By Kristen Onasch

One of my ferrets was recently diagnosed with diabetes. When I did some research, I discovered that there was a definite lack of information available about diabetes in ferrets. This article is not meant to tell you exactly how to treat your diabetic ferret, but rather to share with you the information that I've come across as well as what I have found to be effective or ineffective. Any courses of treatment or changes in treatment should be discussed thoroughly with your veterinarian.

THE INITIAL DIAGNOSIS
A ferret's normal blood glucose (BG) level is between 90 and 120. When I took Cheeba to the veterinarian, his BG was 495. Veterinarians consider readings of over 200 to be symptomatic of diabetes. Other symptoms of diabetes in ferrets include excessive drinking and urination, lethargy, weak hind end, and stumbling or falling over. Some ferrets will develop a strange breath odor, which some people describe as fruity or similar to fingernail polish remover.

Cheeba also had ketones in his urine with levels of 4+. When a diabetic develops ketoacidosis, it means that the body is breaking down fat as an energy source, which floods the blood with ketones. Ketones are acidic, so the blood becomes acidic, causing major issues within the body including nausea, vomiting, pain, confusion and, if left untreated, coma and death. The presence of ketones in the urine, especially at high levels like Cheeba was showing, is a sign that the diabetic is very sick. Ketones can be tested for at home using Keto-Diastix or at the veterinarian with urinalysis.

CAUSES OF DIABETES
My biggest question during that appointment was how did Cheeba develop diabetes? Diabetes is relatively rare in ferrets, and the majority of cases are a temporary result of insulinoma surgery. Possible causes for diabetes in ferrets include: Cheeba did have insulinoma, but we opted for medical treatment (prednisone) rather than surgery, and he was only on it for approximately 6 months before his BG levels shot up. In his case, it is most likely due to an oversensitivity to prednisone or to his adrenal disease. It also appears that his will be permanent rather than a temporary issue that could be fixed by stopping prednisone.

TREATMENT OF DIABETES
Settling on a permanent course of treatment will be a trial and error process, but the following is recommended by several well known ferret veterinarians as the treatment with which you should start. You will want to keep a log of your ferret's treatment, including how much insulin you are giving him, how much he is eating, what his feces look like, and any other information that seems pertinent. Here is what my log looks like:

Date Time BG Test Food Medication Keto-Diastix Stool Vet Info
               
               

It is important to purchase a home glucometer so you can monitor your ferret's BG every day. Diabetic ferrets will have BG levels that fluctuate often, especially in the first period of treatment while you are determining what the appropriate insulin dosage is. Home BG testing is also necessary because in most cases, the diabetes is temporary, and you don't want to give your ferret insulin if he doesn't need it. I test Cheeba's BG at least twice a day before giving him his insulin shot. Whenever his treatment is changed slightly or his behavior seems different (for the better or for the worse), I test him every 2 - 3 hours. The target BG for a diabetic ferret should be around 200.

In addition to when you administer your ferret's insulin, you will also want to test your ferret directly in the middle of the 12 hour cycle. This helps to determine how long your ferret's insulin shot is lasting and how effectively the dosage is controlling his BG. For example, Cheeba is given his morning shot at 7:30. I then test him again as close to 1:30 as possible, 6 hours after his initial shot, to see if his BG is where it's supposed to be. If your ferret's blood sugar is not at the target level or is bouncing back and forth between very low and very high, you may want to speak to your veterinarian about giving your ferret insulin three times a day rather than two (every 8 hours rather than every 12).

There are many different glucometers out there. Some of the meters that ferret owners have used are Freestyle, BD Logic, One Touch Ultra and Ascensia. I use the Ascensia Contour. It takes a very small amount of blood (.6 microliters), it doesn't need to be coded, and it reads up to 600. Anything above that registers as "HI".

It's also advisable that you test your ferret's urine three times a day to monitor the presence of ketones and glucose in his urine. Keto-Diastix test the levels of both ketones and glucose in the urine. I do not recommend relying on the glucose result to know how much insulin you should give however. The Keto-Diastix should just be a way to let you know how much glucose is in the urine. Use a glucometer to determine actual BG levels.

If you determine that your ferret is diabetic, you should also do a full blood panel. This will help you to determine how well the kidneys are working by measuring the levels of several compounds in the blood (BUN, Albumin, Creatinine, Phosphorus, etc). Kidney function can be compromised due to regular high BG levels, so be sure to do regular blood tests thereafter. If your ferret is in renal failure, which is diagnosed with blood work and urinalysis, you need to know about it as soon as possible. Low protein diets are usually recommended for ferrets with renal failure, which can be problematic if the ferret is also diabetic.

ADDITIONAL RESOURCES
The following is a list of links where I found much of this information and where you could check to do further research.

Posts on the Ferret Health List (FHL):
http://ferrethealth.org/archive/browse.php?msg=SG15992
http://ferrethealth.org/archive/SG15191
http://ferrethealth.org/archive/SG6649
http://ferrethealth.org/archive/SG6592
http://ferrethealth.org/archive/SG2385
http://ferrethealth.org/archive/browse.php?msg=YG10124
http://ferrethealth.org/archive/browse.php?msg=SG6649
http://ferrethealth.org/archive/browse.php?msg=SG14903
http://ferrethealth.org/archive/browse.php?msg=YG6778
http://ferrethealth.org/archive/browse.php?msg=YG1420
http://ferrethealth.org/archive/browse.php?msg=SG15191
http://ferrethealth.org/archive/browse.php?msg=SG13506
http://ferrethealth.org/archive/browse.php?msg=SG9003
http://ferrethealth.org/archive/browse.php?msg=SG7264
http://ferrethealth.org/archive/browse.php?msg=SG6592
http://ferrethealth.org/archive/browse.php?msg=SG2385
http://ferrethealth.org/archive/browse.php?msg=SG1258
http://ferrethealth.org/archive/browse.php?msg=SG15480
http://ferrethealth.org/archive/browse.php?msg=SG15460
http://ferrethealth.org/archive/browse.php?msg=YG4476

The majority of these posts are from Dr. Jerry Murray, a well known veterinarian who speaks at ferret symposiums. They cover general questions, treatment issues, medication, diet, and other topics. You could also try searching for specific terms in the FHL archives at http://ferrethealth.org/archive/.

How to test your ferret's BG: http://www.unc.edu/~pjdutche/bloodsugar/

RANDOM TIPS
When administering sub-q fluids, you will want to distract your ferret with a treat. Cheeba loves chicken & chicken gravy baby food, so he gets that during the sub-q fluids. He barely even flinches when the needle goes in.

Warming up the bag of sub-q fluids slightly first will also make it easier on your ferret. I soak the bag in warm water for five minutes or so before administering the fluids.

Do not administer the sub-q fluids at the same site as the insulin shot.

Keep your ferret's stress to a minimum. High amounts of stress can cause the BG to fluctuate.

If you have problems getting a blood sample from your ferret's toe, you could take it from the tip of his tail.

It's a good idea to test your glucometer against an actual BG test at your veterinarian's. Glucometers are made to test humans, so they're going to be slightly off. Comparing it to your veterinarian's BG test will give you an idea of how much it varies.

Insulin comes in a variety of strengths. You want to make sure that the syringes you are using are the proper syringes for the strength of insulin you're using. The strengths you'll see for pets are likely U-40 and U-100. Use the corresponding needles. If you have U-40 insulin and U-100 needles, or vice versa, you can convert the dosage at the following link: http://www.felinediabetes.com/insulin-conversions.htm.




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