Hypoglycemia In Dogs – Symptoms & Causes

Hypoglycemia refers to a condition that can develop in dogs when their blood sugar level reduces to too low levels. For healthy and non-diabetic dogs, the normal blood glucose value is 3.3-6.2 mmol/L. When the blood glucose concentration of a dog is ≤ 60 mg/dL (3.3 mmol/L), then the dog is said to be Hypoglycemic.

Hypoglycemia is not a disease itself; instead, it is a symptom of an underlying condition or disease. There are many causes of hypoglycemia. Cancer in the liver or gastrointestinal system, abnormal growth of pancreatic cells, Portosystemic shunt, Glycogen-storage disease, and inflammation of the liver are a few of the reasons.

Hypoglycemia happens when there is a disruption of glucose homeostasis in which glucose production is lesser than glucose utilization.

Hypoglycemia may arise by these 4 mechanisms:

i) Increase in demand or secondary to hyperinsulinism causing increased glucose uptake and utilization by normal or neoplastic cells.

ii) Hepatic gluconeogenesis - poor dietary intake of glucose and other substrates.

iii) Endocrine defects proceeding in a deficit of counter-regulatory hormones such as cortisol.

iv) Malfunction of hepatic gluconeogenic or glycogenolytic pathways.

Symptoms of hypoglycemia do not usually manifest until concentrations of glucose are < 40 mg/dL to 50 mg/dL(< 2.2 mmol/L to 2.8 mmol/L ). Hypoglycemic clinical manifestations depend on their severity and duration. The symptoms of hypoglycemia result from a failure of glucose supply to the brain (neuroglycopenia) and activation of β-adrenergic receptors (β-ARs) (the sympathoadrenal system).

• Discoloration of skin
• Loss of appetite
• Lethargy (low energy)
• Slow response to stimuli
• Muscle twitching/fasciculations
• Polydipsia (increased thirst)
• Polyuria (increased urination)
• Somnolence
• Ataxia/lack of coordination/ involuntary twitching
• Exercise intolerance
• Trembling
• Partial paralysis of the hindquarters
• Seizures
• Impaired vision
• Syncope

• Raising blood sugar levels – rubbing corn syrup or honey or glucose syrup or 50% dextrose on the gums.
• Enzyme replacement and nutritional intervention(Powdered pancreatic enzymes, Cobalamin injections, vitamin supplements.
• Pain medications.
• Intravenous fluids.
• Antibiotics, in the case of SIBO, are suspected (tetracyclines, Metronidazole, and tylosin).
• Exploratory abdominal surgery - dogs with hypoglycemia and inappropriate insulin production.
• Glucose monitoring: This can be done at home using devices such as OneTouch Ultra glucometer, AlphaTRAK2, etc. skin-mounted sensor (such as freeStyle Libre) is used nowadays.

1. For puppies and young dogs, feeding frequency should be increased and instead of one large meal, several small meals per day can be provided.
2. For overly active dogs, it is recommended to feed a modest meal a few hours before activity and provide small meals or snacks later in the day.
3. If any specific diet has been suggested to your dog, follow the diet very strictly, and never provide or allow others to give your dog treats or other food.

Prevention is not possible for hypoglycemia as the causes in dogs is varied. Treatment and survival rates vary depending on the grade and stage of the condition.

Good overall health and early detection are the only ways to prevent hypoglycemia.

Check your dog on a regular basis and consult your veterinarian immediately if you find any hypoglycemic symptoms.

Boxer, Chihuahua, Chow Chow, Cocker Spaniel, Cavalier King Charles Spaniel, Dachshund, Golden Retriever, German Shepherd, English Setter, Rough Collie, Skye Terrier, Yorkshire Terrier

1. Causes:

• Sepsis
• Pancreas infection
• Pancreatic cancer such as Insulinomas
• Pancreas injury
• Autoimmune diseases
• Hypercalcemia- elevated blood calcium levels
• Overuse of glucose in the body during pregnancy
• Damage to pancreatic functions due to improper usage of medicines
• Hereditary conditions that harm the pancreas, such as cystic fibrosis

2. Types:

Congenital hypoglycemia: Some breeds such as GSD inherit the condition.

Acquired hypoglycemia: This is generally caused due to Pancreas infection, Pancreatic cancer, Pancreas injury, Autoimmune diseases, etc.

3. Mortality:

Although the mortality rate of hypoglycemia is not available, it causes severe damage to your pancreas. So typically the survival rate will be reduced if not treated properly.

4. Diagnosis:

• Routine hematology, urinalysis
• Glucose level exams
• Test for hypoglycemia
• Tissue biopsy
• Abdominal radiographs, ultrasound, or CT scan

5. Differential diagnosis:

Pancreatic diseases:

• Adenocarcinoma of the pancreas
• Acute & chronic pancreatitis
• Pancreatic cystic neoplasms
• Pancreatic artery pseudoaneurysm

Extrapancreatic diseases

• Acute cholecystitis & gallstones
• Glycogen-storage disease
• Intestinal ischemia
• Peptic ulcer disease & gastric cancer
• Ovarian cysts & cancers
• Bowel obstruction

6. Prognosis:

The prognosis for hypoglycemia is really good. The only problem is the existing condition is really hard to identify in the initial stages as the symptoms mimic various other conditions. Relapse is also possible following medical treatment in affected dogs.

Time to visit the vet clinic for an examination, if you notice any of the following:

• Discoloration of skin
• Muscle twitching/fasciculations
• Polydipsia (increased thirst)
• Polyuria (increased urination)

• Feed foods have a lower ( or moderate) Glycemic Index and Glycemic Load than others.
• Diet high in protein, fat, and complex carbs.
• Feed 4-6 small meals spread through the day.
• Protein: High protein diet comprising 40% of dog's calories.
• Fats: Omega-3 and other healthy fats.
• Complex Carbohydrates: fibers and starches (Brown Rice, Whole Grains, Oatmeal, Potatoes & Sweet Potatoes).
• Supplemental dextrose (Karo Syrup).
• For underweight dogs- Higher calorie diets; for Overweight dogs - lower-calorie diets.

Dogs that have been diagnosed with hypoglycemia should be closely monitored for the pancreas functionality to ensure prompt treatment for any changes.

Prognosis for hypoglycemia is unpredictable and is dependent mostly on the actual cause.

Most dogs with this condition never show any external symptoms but may continue to have unimpeded pancreas function.