QUARTERLY BEAT / JULY 2025
prednisolone elevate blood glucose levels by increasing insulin resistance in skeletal muscle and adipose tissue, reducing glucose uptake, stimulating hepatic gluconeogenesis, and promoting glucagon secretion from pancreatic alpha cells. Streptozocin and octreotide are no longer routinely recommended for treating canine insulinoma due to their limited proven efficacy and potential adverse effects in dogs. Meals should be small and fed frequently - up to 4-6 meals per day – with a diet high in protein, fat, and complex carbohydrates, but low in simple carbohydrates to minimize glucose spikes that can trigger additional insulin release. Exercise should be restricted to short leash-walks to minimize glucose requirements.
While feedings and IV dextrose provide temporary relief, they can also trigger further insulin release from the tumor. Glucagon is another option for raising BG without stimulating insulin release, though it’s not always accessible or affordable. Low-dose dexmedetomidine (1 mcg/kg) can also help inhibit insulin release and is often included in anesthesia protocols for insulinoma patients. WHAT’S THE PROGNOSIS FOR CANINE INSULINOMA? If metastasis is present, the prognosis is guarded. With medical management alone, median survival is just 4 months (range 0-8 months) However, in dogs without detectable metastasis, surgical resection can lead to a good quality of life, with a life expectancy of 1 to 3 years (median 2.5 years), and some cases surviving up to 5 years post-surgery. When in doubt, pet owners must be educated on the importance of medical vs. surgical management, clinical signs to monitor for, and related prognosis for treatment of canine insulinoma.
TREATING THE HYPOGLYCEMIC CANINE INSULINOMA PATIENT
As hypoglycemia can be life-threatening, hypoglycemia must be promptly identified and treated. Again, a red top tube should be collected for insulin levels PRIOR to treatment hypoglycemia to send out an IGR level. Conscious dogs can be fed, while more clinically affected patients should be promptly treated with 50% dextrose (1 mL/kg diluted 1:4 with saline, IV), given over several minutes to avoid sudden spikes in blood glucose that can trigger additional insulin secretion and rebound hypoglycemia. For patients in status epilepticus, prompt therapy is warranted – immediate IV catheter placement, bolus of 50% dextrose diluted, followed immediately by a CRI (typically of 5% dextrose, and slowly weaned to 2.5% dextrose supplementation as needed); rarely, in severe cases, persistent seizure activity after normalization of BG may require administration of benzodiazepines (e.g., midazolam, diazepam) and additional anti-epileptic medications (see figure 1). (When in doubt, don’t forget to frequently check that stat BG!)
ABBREVIATIONS
BG: blood glucose CBC: cell blood count CRI: constant rate infusion CT: cat scan
FNA: fine needle aspirate IGR: insulin to glucose ratio
IV: intravenous LN: lymph node TNM: tumor, node, metastasis (staging)
RESOURCES
• Buishand FO. Current Trends in Diagnosis, Treatment and Prognosis of Canine Insulinoma. Vet Sci. 2022. 29;9(10):540. • Datte K, Guillaumin J, Barrett S, et al. Retrospective evaluation of the use of glucagon infusion as adjunctive therapy for hypoglycemia in dogs: 9 cases (2005-2014). J Vet Emerg Crit Care. 2016;26(6):775-781. • Green R, Musulin SE, Baja AJ, et al. Case report: Low dose dexmedetomidine infusion for the management of hypoglycemia in a dog with an insulinoma. Front Vet Sci. 2023;10:1161002. Published 2023 Apr 6. • Ryan D, Pérez-Accino J, Gonçalves R, et al. Clinical findings, neurological manifestations and survival of dogs with insulinoma: 116 cases (2009-2020). J Small Anim Pract. 2021 Jul;62(7):531-539.
Figure 1. Insulinoma patient with persistent focal and generalized seizures despite BG normalization as a result of chronic neuroglycopenia. A 1 mL/ kg dextrose (diluted; IV) bolus raised the patient’s BG from 45 mg/dL (2.5 mmol/L) to 288 mg/dL (15.5 mmol/L), but seizure activity continued as shown here. (Video courtesy of Dr. Amy Kaplan.)
Figure 2. Same patient after treatment with 0.5 mg/kg midazolam IV. (Video courtesy of Dr. Amy Kaplan.)
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