Hypoglycemia
Hypoglycemia is low blood sugar that affects the central
nervous system.  It is mostly a concern for the small
breeds.  Stress is the leading cause.  It can cause death
so do not take this lightly.

Another major cause is not feeding your puppy often
enough.  This is why I tell you to feed your puppy 4 times
a day but I highly recommend that you leave the food out
all day and let your puppy eat when he is hungry.  That way
you are leaving nothing to chance.
If your puppy is getting low blood sugar, you will first
notice that he is listless and lethargic.  Get something
sugary on his gums and
immediately call the vet.  
These are the best choices in order: honey, pure
maple syrup, karo syrup or sugar.

There is usually no warning and missing a meal or not
having water can trigger it.  Also, as stated above, it
is important to reduce the stress for your puppy as
much as possible.

The symptoms will continue on with muscle weakness,
vomiting, diarrhea, tremors, seizures coma and then
death.  It can be quick.
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How to Tell if Your Puppy Has Hypoglycemia