Elderly Rott /w Low Blood Sugar

[BandTan]

Good morning,
3 weeks ago my male Rott was up at the cottage with us, outside, and his face started twitching and he was shaky and faltering. He was aware enough to lay down when I told him (I didn't want him hurting himself if he fell), he was panting really hard. This went on for about a minute. It was NOT a seizure. He really was "out of it" but after the minute he looked at me and it was like he was "back" and he was very confused about what was going on (where am I?). He wasn't overheated, he is generally very healthy. I kept him under close supervision and he seemed back to normal after the episode.
Last Thursday I came home from work and the first thing I do is take him outside. He starts doing the same thing! It was basically like he was shaky and weak on his legs, almost falling over. I called the vet and took him immediately. It passed after about 20 seconds, not near as long or intense as the first time. Because there was no acute problem we could focus on, the vet recommended blood tests as a start. He thought it might be thyroid.
Blood tests come back Saturday - all normal except for his blood sugar. Low normal is 3.6, his was 1.7 (his blood was taken 45 mins after the 2nd episode). I'm going for a follow up visit this coming Saturday (Cartrophen for mild arthritis in his left shoulder) and will talk to the Vet then in more detail.
I've started feeding him smaller portions 3 times a day, instead of twice a day feeds. Needless to say, he's seemingly well and happy. Anybody here have experience with dealing with hypoglycemia with their dog? Thanks.

[scooterjohansen]

Try brown rice it has a pretty slow glycemic index. Increase the protein and decrease the carbs. Watch excericse as this should not be make the dogs heart race. Do not give your dog any foods that contain sugar.

[Judi W]

There will be a "cause" or some underlying disease that is influencing this. I'd want a consult with the vet and also you will want to keep Karo syrup or something similar on hand. The increased feeding frequency might just handle it. Time will tell.

[BandTan]

[quote=Judi W]There will be a "cause" or some underlying disease that is influencing this. [\QUOTE]

Thanks for the feedback, I'll be very interested to speak with the Vet more about this. Indeed, this is usually the case - it's a symptom of something else.

I've seen lots of things with these guys over the years but low blood sugar is a first for me. Why, oh why do they have to get old?

[StephanieandToby]

Interesting. Toby had an incident just like that in the park one day. I made him sit down and he was fine after about 20 seconds and I gave him some cookies. When I asked the Vet he thought it might have been a small seizure...but it didn't really seem like it since Toby was aware of his surroundings and sit when I asked him to.
Low blood sugar would never have occured to me....I'll never know what it was........

[BandTan]

We received a very tragic diagnosis: Insulinoma. Due to his age we've decided to take a more passive treatment with steroids. I cannot put him through exploratory surgery and the recovery that goes along with that. Lots of fun things he likes to do, rides to the DQ, and cooking his favourite foods are in the plans.

This is what we're dealing with:
Insulinomas are functional beta-cell tumors found in the pancreatic islet cells.? Beta-cells are responsible for the production of insulin under normal conditions within the animal.? Glucose enters the beta cells independent of insulin and stimulates the secretion of insulin when blood-glucose levels are greater than 110 mg/dl and inhibits secretion when blood-glucose levels are less than 60 mg/dl.? Insulin is the hormone responsible for lowering blood-glucose by “driving” the glucose into tissue cells for utilization.? Dogs and cats are capable of euglycemia even when fasting, therefore, blood-glucose level less than 60-70 mg/dl are considered abnormal and there presence should warrant further diagnostics.

Most animals with insulinomas are middle age to older with the median age being 10 years.? There are no gender or breed predilections in dogs and cats but ferrets are usually male.? The duration of clinical signs is typically between 1-6 months with the most common being seizure, weakness, collapse and or ataxia followed by muscle twitching, lethargy and bizarre behavior.? Exercise, excitement, fasting and sometimes eating commonly evoke signs.? Physical exam finding are usually unremarkable with the most common finding being weight gain secondary to the anabolic effects of insulin. Insulinomas are malignant tumors with most have metastases either microscopically or grossly by the time clinical signs are present.? Frequent sights of metastases include intra-abdominal lymph nodes, liver, mesentery, and omentum with rare metastases to the lungs.

Neoplastic beta cells are capable of excess hormonal production of somatostatin, glucagons, serotonin, gastrin, pancreatic peptide as well as insulin.? Clinical signs secondary to insulinomas are due to hyperinsulinemia leading to hypoglycemia.? The CNS needs glucose to function properly; uptake of glucose by the CNS is insulin independent hence hypoglycemia leads to neuroglucopenia causing lethargy, weakness, ataxia, behavior change, seizures and coma.? Hypoglycemia also stimulates the release of counter-regulatory hormones (catecholamines and glucagon) causing sympathoadrenal stimulation producing muscle tremors, nervousness, restlessness and hunger.?

Diagnostics and Sonographic Findings
Diagnostically, the only consistent finding on the
chemistry profile with insulinomas is hypoglycemia with the median blood glucose = 39 mg/dl.? In many instances, blood-glucose levels may be within normal range.? If this is the case, check a fasting glucose, if the blood-glucose drops below 60 mg/dl check the insulin levels from the same blood sample, if they are normal or elevated an insulinoma is present.? Radiographs are usually normal because the tumors are small, but they are important to help rule out other causes of hypoglycemia such as acquired liver disease, Addison’s disease, and non-beta cell tumors (hepatocellular carcinoma, leiomyosarcoma).? They also help rule out metastatic disease to the lung or other organs before surgery is preformed. Abdominal ultrasound may not reveal the insulinoma because of its microscopic size but it is still extremely important diagnostic test to perform and should be performed on all animals suspicious of insulinoma prior to surgery.? Ultrasound may reveal enlarged lymph nodes, nodules in the liver or other organs.? When present, an ultrasound-guided fine needle aspirate or core biopsy should be preformed to rule out reactive vs. regenerative vs. neoplasia.

[sophie's-mom]

I'm sorry to read this.

What will the steroids do?

Is this manageable??

[BandTan]

Hi SOPHIES_MOM, I'm no expert but I'll try and explain.

Here goes: Insulin is a hormone that reduces blood glucose. It is produced by the pancreas in response to increased glucose levels in the blood. His blood sugar levels are extremely low (which causes the seizures he's been having). So the tumour is secreting too much insulin, despite the fact his blood sugar is actually very low.
He is extremely hungry (his body is telling him to eat, to raise his blood sugar). His body is not able to regulate his blood sugar levels properly, so even tho they're low, there is too much Insulin. This isn't the way it should be. Yet, he is hungry all the time. It's a catch-22 situation - very frustrating.
So we're approaching on two levels: smaller, frequent meals and steroids. Steroids actually raise blood sugar levels. The problem with steroids is that they have a whole other set of side effects, but, after much consideration, this seems like the most reasonable route for him as it will somewhat alleviate the seizure episodes (caused by low blood sugar). We have corn syrup on hand, all the kids and us are ready to rub it into his gums if he does seizure. He's still very happy and comical, just slowed down considerably. He's being spoiled rotten (as per usual) and that's the best we can do.
We have to focus on the wonderful things he has brought to our family, not on his illness. When he gets to the point that he's uncomfortable and unhappy, we'll do what we need to do. Until then, he's getting all the TLC we can muster.