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==Signalment==
==Signalment==
*More common in dogs than cats
*More common in dogs than cats.
*Middle-aged to older dogs
*Middle-aged to older dogs.
*No sex predilection
*No sex predilection.
*Breed predisposition, more common in medium to large-breed dogs:
*Breed predisposition, more common in medium to large-breed dogs:
**Irish Setter
**Irish Setter
**German Shepherd
**German Shepherd Dog
**Labrador Retriever
**Labrador Retriever
**Standard Poodle
**Standard Poodle
The following signs are related to hypoglycaemia:
The following signs are related to hypoglycaemia:
*collapse
*collapse
*seizures
*muscle tremor
*muscle tremor
*muscle weakness
*muscle weakness
*ataxia
*ataxia
*mentally dull and disorientated
*lethagy and depression
*exercise intolerance
These signs may be intermittent at the beginning of the disease, but they become more often with time. In between hypoglycaemic episodes, the animals are generally normal. A presumptive diagnosis can be made on the demonstration of the Wipple's triad. This includes the presence of clinical signs associated with hypoglycaemia, fasting hypoglycaemia and amelioration of clinical signs with the administration of glucose. Insulinoma should always be considered when clinical signs are associated with exercise, extended fasting or after feeding.
These signs may be intermittent at the beginning of the disease, but they become more often with time. In between hypoglycaemic episodes, the animals are generally normal. A presumptive diagnosis can be made on the demonstration of the Wipple's triad. This includes the presence of clinical signs associated with hypoglycaemia, fasting hypoglycaemia and amelioration of clinical signs with the administration of glucose. Insulinoma should always be considered when clinical signs are associated with exercise, fasting, excitement or feeding.
==Treatment==
==Treatment==
===Emergency===
*In the event of a hypoglycaemic episode, a dextrose bolus should be given immdediately.
*This should be followed by intravenous fluid therapy with 2.5% dextrose.
*Alternatively, if the patient is able to eat, frequent feedings can be used instead of dextrose fluid therapy. This may be preferred to avoid the risk of rebound hypoglycaemia.
===Medical===
===Medical===
This is more suitable for patients in which surgery has been declined or when surgery is inappropriate or fails due to the presence of metastasis.
This is more suitable for 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) of simple carbohydrate content.
*Small and frequent meals (3-6 times/day) of complex carbohydrate content.
*Exercise restriction.
*Exercise restriction.
*Prednisolone to increase hepatic glucose production and decrease cellular glucose uptake.
*Glucocorticoid such as prednisolone to increase hepatic glucose production and decrease cellular glucose uptake.
*Diazoxide, an oral hyperglycaemic drug, to inhibit pancreatic insulin secretion and tissue glucose uptake.
*Diazoxide, an oral hyperglycaemic drug, to inhibit pancreatic insulin secretion and tissue glucose uptake.