Hypoglycemia or low blood sugar is a condition where the blood sugar level (glucose) drops to a dangerously low level in the body. It is a juvenile disorder that can occur in many toy breed puppies, usually from weaning to about 3-4 months of age. Pretty well all puppies with this affliction will outgrow the problem. However, some very tiny dogs (such as the abnormally small, so-called 'teacup' size) can continue to have 'attacks' throughout life.

Puppies prone to hypoglycemia are behind in their ability to regulate their blood sugar level. Stress, smaller size, missing a meal or picky eater, overplaying, vaccinations, cold, intestinal parasites, liver shunt and glycogen storage disease are some of the triggers that can precipitate a sudden drop in the sugar level.

Breeders should be aware that hypoglycemia can run in family lines, so knowing the family history should be taken into account.

Some of the signs of hypoglycemia include: listlessness, depression, staggering, muscles tremors, weakness and the classic pale/white gums. If allowed to continue, the puppy will go further into shock, have convulsions and finally a coma.

At the first signs of hypoglycemia, it is imperative to get the sugar level back up.

Karo syrup or Nutrical are good items to have on hand. In an emergency, honey, corn syrup, Gatorade or even table sugar will work in a pinch. If the puppy is unable to swallow, rub the substance directly onto the puppy's gums. Obviously, if the puppy is in trouble, go immediately to your veterinarian.

Once a puppy has had an attack, the goal is to adopt preventative measures in an attempt to keep the sugar level stable. Frequent small meals throughout the day and night and Nutrical if the puppy is going to be stressed, i.e. a visit to the vet, etc,

If despite all this the puppy continues to have frequent attacks, the veterinarian may need to do further tests to try and determine why this is happening.

Hypoglycemia is one reason why toy puppies should never leave their mothers at too young an age. The American Maltese Association members do not allow puppies to leave until at least 12 weeks of age. Some members will even keep the tinier ones until 4 months of age to ensure that they are eating well. Generally speaking, if a puppy has never had an attack while with the breeder and goes to a new home after 12 weeks of age, the chances of running into hypoglycemia are quite low.

Even if a puppy is sold that has had hypoglycemia, the outlook is good that it will outgrow it and be perfectly fine.