Hypoglycemia

MUHAMAD AKMAL B. NOOR EZAT D09A014

DEFINITION
Hypoglycemia, also called low blood glucose or low blood sugar, occurs when blood glucose drops below the normal levels

PATHOPHYSIOLOGY
First defense is decrease in insulin secretion
Glucagon and epinephrine then stimulate hepatic

glucose production Glycogen reserve is limited and will be reduce in number after 24-48 hours of fasting With continued fasting, gluconeogenesis becomes primary source of glucose

 Mechanisms responsible for hypoglycemia:

Excess insulin or insulinlike factors (e.g., insulinoma, extrapancreatic paraneoplasia, and iatrogenic insulin overdose) Reduction of hormones needed for maintenance of normal serum glucose (e.g.,hypoadrenocorticism) Reduced hepatic gluconeogenesis (e.g., hepatic disease and glycogen storage diseases) Excessive utilization (e.g., hunting dogs and pregnancy) Reduced intake or underproduction (e.g., puppies and kittens, and severe malnutrition or starvation)

Systems Affected
Nervous- blood glucose levels that are way below

the safety levels will cause the body to look for alternative sources of energy and brains starving from sugar will shut down essential body processes that it may deem the least important, resulting in abnormal responses and behavior that the patient cannot control or resist. Musculoskeletal- Cells of the skeletal muscle rely heavily on a readily available and balanced supply of this fuel (glucose) in order to produce the energy needed for many basic functions.

Signs and symptoms of low blood sugar are:

Convulsions or seizures

Coma
Lack of energy Weakness

Head tilting
Hunger Restlessness

Drowsiness
Shivering

 Weight gain depression

Disorientation
Stupor- a state of near-unconsciousness Ataxia - meaning the body is out of balance;

wobbling when walking; usually lack of muscular coordination, but maybe changes in head and neck movements Some animals appear normal aside from findings associated with underlying disease.

Head tilting

Weight gain

depression

stupor

ataxia

Common causes of low blood sugar are:

1. Meal spacing (not eating often enough)

2. Lack of protein
3. Reduced glucose formation or storage

4. Seizures
5. Exercise

6. Insulinoma: Insulinomas are tumors of the insulin producing cells in the pancreas.
7. Insulin overdose: An excess of insulin can also occur in diabetic animals on insulin injections if the dose is inappropriate. 8. Hormone function: Abnormal functioning of the hormones can cause low blood sugar, as can the inability of the body to store adequate amounts of blood sugar. It may also be caused by the reduced ability of the liver to produce glucose or store glycogen.

TREATMENT
Animals with clinical hypoglycemia and whose underlying disease needs support should be treated as inpatients. If able to eat (i.e., responsive, no vomiting), feeding should be part or all of initial treatment for hypoglycemia. Surgery is indicated if a portosystemic shunt or insulinoma is the cause of hypoglycemia.

The following nutrients have been shown to help normalize blood glucose levels:
Chromium. It has multiple effects on insulin

levels. Its also have ability to lower blood sugar levels at higher doses by increasing insulin sensitivity. Chromium also can help enhance glucagon secretion N-acetylcysteine. N-acetylcysteine (NAC) is a protein amino acid that has antioxidant properties. It act by preventing the rapid loss of glucose. oral consumption of glucose or sucrose

MEDICATIONS
DRUGS AND FLUIDS Emergency/Acute Treatment In hospital-administer 50% dextrose At home-do not attempt to have the owner administer medication orally during a seizure; If a short seizure has occurred and ceased or other signs of a hypoglycemic crisis are present, recommend rubbing corn syrup or 50% dextrose on the buccal mucosa followed by 2 ml/kg of the same solution orally once the patient can swallow. Then, seek immediate attention. Frequent feeding of a diet low in simple sugars or, if unable to eat, continuous fluid therapy with 2.5% dextrose should be initiated.

 Long-Term Treatment

Hunting dog hypoglycemia-feed moderate meal of fat, protein, and complex carbohydrates a few hours before hunting. Snacks (e.g., dog biscuits) can be fed during the hunt every 3-5 hours. Toy breed hypoglycemia-increase the frequency of feeding Puppy and kitten hypoglycemia-increase the frequency of feeding (i.e., nursing or hand feeding) Other causes of hypoglycemia require treatment of the underlying disease and do not usually need long-term treatment.

Lifestyle Changes for Hypoglycemics

Foods high in rapidly absorbed sugars should be

avoided. Alcohol, caffeine, tobacco, and other stimulants should be avoided because they are capable of precipitating a hypoglycemic attack. Small meals taken often during the day are recommended to control the amount of carbohydrates entering the system and to prevent rapid declines in blood glucose levels.

REFERENCES
http://www.canine-epilepsy-guardian-

angels.com/hypoglycemia https://www.vetconnect.com http://www.lef.org/metabolic_health

Thank you