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Testing for Low Blood SugarWhat might be causing low blood sugar in my pet?There are several conditions that may cause hypoglycemia
(low blood sugar, also known as low blood glucose), some of which are
more serious than others. Severe liver disease, hypoadrenocorticism
(Addison's disease), severe bacterial infection (sepsis), inadequate
nutrition in kittens and toy breed puppies, and some types of tumors may
all cause this abnormality. One of the more common tumors to cause
hypoglycemia is a specific tumor of the pancreas, called an islet cell tumor or insulinoma,
which produces excessive levels of insulin, thus lowering the blood
sugar level. Other tumors that may result in hypoglycemia include tumors
of the liver and smooth muscle. The clinical signs of low blood sugar may include episodes of weakness, collapse, and/or seizure activity.
Occasionally a low blood sugar concentration will be noted as an incidental finding when blood testing is done for other reasons. In this instance, we need to confirm that this laboratory finding was real. It is possible that the finding is a sampling artifact, due to consumption of glucose by red blood cells within the sample after the sample was taken. To rule this out, another blood sample will be collected into a special tube that prevents blood glucose consumption and the blood sugar will be re-measured. If this repeated sample is within the reference or normal range and your pet does not show any of the clinical signs that are typically associated with hypoglycemia, then we can be assured that the initial findings were erroneous.
How do we determine the cause of low blood sugar in my pet?A thorough history and physical examination may give us 'clues' as to the cause of low blood sugar in your pet. For example, the presence of physical examination findings such as jaundiced (yellow) gums will suggest the possibility of underlying liver disease, whereas the presence of a fever might indicate an underlying infection. Screening tests, including a CBC (complete blood count), a serum biochemistry profile, and a urinalysis, are also recommended.
What might these screening tests indicate?The CBC (complete blood count) provides us with an evaluation of the red blood cells, the white blood cells and the platelet components of a blood sample. A hematology (blood) analyzer will determine the total numbers of these cells, and evaluation of a blood smear will document the physical characteristics of these cells Anemia is indicated by decreases in the red blood cell numbers, hemoglobin, and packed cell volume (PCV) of a sample. Anemia may be a consequence of any chronic disease, including Addison's disease and liver disease.
Hypoglycemia related to a severe, underlying infection might be indicated by increases in the total white blood cell numbers as well as by increased numbers of immature white blood cells in circulation. The presence of underlying hypoadrenocorticism (Addison's disease) may be suggested by alterations in the proportions of specific types of white blood cells.
Increases in the liver related enzymes alanine aminotransferase (ALT), alkaline phosphatase (AP), and gamma glutamyltransferase (GGT) are suggestive of underlying liver disease. Decreases in glucose, cholesterol, albumin (a blood protein), and urea (a product of protein metabolism which is made by the liver and removed from circulation by the kidneys) are supportive of severe, chronic liver disease. Changes in the electrolyte composition may be suggestive of underlying Addison's disease. Electrolytes are salts and minerals found within the blood. Addison's disease causes altered electrolyte (sodium and potassium) ratios as well as decreases in blood sugar concentrations.
If your dog is suffering from an underlying pancreatic tumor (insulinoma) or other tumor, these screening tests may be essentially normal with the exception of the presence of hypoglycemia. What additional tests might be indicated for the evaluation of hypoglycemia?"Any additional testing depends entirely on the combined results of the history, physical examination, and screening tests." Any additional testing depends entirely on the combined results of the history, physical examination, and screening tests. If either underlying liver disease or a portosystemic shunt is suspected, then additional tests will include determination of serum bile acids.
Suspected Addison's disease will need to be confirmed by an ACTH stimulation test. Systemic bacterial infections (sepsis) are confirmed by culturing a blood sample so that the type of bacteria can be identified and appropriate antibiotic therapy can be started. In addition to finding a mass in association with the pancreas, simultaneous measurement of blood insulin and blood glucose concentrations may be used to confirm the presence of a pancreatic islet cell tumor. |
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