Introduction

• Cause: excess of insulin (pancreatic tumor (insulinoma)/iatrogenic), other neoplasia, severe hepatitis (toxic/inflammatory), cirrhosis of the liver, sepsis, starvation/ malnutrition, anorexia, polycythemia vera, other metabolic disturbances.
• Signs: intermittent in nature, weakness, lethargy, coma, death.
• Diagnosis: clinical signs, low blood glucose levels, baseline biochemistry/hematology, abdominal imaging (CT/US).
• Treatment: depends on underlying cause, initially stabilize by raising blood sugar, investigate and treat underlying cause. Start support feeding (food high in fat and protein).
• Prognosis: dependent on the underlying cause.

Pathogenesis

Etiology

• Islet cell disease:
  • Insulinoma Insulinoma (hyperplasia):
    • Compared to dogs these rarely metastasize.
    • Accounts for 20-25% of all neoplasms in ferrets.
    • There is a suggestion that a genetic component could be involved.
    • There is also a suggestion that a high carbohydrate diet may be implicated, in comparison to their high protein diet that is more suited to the species.
  • Beta cell adenoma.
  • Beta cell carcinoma.
• Other neoplasia, eg can be seen in some cases of lymphoma Lymphoma overview.
• Liver disease: toxic/inflammatory/cirrhosis
• Sepsis.
• Starvation/malnutrition/anorexia, eg can be seen in megaesophagus cases due to chronic starvation and regurgitation.
• Seen alongside endocarditis and other cardiac disturbances.
• Polycythemia vera.
• As a result of vomiting and/or diarrhea.
• Pregnancy toxemia:
  • Primiparous jills, where there is an abnormal energy metabolism that leads to hypoglycemia, hyperlipidemia, ketosis and hepatic lipidosis Hepatic lipidosis in the last 10 days of gestation.
  • Poor dietary intake is implicated as is excess demand for nutrient due to large litters.
• Xylitol toxicity: lead to a rapid release in insulin and subsequent hypoglycemia.
• Iatrogenic insulin overdose.

Pathophysiology

• Islet cell disease (hyperplasia, adenomas or carcinomas): islet cell tumors secrete insulin, leading to repeated bouts of hypoglycemia:
  • Insulin increases tissue uptake of glucose and decreases hepatic gluconeogenesis which results in low blood glucose, which the central nervous system needs to function.
  • Absorption of glucose stimulates the neoplastic beta cells to secrete more insulin, which will further drop blood glucose. This may become so low that the brain is unable to function, resulting in convulsions and unconsciousness.

Diagnosis

Treatment

Outcomes