General Information
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 who 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 tissue 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 properly regulated.

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 our into the blood and
more being used by the brain, which is dependent upon adequate glucose in order to
function. In small and toy breed, this discrepancy is more pronounced. Even a brief perios
of fasting in a toy breek puppy can trigger a hypoglycemic “attack.” As discussed, one of
these attacks may appear as weakness, confusion, wobbly gait, ro seizures. Eating food
that is readily digested and metabolized will reverse minor signs, but intravenous glucose
administration is required for sever 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 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) feeding 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.

We use Nutr-Cal, Nutri-Stat,  white corn syrup, and honey as a preventive.