What Is Hypoglycemia
and Why Is It A Concern?
Everyone seems to want the t-tiny little Poms (some call them T-cups). At Special Angels our smallest
dogs are 3 to 4 lbs and we think that's small enough. The tiny breed dogs are very delicate and fragile,
very cute, but not always the best choice for everyone. We prefer the medium size Poms because they
just don't seem to have as many  health concerns as the smaller Poms. At Special Angels we strive to
raise good, sturdy, quality pups with a minimum of health concerns so you can enjoy your new baby.
Any small breed puppy is subject to Hypoglycemia and anyone who aquires a small breed puppy
should be aware of the signs, for your puppy's well being.
Hypoglycemia





Stress and low blood Sugar; Toy-breed dogs particularly can be susceptible to stress, which can
cause a condition of low blood sugar, called hypoglycemia. Puppies under 10 weeks of age are
more prone to get hypoglycemia.  In small breed puppies from post-weaning to 4 months 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. 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.

Why are small breeds different? Puppies of very small size 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 are, 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.  If your puppy is lethargic, listless, or not interested in
eating, stress and low blood sugar may be the cause.

Eating food that is readily digested and metabolized will reverse minor signs, but 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, which 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, worming, 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 high-fat
foods. Normal feeding schedules will be 3-4 times per day. Our puppies are free fed (food always
available in dish) until they are 5-6 month old. Make sure that Water is available at all times!
Stress and hypoglycemia can cause dehydration and can lead to death. If your puppy shows signs of
stress, you can use a quick remedy for this: Pedialyte (or generic electrolyte replacement formula)
can be purchased at Wal-Mart and is an effective quick remedy for stress & hypoglycemia.
Gatorade or similar electrolyte sports drinks can also be utilized. Even a quick remedy of plain sugar
water or corn syrup can be used, if you do not have anything else available. If he will drink the fluids
on his own, allow him to do so! Improper administration of fluids by syringe or any other means can
result in choking or aspiration and can lead to aspiration pneumonia. if puppy won't drink on his own
rub a little bit of karo syrup on his gums.  Contact your veterinarian immediately if the puppy does
not respond to the Nutrical or Karo syrup.
Hypoglycemia in Pomeranians

Hypoglycemia, or low blood sugar, is common in toy breed dogs and puppies. Because Pomeranians
carry little body fat or reserves, if they become stressed, miss a meal, overexercise, become ill,
etc....they may experience a dangerous drop in glucose (sugar) in their blood. This drop causes the
Pom to become weak, lethargic, nauseous and generally unwell. Hypoglycemia is LIFE
THREATENING if left untreated. You MUST intervene and get your Pom's sugars up and stabilized.

When a Pom experiences a hypoglycemic episode, his or her brain is literally STARVED for glucose
(sugar) and the Pom's brain begins shutting down.

Hypoglycemia is not a disease and it's not contagious, it's a condition that can happen to any small
dog, regardless of health or age. It's most common in puppies up to six months old and up to a year
old if the Pom will be exceptionally small.



SYMPTOMS

The puppy may exhibit SOME or all of the following: appearing weak, disoriented, acting "drunk",
not responsive when you call his or name. Vomiting. Can't stand up or walk well. Trembling or being
nervous, uneasy or agitated. Most will seem VERY lethargic and listless.

Advanced hypoglycemia can include seizures, brain damage, loss of consciousness and if left
untreated, coma and death.

Most hypoglycemia cases can be treated at home, however you   
MUST SEEK IMMEDIATE VETERINARY CARE IF:

The Puppy loses consciousness, experiences a seizure, is non-responsive to at home treatment, OR if
you don't know the cause of the episode.

If you are aware that your puppy missed a meal or was over exercised, then providing at home care
is acceptable as long as the Pom responds immediately to care.

AT HOME TREATMENT

#1) DO NOT PANIC

These little dogs bounce back fast when treated properly, so keep calm, follow the steps below and
please, CALL US if you need some reassurance. It can be scary to see your little puppy suffering
from low blood sugar, but they recover very quickly in almost all cases, so take a deep breath!

It is imperative to keep INSTANT GLUCOSE GEL on hand at all times (and with you when you
travel with your pom!) This can be found in the HUMAN Diabetic department of your pharmacy for
about $6. This gel is absorbed through the gums quickly to get sugar into the bloodstream and
glucose to the brain.

If you do not have instant glucose gel, you may use any color Karo Syrup (very small amount).
Nutrical (a high calorie pet product that's like a thick syrup) works well too and can be given in
advance of a hypoglycemic episode if you know your puppy is under stress, not eating well, was
overexercised, etc...Do not over-do it on treatment or you could upset the puppy's stomach or cause
loose stools.

Keep your puppy warm and put several PEA sized drops of gel in his or her mouth (by force if you
have to-unless he is having a seizure).....every 20 minutes or so until the puppy "perks up". You
should see a huge improvement within 30-60 minutes.

If the puppy is CONSCIOUS, then offer him SOFT FOOD (jarred baby food in a meat variety,
vienna sausages, hot dog/lunch meat/srambled eggs......something soft and tasty to entice the puppy to
eat! He will not want his hard kibble, he isn't feeling well at this point.)

If he won't eat, give him some time and glucose...remember, he is nauseous from the hypoglycemia.
It's okay if he/she vomits the food up at first, but he should be able to keep it down within the first few
hours.  Monitor the puppy closely, continue to keep him warm and watch to see how he does. If
there is little or no improvement, take him to your vet asap. If he relapses for an unknown reason, it's
to the vet.

If the at home care is working you'll see your puppy "perk up", eat the soft food well and begin acting
normal again within a 1-2 hours. Do not let him or her run around or exercise for a day or two. Keep
him or her warm, calm, quiet, well fed and monitored VERY closely for a relapse. Keep the puppy
with you when you sleep and check him or her every two hours or so (in a small laundry basket in
bed with you works well).

AT THE VET

If your puppy needs to be taken to the vet because he is unconscious, has experienced a seizure or is
not improving, here is what to expect.

The vet techs will wisk the puppy to the back while you fill out paperwork (be prepared for an
emergency exam fee). The vet will want to start to check the glucose levels (with a pin prick to the
puppy's paw pad or ear) and then immediately start a GLUCOSE DRIP (which is an IV into the
puppy) which delivers glucose directly into the bloodstream. This is the quickest and best way to get
the puppy stable and prevent seizures, brain damage, coma and death.

After getting the puppy stable, they'll want to run hundreds of dollars in tests. We recommend starting
with one or two and working your way slowly to find out what caused the episode (if you don't know
already). In addition to the glucose test and glucose drip, we recommend starting with a FECAL
CHECK to look for parasites that may have caused the puppy to lose his appetite which resulted in
the episode. If parasites are found (worms, cocci or ghiardia), then treatment should begin when the
vet says it's safe. If nothing is found (or the puppy is exhibiting other symptoms) then a PARVO test is
next on the list. Parvo is almost always fatal, even in large breed puppies/adults. It can be kinder to
euthanize a parvo toy breed puppy than to drag out it's  suffering. Parvo symptoms will show up
10-14 days after exposure. Keep your puppy UTD on vaccines and off public grasses/sidewalks until
he is 4+mths old and fully vaccinated.

We've never sold a puppy that has tested positive for Parvo after being placed, we work hard to
keep vaccines up to date and to keep our whelp boxes and playpens clean, but your vet will need to
rule it out. (March 2013)

If the parvo and fecal check come back negative, then the vet will want to run a blood panel. Some
toy breed dogs can have liver or kidney problems that can result in hypoglycemic episodes. We've
never had a test come back positive (or had any puppy we've placed who has been treated come
back positive) but it's the next step in testing to be sure.

There are other tests, but these are the most common ones to expect.

The bottom line is that although low blood sugar (hypoglycemia) is common and easily treated in
Pomeranians (if caught early), your vet will most likely want to run (and have you pay for) lots and
lots of tests. Low blood sugar can happen to a healthy puppy who missed a meal, is stressed,
overexercised, etc.....so don't let your vet push you around. Do your research, be informed and get a
second opinion if you're not sure.