Changes

==Description==

==Description==

Insulinomas are well slow growing, encapsulated, functional tumours of the beta cells of the pancreatic islet cells,  They secrete inaappropriately high amount of insulin irrespective of the serum glucose level.  They are predominantly malignant (90% of canine isulinomas), with a high metastatic rate to regional lymph nodes, liver and omentum.

Insulinomas are well slow growing, encapsulated, functional tumours of the beta cells of the pancreatic islet cells,  They secrete inaappropriately high amount of insulin irrespective of the serum glucose level.  They are predominantly malignant (90% of canine isulinomas), with a high metastatic rate to regional lymph nodes, liver and omentum.  60% of isulinomas are carcinomas, which are more likely to be endocrinologically active, the others being adenomas.

*mentally dull and disorientated

*mentally dull and disorientated

These sigs may be intermittent at the beginning of the disease, but this becomes progressively more often.  In between hypoglycaemic episodes, the animals are normal.  A presumptive diagnosis can be made on the demonstration of the Wipple's triad.  This includes presence of clinical signs associated with hypoglycaemia, fasting hypoglycaemia and amelioration of clinical signs with the admistration of glucose.   

These sigs may be intermittent at the beginning of the disease, but this becomes progressively more often.  In between hypoglycaemic episodes, the animals are normal.  A presumptive diagnosis can be made on the demonstration of the Wipple's triad.  This includes presence of clinical signs associated with hypoglycaemia, fasting hypoglycaemia and amelioration of clinical signs with the admistration of glucose.  Insulinoma should be considered especially when clinical signs are associated with exercise, extended fasting or after feeding.

====Other Tests====

====Other Tests====

*Increased serum insulin level in the presence of hypoglycaemia confirms the diagnosis.

*A tentative diagnosis can be made if inappropriately high serum insulin level in the presence of hypoglycaemia is shown.

===Diagnostic Imaging===

===Diagnostic Imaging===

==Treatment==

==Treatment==

===Medical===

===Medical===

This is more suitable to patients which are not a good candidate for surgery such as signs of metastasis is present.

This is more suitable to patients in which surgery has been declined or when surgery is inappropriate or fails due to the presence of metastasis.

*Small and frequent meals (3-6 times/day), with a high protein and complex carbohydrate content, should be fed.

*Small and frequent meals (3-6 times/day) of a simple carbohydrate content.

*Exercise restriction.

*Exercise restriction.

*Lowest possible dose of glucocorticoid given to increase hepatic glucose prodection and decrease cellular glucose uptake.

*Lowest possible dose of glucocorticoid given to increase hepatic glucose prodection and decrease cellular glucose uptake.