and he is on prednisone and that was working fine, but in the past few months he has lost weight and I am having trouble getting him to eat anything that will help him gain weight, I was just wondering if you had any suggestions, I have tried eggs, chicken, ham, baby food, and soft cat food, all with no luck. Also I was wondering if there had been any new Developements with the experimental drugs listed above, and if I could get the names of them.
Try Glucerna. It’s a liquid diet for people with diabetes. The hospital grade product is best, but the shakes will do in a pinch.
Not much going on with chemotherapy. If your friend is not doing well with the prednisolone (we give doses up to 1 mg/kg twice daily) then it’s time to go to surgery and debulk his tumor. We even cure some of them !!!
Hello again. I brought home two ferrets because one of the two I had passed away. I just noticed today that one of them has green diarrhea. But I don’t know which One. But all three seem healthy and they all eat good. And drink plenty of water. Also there all very playful. What should I do or give them?
Most important is to quarantine them away from any older ferrets.
There is a good chance that the green diarrhea is just caused by dietary discretion (lots of ferret diarrhea is green in color due to the high levels of bile in ferret GI tracts). That said, if one of the new ferrets has the viral diarrhea (commonly called “green slime disease”), it can be very hard and sometimes lethal to older ferrets.
It would be wise to have the new ferrets see your veterinarian (something you should do with all new ferrets). Take samples of their stools with you.
My male, 4 year old ferret died yesterday morning. For the past month I have noticed that his eating habits were diminishing until eventually he wouldn’t eat at all. He also lost most of his body weight. I began mushing up his food with water, and he began eating it lightly. He began acting normal again, then I noticed other symptoms, including hind leg weakness, and dark diarrea that he couldn’t control. He was messing all over the cage and his hammock so I had to take him out of the cage, and isolate him so it would be easier for him to go to the bathroom. Just 2 months ago he was behaving, eating, pooping normal. So the quickness of this downhill health problem was fast. It sounds like he had insolioma. I was in the process of getting him to the vet, but the nearest ferret vet to me is 3 hours away, so it’s a big deal for me to take him there. I found him in his hammock dead yesterday morning. I cannot believe my little boy is gone. I still have his sister with me, and she has adrenal disease, she is currently on Lupron. I can’t believe how FAST this happened, and I’m very sad, shocked and devastated.
Sorry to hear of your loss. I agree that your ferret could have had an insulinoma. With luck, deslorelin implants will become more available and that will make managing ferret adrenal disease much easier.
Dr. Jenkins, I have two male ferrets who will be turning 5 this year. They are Marshal Farms ferrets. From your experience, is there a higher prevalence of Insulinoma or other serious ailments associated with ferrets that come from breeding farms versus small, private breeders? Are they at a higher risk at a younger age? They are not showing any warning signs, but I cant help but be worried about this 5yr mark. Thank You!
Hi Michele
In my experience, Marshall Ferrets are as healthy, if not more healthy, than others we see. We see problems in all ferrets, even ferrets from England and Europe.
A couple of things that may help reduce your ferrets chance of having problems is to start them on a low dose of melanin (I’d suggest 1/4 mg, that’s 1/4 of the 1 mg tablet) nightly. This is thought to regulate adrenal gland cycles and may reduce the chance of adrenal disease. Feed a good quality diet and don’t let your ferrets become overweight. See your ferret veterinarian regularly. At least yearly, but in older ferrets, every 6 months would be a good idea.