Maltese nutrition: puppy blood sugar, gums and liver shunts

The American Kennel Club standard puts an adult Maltese at under 7 pounds (about 3.2 kg), with a life expectancy of 12 to 15 years. Nearly every feeding decision for the breed follows from that size. A Maltese puppy that eats poorly for a day can run low on blood sugar. Small, crowded mouths collect plaque, and in UK primary-care records of more than 22,000 dogs the odds of a periodontal disease diagnosis fell steadily as adult bodyweight rose, so the smallest dogs carried the most risk. The breed also has a higher rate of congenital liver shunts than dogs in general.

Low blood sugar in puppies

Maltese are among the toy breeds named in Veterinary Partner's guidance on hypoglycemia. Very small puppies often get their chewing teeth late, lose body heat easily and eat less as a result, and a puppy that eats less struggles to keep its blood glucose up. The brain depends almost entirely on glucose, which is why the signs are neurological.

• Early: listlessness, unusual quietness, reluctance to play or eat
• Worsening: wobbliness or incoordination, feeling cold to the touch
• Severe: collapse, loss of consciousness, seizures

Infection, diarrhea, parasites and stress all use up sugar faster, so a Maltese puppy that is unwell for any reason is at higher risk. A liver shunt can also cause low blood sugar, since the liver helps regulate it, and a liver function blood test rules that out.

Calories and meals

Toy-breed puppies may need four to six meals a day, with soft or moistened food if they have few teeth. The number of meals drops as the puppy grows, and most adult Maltese do well on two or three. For quantities, the Merck Veterinary Manual formula is a reasonable place to start. Resting energy requirement (RER) is 70 × body weight in kg to the power 0.75, multiplied by 1.6 for a neutered adult, 1.8 for an intact adult and 1.4 for a dog that gains weight easily. Puppies under four months get 3 × RER and older puppies 2 × RER, calculated on current weight.

Individual dogs can need quite a bit more or less than the formula suggests. A kitchen scale for the food and a regular weigh-in for the dog are the practical tools. Treats and chews should come out of the daily total. At 250 kcal a day, two or three small biscuits can amount to a sizeable share of what the dog eats.

Teeth and gum disease

Periodontal disease starts with plaque along the gum line and progresses to inflammation and loss of the tissue that holds teeth in place. The UK study found an overall one-year diagnosis rate of 12.5% across all dogs, with the risk climbing as bodyweight fell. Records like these mostly reflect what a vet can see in an awake dog. A review of the published studies found prevalence between 44% and 100% when dogs were examined under anesthesia, far above the primary-care figures. Retained puppy teeth add to the crowding and are worth checking once the adult teeth are in.

Food can help a little and hurt a little. Kibble sized for toy breeds gets chewed rather than swallowed whole, and treats that are sticky or sugary leave residue on the teeth. Neither replaces brushing. Daily brushing with a canine toothpaste, started in puppyhood so the dog accepts it, does more than any diet, and most Maltese will also need professional cleaning under anesthesia at intervals set by the vet after examining the mouth. Bad breath, red gums, dropping food or chewing on one side are reasons for a dental check.

Tear staining

The reddish-brown marks under a Maltese's eyes come from tears overflowing onto the face instead of draining through the tear ducts. According to VCA Animal Hospitals, the overflow, called epiphora, is a symptom with many possible causes. Tear production rises with conjunctivitis, allergies, abnormal eyelashes, rolled-in eyelids, corneal ulcers and glaucoma. Drainage can fail when hair around the eye blocks the duct openings or debris plugs the duct itself. A vet exam comes first, because some of those causes are painful or threaten the eye.

Once those are ruled out, the staining is often cosmetic. Keeping the area clean and dry and trimming the hair short around the eyes helps. Low doses of antibiotics are no longer recommended for tear staining because they encourage resistant bacteria. VCA notes some evidence that daily probiotics can help, although improvement takes a couple of months. Over-the-counter tear-stain products have not been proven effective in research trials, and anything containing hydrogen peroxide should be kept away from the eyes. If staining started alongside itchy skin, ear problems or digestive upset, a food allergy is worth discussing with the vet, since allergies are among the listed causes of extra tear production.

Liver shunts

A congenital portosystemic shunt is a blood vessel that routes blood from the gut around the liver. Toxins the liver would normally clear, including ammonia from protein digestion, circulate instead. In North American teaching hospital records from 1980 to 2002, shunts were diagnosed in 1.6% of Maltese, against 0.18% of all dogs and 0.05% of mixed breeds.

The most common signs are stunted growth, poor muscle development, disorientation, staring into space, circling, head pressing and seizures, with the behavioral ones sometimes appearing only after a high-protein meal. Heavy drinking and urination, vomiting and diarrhea are less common, and some dogs show no signs until they are older. Crystals in the urine can be a clue. A bile acid test is the standard screen, and many shunts can be corrected surgically.

Diet for an affected dog is the vet's decision. VCA's overview of the condition says the ideal diet has not been firmly established. The emphasis has moved away from strict protein restriction and towards highly digestible protein. Soy-based rather than meat-based diets and limits on copper and manganese have also been recommended, though VCA says more research is needed. Lactulose is commonly added to reduce ammonia absorption from the gut. After surgery a protein-restricted diet is usually continued for six to eight weeks or more. Maltese without a shunt do not need a liver diet.

The coat and fussy eaters

The long white coat does not need special nutrients beyond what a complete and balanced food already supplies: good-quality protein, essential fatty acids and zinc. A coat that turns dry or thin on a complete diet is a reason to look for skin disease, parasites or hormonal problems before reaching for supplements. Fish oil and similar products are dosed by body weight, and a capsule meant for a 30 kg dog is far too much for a 3 kg Maltese.

Maltese have a reputation for being picky. In a toy breed the usual advice for fussy dogs, taking the bowl away until the dog gets hungry, is risky, especially in puppies, because of the blood sugar problem described above. Gentler approaches work better. Feed at set times, warm wet food slightly to strengthen its smell, or mix a spoonful of wet food into kibble. A Maltese that was a good eater and suddenly stops needs a vet visit, since dental pain and nausea can both put a dog off its food.

Sources

1. Maltese dog breed information. American Kennel Club.
2. Epidemiology of periodontal disease in dogs in the UK primary-care veterinary setting. Journal of Small Animal Practice, 2021.
3. Hypoglycemia (low blood sugar) in toy breed dogs. Veterinary Partner, VIN, revised 2025.
4. Nutritional requirements of small animals. Merck Veterinary Manual.
5. A review of the frequency and impact of periodontal disease in dogs. Journal of Small Animal Practice, 2020.
6. Eye discharge (epiphora) in dogs. VCA Animal Hospitals.
7. Association of breed with the diagnosis of congenital portosystemic shunts in dogs: 2,400 cases (1980-2002). Journal of the American Veterinary Medical Association, 2003.
8. Portosystemic shunt in dogs. VCA Animal Hospitals.