Hypoglycemia tends to be a problem seen most often in toy breed puppies. Hypoglycemia is the medical term for low blood sugar. In small breed puppies from post-weaning to 4 month of age, the most common form of hypoglycemia is called Transient Juvenile Hypoglycemia: "Transient" because the symptoms can be reversed by eating; "Juvenile" because it is seen in young individuals.
Background on blood sugar:
Glucose is the "simple" sugar that the body uses for "fuel" to run its various functions. Table sugar, or sucrose, is made up of two simple sugars, glucose and fructose, and can be broken down rapidly after eating. All sugars are carbohydrates. Grains are also carbohydrates but are considered "complex" carbohydrates because they have many more components and take longer to be broken down. The body uses glucose as its primary energy source. All the parts of the body except the brain can, if needed, use alternate energy sources--fatty acids, for example, which the body accesses by breaking down fat stores. The brain, however, is completely dependent upon glucose to function. If the glucose in the blood is lower than normal, the brain function is the first to show signs. In dogs, these signs may be seen as weakness, behavior changes, confusion, wobbly gait, or even seizures. In fact, in young dogs that have had what may appear to be an epileptic seizure, low blood sugar is generally ruled out before a diagnosis of epilepsy is made. The liver is responsible for manufacturing glucose and for storing it in a usable form, for release into the blood stream as needed. Muscle tissues store some of the important materials used in this process. Therefore, a serious liver abnormality or insufficient muscle mass may make it difficult for the body to keep its blood sugar regulated properly.
How are small breeds different?
Puppies of very small and toy breeds of dogs have characteristics that make them more prone to the development of Transient Juvenile Hypoglycemia, which is brought on by fasting. Pups of any breed are more likely to develop hypoglycemia than adults, because their skeletal muscle mass and liver size are smaller and brain size, larger, in proportion to the rest of their body. Therefore, there is less glucose being put out into the blood and more being used by the brain, which is dependent upon adequate glucose in order to function. In small and toy breeds this discrepancy is more pronounced. Even a brief period of fasting in a toy breed puppy can trigger a hypoglycemic "attack." As discussed, one of these attacks may appear as weakness, confusion, wobbly gait, or seizures. Immediate action is necessary to prevent an “attack” from become more severe. Nutri-cal, honey, or Karo syrup licked from a finger will normally reverse the condition if it is caught soon enough. Eating food that is readily digested and metabolized will also reverse minor signs but we normally feed the puppy after getting the low blood sugar remedied. Intravenous glucose administration is required for severe cases.
Puppies with Transient Juvenile Hypoglycemia have normal liver size and function, but inadequate glucose precursors or glucose in its stored form. Therefore, any significant stress, such as a routine trip to the vet's, that occurs in the absence of a recent meal, can cause the blood sugar to drop to dangerously low levels. Low environmental temperatures, infections, vaccinations, strenuous exercise, and inadequate nutrition increase the risk even further.
Feeding recommendations for puppies at risk for hypoglycemia include frequent (4 - 5 times a day) feedings of high-carbohydrate, high-protein and /or -fat foods. For pups who have had recurrent or prolonged signs, monitoring the urine for ketones with a "dipstick" made for diabetics is helpful, since a return to "ketone negative status" signals a return to normalcy.
Are there other causes of Hypoglycemia in puppies?
There are numerous other causes of hypoglycemia in puppies, but they are much less common. It is important to distinguish between whether the signs of hypoglycemia occur with fasting or just following a meal. Some conditions are caused by liver problems, such as a defect involving an abnormal blood vessel shunt (a "detour," of sorts) around the liver, and some are caused by hereditary metabolic defects, hormone defects and deficiencies, and severe bacterial infections. All of these are serious problems that need to be diagnosed as soon as possible
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