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Hypoglycemia - low blood sugar in dogs
Hypoglycemia
Hunting Dog Hypoglycemia
More Hunting Dog Hypoglycemia
Hypoglycemia possible
also see vestibular problems
also see Insuloma
HypoglycemiaQ: Dear Dr. Richards,
Thank you very much for the information on stroke and vestibular
syndrome. I have another question. (My Vet is still on vacation.) Is it
possible that my Yorkie's stroke-like symptoms could be caused by
hypoglycemia or an electrolyte imbalance? (She suffered a week long bout
of vomiting and diarrhea prior to her symptoms.) After this was suggested to
me, I started giving her a little sugar in her food and water. She does seem to be feeling
better and walking more normally. Although, she still seems to be a little
disoriented. If hypoglycemia is possible, what is the proper way to treat
this?Again, thank you very much,
Debra
A: Debra-
It is possible for disorientation, weakness and even seizures to occur with
hypoglycemia. Small breeds are more likely to become hypoglycemic from
illnesses than larger breeds but most older dogs do not have much problems
with this whether they are large or small. Older dogs do have problems with
insulin producing tumors of the pancreas sometimes, though. This is
probably the most common cause of hypoglycemia in older dogs. A temporary
fix is to feed several small meals a day rather than one or two large ones.
That would help until your vet got back. Then the best thing to do would be
a general lab panel or blood glucose test (but I'd run the whole panel most
of the time) and check for hypoglycemia. If it is present then checking
another sample is a good idea. Then checking the insulin/glucose ratio on a
blood sample would be a more definitive test for excess insulin.
Insulinomas can be treated surgically or medically but surgery has a chance
of curing the dog and medical treatment doesn't.Good luck with this. Peripheral vestibular syndrome clears up in most cases
spontaneously so response to therapy for other possible problems isn't a
good way to rule it out. Discuss all of this with your vet and I'm sure he
or she will help you make the right choice about how to go from here.Mike Richards, DVM
Q: Dr. Mike-
We have a male Red Beagle that was bred for hunting Snowshoe Hares. They are fast on the trail by comparison to standard Beagles. We purchased the puppy
at 6 weeks of age. He is now 10 months old and is a very intense and hard
hunting dog. He weighs 27 lbs., stands 15" at the withers, and is in
excellent physical condition. He had all of the necessary puppy vaccinations. He started running rabbits at 5 months old and was hunted about 4 days a week and had developed into an excellent hunter and trail dog, sometimes chasing a rabbit for 45 minutes.When he reached 8.5 months of age, he had a seizure when running a rabbit
trail that he had been on for about 30 minutes. When he went into a seizure
he exhibted the following symptoms:- Yelping like he was injured
- Mouth wide open with his tongue hanging out
- Eyes wide open, not blinking, not rolled back in his head
- Running in tight circles, running into the small bushes and treesOn occasion he would sit on his haunches. When we would call to him, he
would start toward us, then turn and run the other way. When we caught him
he continued to yelp. This seizure lasted approximately 3 to 5 minutes. His
gums were beet red in color. He was confused and afraid, and after the
siezure was over, he was completely exhausted for the rest of the day. Four
days later while hunting him he had another seizure on the third rabbit he
ran. He had the same symptoms, but this time he was also frothing at the
mouth. We took him to the local vet two days later for a complete physical
which included baseline blood work. Everything was "OK" and his glucose
level was 104.Several days later we took him back to the clinic which is on a farm, in
order to hunt closer to where we could have blood drawn. After a very short
run of 3 to 5 minutes on a rabbit, we pulled the dog off the trail and
immediately got him into the clinic for another glucose test. His level had
dropped to 41, and at that point he was diagnosed with Hunting Dog
Hypoglycemia. We have noted the only time this happens is when he is on the
trail of a rabbit. He can chase in our yard with the other dogs for 1/2 hour
without having a seizure. Our vet said to feed a high protein, high complex
carbohydrate, and high fat diet. Feed small meals (6 times per day), and
stop the dog in between rabbits and feed bread with peanut butter and honey.
The problem we have with this is that the dog will not eat in the morning,
or through the day. He eats only in the evening. When the dog is in the
field, he will not eat anything due to the excitement of the hunt. The thing
we do while in the field is squirt honey into his mouth with a squeeze bottle.There have been several changes in the dog's life just prior to the onset of
these seizures. We vaccinated with 7 way DHLPP-CV (he had 5 way DHLPP before this) we wormed with 1% Ivomec (0.3cc) instead of Panacur, the average
outside temperature increased plus 10 degrees, he was hunting on grass (no
snow) and the rabbit scent is much stronger on grass. There was no change in
the feed, or in the schedule of feeding (once per day in the evening)We have the following questions:
1) What can be done to eliminate the seizures when hunting?
2) Will he outgrow these problems?
3) Is there a medication that would eliminate this problem?
4) How long does it take ta complex carbohydrate to turn into the sugar he
needs?
5) Does fiber slow the breakdown of carbohydrates into sugar?
6) Is this problem hereditary?
7) If honey is fed just before hunting the dog , does the honey drive up the
insulin resulting in less sugar?
8) Can honey be fed during the hunt at one hour intervals to keep the dog
from going into a seizure?Unless we can come up with a better diet, we are going to try the following:
1 cup of fried hamburger
1 cup of Purina Dog Chow (27% protein, 9% fat)
1 cup white or brown rice
1/2 cup whole milk, mixed with aboveOnce the dog settles into the above diet, we will conduct another field test
to check the glucose level again. Just before hunting, we will squirt 1/2
ounce of honey into the dog's mouth, then put the dog on a rabbit trail for
15 minutes, stop, and immediately do a glucose level check. If his glucose
level is in the rage of 20 to 40 he will no longer be used for hunting.I have enclosed copies of his blood work and notes from our local vet.
Thank you in advance for any assistance you can offer. Our goal is that our
dog lead a happy, healthy life, which, if possible, will include being able
to hunt.Terri
A: Dear Terri
I have reviewed the records you sent and it is highly likely that your vet
has correctly diagnosed this condition and recommended proper treatment. In
most cases hunting dog hypoglycemia can be controlled by feeding small meals
or treats several times during the day of the hunt. No one I spoke with knew
of a way to handle this situation without being able to feed the dog several
times during the day. The only thing that bothers me is that hunting dog
hypoglycemia is more commonly reported to be an adult onset condition than a
juvenile onset condition.I spoke with the technical vets at Purina and at Hill's just to see if they
had a food recommendation. The Purina vet felt that their prescription diet
called "DCO" may be helpful due its composition but wasn't too confident it
would work well enough to resolve the problem without the benefit of small
feedings on hunting days. The Hill's vet felt that it was probably not
possible to find a diet that would work to resolve this problem without
multiple feedings on hunting days.I reviewed the information on the Veterinary Information Network and NOAH
and did not find anything that really seemed as if it would be helpful
except for a a suggestion for getting dogs to eat during hunting when they
are reluctant to do so. One vet had good success using Gaine's burgers or
similar soft/moist type foods since many dogs find them to be very
attractive and the propylene glycol in them may be beneficial for the
hypoglycemic condition. It is considered to be better to feed a regular
food, especially a carbohydrate based food, than to use a sugar based food
source such as candy, because of rebound insulin effects -- although there
are recommendations to carry candy to treat the seizure problems when they
occur anyway.I checked into hypoglycemia in human athletes using the PubMed site and
there was one article recommending carbohydrate loading the day before an
event and then using carbohydrate containing liquids (I forgot to save this
article so I can't reference it exactly but their recommendation was to
drink 100ml of the liquids every 30 to 60 minutes, I think. It should be
possible to cut that dose considering the size of a beagle, maybe to
something like an ounce at a time). It may be possible to condition your
beagle to drink these liquids instead of water on the days you want to hunt.
Also, I wouldn't rule out the high energy foods made for human athletes
(energy bar type things). It may be that one of these is sufficiently
attractive to make it worth a break during the hunt.Some dogs are reported to outgrow the hypoglycemia problem when it has an
early onset, so there is some hope for this as well. We have seen a hunting
dog that had a lot of problems with this and then less and less problems as
it got older but I don't recall the problem completely disappearing.This is a list of rule-outs for hypoglycemia. I didn't see any evidence for
any of these conditions in the labwork or history you sent, but it sometimes
helps to think about other possibilities. This list is from Dr. Chastain and
Dr. Ganjam's book "Clinical Endocrinology of Companion Animals":Hypoglycemia that first occurs in young dogs:
hepatic vascular anomalies (portosystemic shunts, microvasular shunts)
ketotic hypoglycemia from alanine deficiency
congenital hypothyroidism
glycogen storage diseases (there are several)Adult onset hypoglycemia
insulinoma
extrapancreatic tumors
liver disease
hypoglycemia of hunting dogs
late pregnancy or heavy lactation
intestinal malabsorption with weight lossUnassociated with age
bacteremia
hypopituitarism
hypoadrenocorticism
drug reactions or toxin exposure
sulfonylureas, insulin overdose, salicylates, ethanol, antifreezeIt is important to note that blood sugar levels drop pretty rapidly in blood
once it is drawn unless serum is promptly separated from the cells.
Sometimes blood that is separated in serum separator tubes will still
undergo a loss of glucose, since contact with cells can sometimes still
occur in these tubes. While this isn't likely to be a factor in the labwork,
it has to be considered.Of the differentials that are listed, there is one that you should probably
consider further testing for. Hypoadrenocorticism might be worth ruling out.
In many dogs, this condition will cause high potassium and low sodium levels
in the blood, which is not the case for your dog. However, there are also a
number of cases of hypoadrenocorticism in which bloodwork is essentially
normal. An ACTH response test would help to rule out hypoadrenocorticism.
There is probably a very small chance of a liver circulatory anomoly as
well. This is much less likely with the history and clinical signs you are
seeing but if you wish to pursue all the options it might be worth
considering a bile acid response test just to be sure that there isn't a
liver disorder.Hypoglycemia in hunting dogs is most commonly associated with dogs that are
infrequently hunted and are therefore thought to be likely to be out of
shape and not able to respond to a sudden need for efficient glucose
metabolism. This doesn't sound like your dog but there are cases reported
that seem to occur in dogs that are fit and exercised regularly.Some dogs with seizure disorders can be induced to seizure by excitement.
There is some chance that the hypoglycemia may be an incidental finding and
that a seizure disorder is present. If this is the case you should
eventually see seizure activity that is not related to excitement or hunting.Your questions were:
1) what can be done to eliminate the seizures while huntingYour vet's plan is the standard recommendation- stop and feed the dog
several times during the course of hunting. Since this isn't easy without
his cooperation I am hoping that one of the suggestions will work (
carbohydrate containing sport drinks, energy bar type treats or soft/moist
dog food like Gaines Burgers. If it continues to be impossible to get him to
eat it will be hard to control this problem if it is truly the hunting dog
hypoglycemia syndrome. I think it would be worthwhile to rule out
hypoadrenocorticism (Addison's disease) as well, since that is treatable.2) Will he outgrow these problems?
Maybe. Some dogs seem to just outgrow juvenile onset sugar regulation
problems. Also, working on conditioning him regularly, if that isn't being
done, may be helpful. It sounds like he is probably in good physical
condition, though.3) Is there a medication for this?
Not that I am aware of or can find reference to in the literature available
to me.4) How long does it take a complex carbohydrate to turn into the sugar he needs?
It takes a while, since carbohydrates are pretty much broken down into
disaccharides and monosaccharides to be absorbed into the digestive tract.
The advantage of complex carbohydrates is slower absorbtion which
theoretically leads to more efficient utilization. The idea is to make
glycogen (the form that the body stores sugar in) so that glucose is
available in times of need. When he is actually having a seizure due to
hypoglycemia it is much better to use simple sugars to provide the glucose
he needs --- corn syrup, sugar syrups (almost any pancake syrup), honey,
fruit juices and sugar solutions.There is another option in getting advice on this condition. You may want to
ask your vet to call a veterinary school or referral facility that has a
clinical nutritionist who can make suggestions for helping. I can make this
contact but they are going to need specific information which your vet would
be better at supplying.If none of this helps, the good news is that most dogs with this condition
do fine if they do not hunt or engage in high-energy activities. Even in
dogs in which hunting continues there does not seem to be a really high risk
of death from the condition, although it obviously is a risk and an
interference in their ability to work.Hope this helps some.
Mike Richards, DVM
Answer: Terri-
I misplaced the last page of your note and consequently overlooked the rest
of your questions. To sum up the answers to the rest of them:5) Does fiber slow the breakdown of carbohydrates into sugar?
It appears to. For this reason, moderate to high fiber diets are recommended
for diabetic patients in order to keep sugar absorption at slower rates
which should help in the regulation of insulin levels. There is still some
controversy over exactly how effective fiber is at this task but I think
most vets agree that it seems to help some. In theory, that same effect
should be beneficial for hypoglycemia from other causes.6) Is this problem hereditary?
I can not answer that question with certainty in regards to hunting dog
hyoglycemia. I have not seen are reference to heredity for this condition
but it is more likely that heredity hasn't been studied than that it has
been ruled out.7) If honey is fed just before hunting the dog, does the honey drive up the
insulin resulting in less sugar?This question is really hard to answer. This theory has definitely been
mentioned in the literature but recent studies in human athletes seem to
show that glucose levels may drop to levels that would ordinarily be
indicative of hypoglycemia without any clinical signs of low blood sugar
levels. So the question now is whether the drop in blood glucose noticed in
studies of sugar administration and exercise were actually normal or whether
they were induced by the added sugar. My personal opinion is that it
probably does not cause significant problems to give honey prior to hunting
and several times during the hunt.8) Can honey be fed during the hunt at one hour intervals to keep the dog
from going into a seizure.?I think so. This would match the recommendations to use carbohydrate
containing liquids for human athletes on an hourly basis during long
competitions.If you wish to use a diet other than a commercial diet or to make changes to
a commercial diet that are significant it is best to work with a clinical
nutritionist to ensure that the additions to the diet do not cause
imbalances in minerals or vitamins. If you are just going to use the
alternative diet the day before hunting as a way to try to achieve
carbohydrate loading it is less necessary to worry about this step.
Veterinary schools usually have clinical nutritionists and they are
generally very helpful. Your vet can call to review the proposed diet with a
nutritionist at the veterinary school in Wisconsin.I don't think that it is going to be possible to correct this problem with
dietary changes other than supplementing energy levels in some way on the
day of hunting, such as using honey, small meals or other supplements.
However, I am not a nutritionist and have been wrong about issues like this
before. If you hit on a successful formula for avoiding hypoglycemia it
would be great to know what it was.In your plan to evaluate blood glucose during hunting it would be best to
use blood glucose levels in a couple of your other beagles as "controls", if
possible. Checking blood glucose in three or four dogs under similar
conditions may make it easier to evaluate how low the glucose level is in
comparison to a "normal" level established among the unaffected dogs.
Otherwise, it will be hard to tell whether the drop is significant since it
is known that drops in blood glucose can occur during exercise without
inducing clinical signs of hypoglycemia even if they might normally occur in
a resting dog with similar glucose levels.Good luck with this. It is a challenging case.
Mike Richards, DVM
Q: I have a pekinese skipperke mix breed dog about 5 years old who started having what I think may be seizures. I took my dog to the veterinarian (we have been with this vet since the dog's birth) immediately after a seizure. Blood was taken etc... I am a Nuclear Medical Tech. retired and the more I see these seizures which are not daily but occur monthly I am getting the impression that my dog is having incidents of vertigo. After bringing this to the attention of the vet. I am dissatisfied with their response. Primarily due to the lackadaisical attitude of their not hearing what I am saying. Question ? How do I find out what a seizure (mild) response is in a dog? Is it similar or the same as I have seen in a human? Skipper's muscles stiffen as I have experienced dealing with human seizures but he does not lose his body functions or a has a loss of mental awareness. He spread eagles to the ground gripping the carpet and crawls to someone or to the wall and leans into it as if to stabilize.( for fear of falling?) After the incident passes, skipper vomits and then is fine. I asked the vet about possible allergies? No response negative or positive. I asked about vertigo. No response positive or negative. I treated him with that anti-flea pill from England and he had black loose bowel movements. When I took him to the vet..the vet stated that NO dogs tested had any reaction to the medication and it was completely safe. Excuse my french but bullsh-t. Anything chemically induced to sterilize a host flea has to have something reactable to it. My vet said To test this out I was to give skipper a second pill the following month. I told him to forget it. They took blood tests, physically examined my dog and x-rays for bowel problems and finally suggested exploratory surgery..that is when I guess you would call it.. I LOST FAITH in my vet. The seizure like incidents started about 6 months later. How do I find a good practicing vet in my area. Or is my medical background getting in the way of accepting my vets GOOD ADVICE?
A: I think that your vet should listen to you and should respond to your questions to the best of their ability. I just think that should be a part of the relationship that you should accept. The unfortunate thing in this case is that there may not be a good response. That always makes it hard for me to decide if someone is not responding because they don't want to say "I don't know" or if they are ignoring the question.
The problem is that I am not aware of a good way to decide if a dog has vertigo unless it has accompanying symptoms like nystagmus (rhythmic eye movement) or loss of balance. This is just one of those times when being able to ask what our patients are feeling would be really advantageous.
The other problem is that the symptoms you are describing differ slightly from a "typical" seizure, as you have already surmised. The most disturbing difference is the retention of consciousness and seeking comfort during the episodes. This would be unusual behavior for a seizure. Therefore, to me, it does make a lot of sense to look for other problems. In general, dogs do lose consciousness and they often, but not always, urinate or defecate during a seizure.
The first problem that I would want to rule out is hypoglycemia because the description of the episodes does sound more typical for this problem. Dogs seem to seek out something to lean on during hypoglycemic episodes and they often retain consciousness but exhibit signs similar to a seizure. In most cases, low blood sugar is detectable with this sort of problem if it is the cause but in some cases the hypoglycemia is transient enough to make detection difficult. In these cases it can be helpful to run glucose and insulin levels on the same sample and look at the ratio. The second thing I'd worry about is a heart problem. Muscle stiffness isn't usually seen with collapse from cardiac problems but I have talked to a cardiologist who said it can be seen. Usually dogs faint when they have heart conditions but weakness may be possible. Once I was satisfied that these conditions were not the problem and if the other blood work is normal, I think I'd be at a loss and be thinking about referral to a neurologist, if possible. I think I'd prefer that option to exploratory surgery unless I had a good idea of what I was looking for.
Allergies do seem to be able to precipitate seizure activity and they can mimic other conditions at times but it can be very frustrating to document allergic reactions of this type and I suspect it doesn't get done very often due to that.
The company that makes the flea pills (Program) does claim that there are no documented reactions to it, other than some dogs with gastric discomfort immediately after administration. At least they were saying that the last time I went to a seminar but that was a while ago. Ciba-Giegy seems like a reputable company to me but I tend to agree with you that all medications cause reactions in somebody. Sooner or later, we'll have an idea of what those reactions are. You should find a vet who you feel listens to you. Since you were previously happy with the vet you have, you might want to call and tell the veterinarian that you feel you haven't been listened to and see if that helps. Once in a while a client will tell me that --- and many times they are right. I am glad they have the faith in me to let me know and I try to do better!
Mike Richards, DVM
Last edited 01/30/05
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