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Differential Diagnosis: Hypoglycemia

Shanna Hillsman, LVMT, University of Tennessee

M. Katherine Tolbert, DVM, PhD, DACVIM (SAIM), University of Tennessee

Endocrinology & Metabolic Diseases

|September 2018|Peer Reviewed

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Differential Diagnosis: Hypoglycemia

Following are differential diagnoses, listed in order of likeliness, for patients presented with hypoglycemia.

  • Spurious (eg, storage artifact)
  • Neonates (typically <6 weeks of age; normal finding or related to another condition [eg, portosystemic shunt])
  • Toy-breed puppy (can occur in healthy puppies when fasting or if no access to nursing)
  • Exogenous insulin overdose
  • Hepatic failure
  • Portosystemic shunt
  • Hypoadrenocorticism
  • Sepsis
  • Systemic inflammatory response syndrome
  • Insulinoma
  • Xylitol toxicity
  • Paraneoplastic syndrome (eg, leiomyoma/leiomyosarcoma, hepatoma)
  • High-intensity exercise
  • Pituitary dwarfism
  • Glycogen storage disease
  • Renal glucosuria
  • Polycythemia
  • Oleander toxicity
  • Amphetamine-dextroamphetamine toxicity
  • Trypanosoma congolense infection (only in specific geographic regions)


For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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