HYPOGLYCEMIA

WHAT IS IT?  ...  HOW DOES IT AFFECT OUR YORKIES?  ... WHAT CAN WE DO?

Let's start with the basics on hypoglycemia so everybody stays on the same page.  Hypoglycemia is one of the medical concerns of the Yorkshire Terrier Breed.  It is a concern in several other breeds as well  where breeders are determined to downsize the breed and cause irreparable harm and possible death to so many of the offspring.  It also tends to run in bloodlines thus leading us to believe it is a genetic occurrence but NO research to this date has proven such.
WHAT IS IT :  

Hypoglycemia, also called low blood sugar or insulin shock, occurs when your blood glucose (blood sugar) level drops too low to provide enough energy for the body's activities.

Glucose, a form of sugar, is an important fuel for your body.

Carbohydrates are the main dietary sources of glucose. Rice, potatoes, bread, tortillas, cereal, milk, fruit, and sweets are all carbohydrate-rich foods.

After a meal, glucose molecules are absorbed into the bloodstream and carried to the cells, where they are used for energy. Insulin, (a hormone produced by the pancreas), helps glucose enter cells. If more glucose is produced than the body needs at the time, the body stores the extra glucose in the liver and muscles in a form called glycogen. The body can use the stored glucose whenever it is needed for energy between meals. Extra glucose can also be converted to fat and stored in fat cells.

When blood glucose begins to fall, glucagon, (another hormone produced by the pancreas), signals the liver to break down glycogen and release glucose, causing blood glucose levels to rise toward a normal level. If a puppy has diabetes, this glucagon response to hypoglycemia may be impaired, making it harder for the glucose levels to return to the normal range.

HOW IT OCCURS:

HYPOGLYCEMIA in Puppies Who Do Have Diabetes:

Hypoglycemia can occur in puppies with diabetes who take certain medications to keep their blood glucose levels in control. Usually hypoglycemia is mild and can easily be treated by eating or drinking something with carbohydrate. But left untreated, hypoglycemia can lead to loss of consciousness. Although hypoglycemia can happen suddenly, it can usually be treated quickly, bringing the blood glucose level back to normal.

Hypoglycemia in Puppies Who DO NOT Have Diabetes:

Two types of hypoglycemia can occur in puppies who do not have diabetes: reactive (postprandial, or after meals) and fasting (postabsorptive). Reactive hypoglycemia is not usually related to any underlying disease; fasting hypoglycemia often is.

Reactive Hypoglycemia

In reactive hypoglycemia, symptoms appear within 4 hours after they eat a meal.

Diagnosis
To diagnose reactive hypoglycemia, your Veterinarian may

  • ask you about signs and symptoms

     

  • test the blood glucose while they are having symptoms (Your Veterinarian will take a blood sample and send it to a laboratory for analysis. A personal blood glucose monitor cannot be used to diagnose reactive hypoglycemia.)

     

  • check to see whether the symptoms ease after the blood glucose returns to 70 or above (after eating or drinking)

A blood glucose level of less than 70 mg/dL at the time of symptoms and relief after eating will confirm the diagnosis.

The oral glucose tolerance test is no longer used to diagnose hypoglycemia; experts now know that the test can actually trigger hypoglycemic symptoms.

Causes and Treatment
The causes of most cases of reactive hypoglycemia are still open to debate. Some researchers suggest that certain puppies may be more sensitive to the body's normal release of the hormone epinephrine, which causes many of the symptoms of hypoglycemia. Others believe that deficiencies in glucagon secretion might lead to hypoglycemia.

A few causes of reactive hypoglycemia are certain, but they are uncommon. Gastric (stomach) surgery, for instance, can cause hypoglycemia because of the rapid passage of food into the small intestine. Also, rare enzyme deficiencies diagnosed early in life, such as hereditary fructose intolerance, may cause reactive hypoglycemia.

To relieve reactive hypoglycemia, some health professionals recommend taking the following steps:

  • eat small meals and snacks about every 3 hours

     

  • exercise regularly

 

  • avoid or limit foods high in sugar, especially on an empty stomach

Although some health professionals recommend a diet high in protein and low in carbohydrates, studies have not proven the effectiveness of this kind of diet for reactive hypoglycemia.

Fasting Hypoglycemia

Diagnosis
Fasting hypoglycemia is diagnosed from a blood sample that shows a blood glucose level of less than 50 mg/dL after an overnight fast, between meals, or after exercise.

Causes and Treatment
Causes include certain medications, alcohol, critical illnesses, hormonal deficiencies, some kinds of tumors, and certain conditions occurring in infancy and childhood.

Medications
Medications, including some used to treat diabetes, are the most common cause of hypoglycemia. Other medications that can cause hypoglycemia include

  • salicylates, including aspirin, when taken in large doses

     

  • sulfa medicines, which are used to treat infections  (*ALBON)

     

  • pentamidine, which treats a very serious kind of pneumonia

     

  • quinine, which is used to treat malaria

If using any of these medications causes the blood glucose to drop, your Vet may advise you to stop using the drug or change the dosage.
Critical Illnesses
Some illnesses that affect the liver, heart, or kidneys can cause hypoglycemia. Sepsis (overwhelming infection) and starvation are other causes of hypoglycemia. In these cases, treatment targets the underlying cause.

Hormonal Deficiencies
Hormonal deficiencies may cause hypoglycemia. Shortages of cortisol, growth hormone, glucagon, or epinephrine can lead to fasting hypoglycemia. Laboratory tests for hormone levels will determine a diagnosis and treatment. Hormone replacement therapy may be advised.

Tumors
Insulinomas, insulin-producing tumors, can cause hypoglycemia by raising the insulin levels too high in relation to your blood glucose level. These tumors are very rare and do not normally spread to other parts of the body. Laboratory tests can pinpoint the exact cause. Treatment involves both short-term steps to correct the hypoglycemia and medical or surgical measures to remove the tumor.

WHAT CAUSES IT:

In puppies taking certain blood-glucose lowering medications, blood glucose can fall too low for a number of reasons:

  • meals or snacks that are too small, delayed, or skipped

 

  • increased activity or exercise

 

  • Stress
    Because epinephrine, one of the hormones that is activated by hypoglycemia, comes from the central nervous system, the majority of early symptoms of hypoglycemia are related to the nervous system.
     

     

  • excessive doses of insulin or some diabetes medications, including sulfonylureas and meglitinides (Alpha-glucosidase inhibitors, biguanides, and thiazolidinediones alone should not cause hypoglycemia but can when used with other diabetes medicines.)
  • excessive drinking of alcohol  (*don't laugh as I have known people to give their dogs alcoholic beverages - It's a BIG NO NO).

      ******* Basically anything that causes an increase in the metabolism that eats up the sugar reserve without the intake of food in which to produce the needed glucose.

WHICH PUPPIES ARE MORE LIKELY TO HAVE IT?

WITHOUT A DOUBT the smaller they are the more likely they are to be afflicted with hypoglycemia.

There is also evidence that supports that puppies from parents who were hypoglycemia as puppies are more likely to be hypoglycemic themselves.

Condition Occurring in Puppy-hood:

Yorkie Puppies often develop hypoglycemia. If they do, causes may include

  • Brief intolerance to fasting, often in conjunction with an illness that disturbs regular eating patterns. Puppies usually outgrown this condition by 16 to 20 weeks of age.

     

  • Hyperinsulinism, which is the excessive production of insulin. This condition can result in transient neonatal hypoglycemia, which is common in puppies of mothers with diabetes. Persistent hyperinsulinism in puppy-hood is a complex disorder that requires prompt evaluation and treatment by a specialist.

     

  • Enzyme deficiencies that affect carbohydrate metabolism. These deficiencies can interfere with the body's ability to process natural sugars, such as fructose and galactose, glycogen, or other metabolites.

     

  • Hormonal deficiencies such as lack of pituitary or adrenal hormones.
SYMPTOMS:  

Keep in mind that these symptoms can mimic other problems as well.

Common symptoms of hypoglycemia include the following:
  • hunger
  • nervousness and shakiness  (*trembling)
  • dizziness or light-headedness (*fainting possible)
  • sleepiness (*fatigue)
  • confusion (*circling)
  • difficulty barking
  • feeling anxious or weak (*anxiety)
  • Palpations (*Rapid heart rate)
  • Staggering
  • Laying on side with head thrown back and feet paddling.
  • Behavioral Changes
  • blurry vision
  • Irritable (*possible aggression)
  • Different size pupils
  • Muscle pain
Because the brain is deprived of glucose, a second set of symptoms follows:
  • Decreased alertness
  • Confusion
  • Headache  (*causing likelihood of aggression)
  • Seizures (*Convulsions)
  • Coma
  • Ultimately, death if not treated immediately.

 

Sugar level can drops when sleeping also:
The symptoms are:
  • cry out or have nightmares
  • excessive movement
  • awake irritable, confused or still sleepy
WHAT CAN WE AS BREEDERS DO?

The first thing that every breeder should do is be aware that hypoglycemia is a problem in the Yorkshire Terrier breed and should be of great concern and every effort should be made to not produce puppies that are so small in size that their own systems can not function properly thus putting their life at great risk.  This however is tougher to do than it is to say.

The second thing that every breeder should do is document and evaluate any of their breeding stock that consistently produces hypoglycemia offspring and remove those from their breeding program.

WHAT CAN A DOG OWNER DO FOR QUICK INTERVENTION:
  • Rub Honey or Syrup on the gums if dog is beyond swallowing  (*Temporary fix at best)
  • Give Glucose gel if available and on hand  (*Temporary fix at best)
  • If dog is alert enough to swallow give sugar water - (*heavy on the sugar) (*Temporary fix at best)

IMPORTANT - IMPORTANT - IMPORTANT

  • If dog is still alert enough to swallow it is very important that you get something into it's stomach that will up the glucose level such as APPLESAUCE, PUDDING, or BABY RICE CEREAL mixed with sugar water and a teaspoon of peanut butter.
  • If dog is not alert enough to swallow then try the honey or syrup on the gums and when puppy becomes alert enough food MUST BE of primary importance.

 

*** GOES WITHOUT SAYING BUT I'LL SAY IT ANYWAY ***

CONSULT YOUR VETERINARIAN IMMEDIATELY

 

WHAT CAN A DOG OWNER DO FOR QUICK INTERVENTION:

  • Rub Honey or Syrup on the gums if dog is beyond swallowing
  • Give Glucose gel if available and on hand
  • If dog is alert enough to swallow give sugar water - (*heavy on the sugar)
  • If dog is still alert enough to swallow it is very important that you get something into it's stomach that will up the glucose level such as APPLESAUCE, PUDDING, BABY RICE CEREAL mixed with sugar water.
WHO IS TO BLAME?
Blame is such a harsh word and sometimes nobody is to blame.  

There is no shame in producing a hypoglycemic puppy unless of course it was the result of deliberately producing the tiny puppies often called T-cups whose systems are just not capable of doing what nature intended them to do.  The shame is if you KNOW you are producing hypoglycemic puppies and have not taken steps to prevent it in the future.  EVERYBODY has problems in their lines with something and hypoglycemia is just another concern for those who breed Yorkshire Terriers.  Hypoglycemia however is one of those MAJOR concerns as it is life-threatening.  It is however, NOT something that everybody should assume is going to take them by storm and wipe out their bloodlines.

Breeders are to blame for 90% of the hypoglycemia Yorkie puppies born today due to their insistence of trying to produce smaller and smaller puppies who body can no longer function as nature intended. 

Once again let me repeat:

There is no shame in producing a hypoglycemic puppy.  The shame is if you KNOW you are producing hypoglycemic puppies and have not taken the first step to prevent it in the future.

I can assure you that the larger, more robust and healthy Yorkies have 90% less occurrence of Hypoglycemia in their litters than do the under 4 pound ones.

IS IT RUNNING RAPID IN YORKIES?

NO it is not running rapid in Yorkies but it has shown to be on the increase in the past 10 years.  The notice in increase is without doubt due to the determination of so many who are after the tiny $2000.00 puppies that they are willing to sacrifice the health of the animal to do so.

The Yorkshire Terrier however has shown to have a higher incidence of hypoglycemia than any other breed of dog. 

You have a far greater chance of receiving a puppy affected with hypoglycemia if it is what many refer to as T-Cup size.  Hypoglycemia is also life-threatening, to be sure, so I'd be more concerned about my puppy be affected by hypoglycemia than liver shunt.

TESTING:
Other Medical Issues that could cause Hypoglycemia other than Diabetes:

Medications:

Diseases:

Hormone:

Enzyme Deficiencies:

Tumors:

What age is Hypoglycemia Diagnosed:

Hypoglycemia can be diagnosed at any age.  The problem lays that very few puppies are found in time to get the medical attention that is needed so their death goes undiagnosed.

IN CLOSING:

Yes, hypoglycemia is a concern in Yorkies.  Hypoglycemia may or may not be genetic but everything leads us to believe that it CAN BE.  Hypoglycemia can however be caused by other outside sources and other medical ailments. 

There is no shame in producing a hypoglycemic puppy - the shame is not taking the first step to prevent it by raising the more healthy size to begin with.

Hypoglycemia is the NUMBER 1 killer of Yorkie puppies under the age of 20 weeks. 
 

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