In June of 2016, a four-hour old cria presented to Cornell’s Large Animal Internal Medicine Service for severe hypothermia and inadequate colostrum intake following a six-week premature birth. Initial diagnostics indicated a severe hypoglycemia, a moderate hypoproteinemia, a mild leukopenia, and a mild anemia. She was presumed to be septicemic. The presentation of this case focuses on the management choices that were made to address the cria’s severe hypoglycemia, and persistently poorly regulated glucose levels. An emphasis is placed on the physiological mechanisms for glucose regulation as well as differentials for the cria’s hypoglycemia. The provision of parenteral nutrition, and the occurrence and management of neonatal sepsis are acknowledged in the context of the influence that both had on the cria’s hypoglycemic state and the ultimate outcome of the cria’s case.