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Diabetes Alert Dogs

by Marie Rosenthal, MS

Breanne Harris, 25, first encountered a diabetes alert dog when she was a counselor at a camp for children with diabetes. Two people from Dogs4Diabetics, Inc., (D4D) — a nonprofit organization that trains assistance dogs to detect hypoglycemia in people with diabetes — brought an alert-dog-in-training to camp. Every night, the counselors would make midnight rounds to check campers’ blood glucose levels. In the dormitory, the dog tore free from the trainer, ran to one teenager, jumped on the bed, and tried to awaken the girl. “We checked her blood sugar immediately, and her sugar was 32 mg/dl, which is severely low,” says Harris, who has lived with Type 1 diabetes since she was 4. “I was sold at that point and applied for a dog.”

Kristen Beard, 24, who also has Type 1 diabetes, got a golden retriever puppy named Montana when she was about 19. One night Montana would not leave her alone as she slept. “He was crying and pawing at me. I was mad because he woke me up, but once I became aware, I thought maybe I should test my blood sugar. I tested it, and it was low,” Beard says. “I thought it was a fluke, but he started doing it regularly.” Now he wakes her at least twice a month to warn about her falling blood glucose. “He just started doing it on his own, and I reinforce the behavior with treats,” she says.

Veterinarian Nicholas Dodman recalls a client who had a German shepherd that was afraid of men, including the woman’s husband. The dog would avoid him even if they were in the same room. But one night, the dog woke him. The man realized that his wife, who had diabetes, was becoming hypoglycemic. After that, if the woman’s blood glucose dropped dangerously low, the dog would overcome his fear and wake up the man to help her.

“It was the only time he would go near the man,” says Dr. Dodman, professor and program director of the animal behavior department at Tufts University Cummings School of Veterinary Medicine in Massachusetts. “He saved her life several times over.”

Diabetes alert dogs, which warn people with diabetes when their blood glucose reaches dangerously low levels, are relative newcomers to the assistance dog scene, but they are making a real difference. In Beard’s case, a dog enabled her to live independently for the first time in her life. “Diabetes was a huge strain on my friends and my family before I got the dog,” says Beard, who has been living with diabetes since she was 7.

How do they do it?
The obvious question that everyone asks is how a dog can tell when a person is hypoglycemic, or has low blood glucose. The answer: They probably smell it.

“With its superior sense of smell and good ability to read body language, a dog can be taught to react to different situations,” says Dr. Dodman, the author of several books on animal behavior, including If Only They Could Speak (W.W. Norton & Co., 2002). “A diabetes alert dog picks up on an odor, and he is trained when this particular smell is around to alert his owners, because he will get a food treat.”

When a person has hypoglycemia, there is not enough glucose to make his brain function properly, so the body releases chemicals to raise blood glucose levels. If the body cannot raise the blood glucose level on its own, the person may become confused, pass out, have a seizure, or even die. Doctors usually recommend treating for hypoglycemia when a person’s blood glucose level falls below 70 mg/dl.

Among the chemicals the body releases in response to hypoglycemia are ketones. And just as narcotics dogs can smell drugs and search and rescue dogs can smell bodies, diabetes alert dogs appear to be able to recognize the unique odor of ketones, as well as of other chemicals released by the body.

“As your blood sugar starts to change, your biochemistry starts to change as well, and that biochemistry change releases a scent that they can pick up,” says Harris, who now works for D4D in California, where she got her alert dog, Destiny.

Training the dogs
Destiny was among the first dogs that D4D trained, so she uses an older, more physical alert style. The dog puts her paws on Harris or jumps on or nudges her when her blood glucose starts to fall.

“Today, we train them to pick up a bringsel, which is like a stuffed toy about 5 inches long. It hangs from the dog’s collar or the person’s belt loop, and the dog is trained to pick that up to get the person’s attention. If it is on the belt loop, the dog will pull and the person will notice. If it is on the collar, the dog will pick it off its collar and then make physical contact. The idea is that the bringsel is a clear alert, so you can’t mistake the signal,” Harris says.

Service dogs tend to be smart, trainable breeds that love to be around people, love to work, and want to please their owners, according to Dr. Dodman. “Service dogs in general are very smart, and they can be trained to focus on the job at hand. They can learn and observe.”

Today, black and yellow Labrador retrievers and golden retrievers are among favorite service breeds, but many organizations still use a fair share of German shepherds and other herding breeds.

D4D does not breed its own dogs. Instead, it takes dogs as donations from other programs that are members of Assistance Dogs International (ADI), a coalition of not-for-profit organizations that train and place assistance dogs; ADI has developed standards and ethics for the training of such dogs. A dog may be donated to D4D when it has the right temperament to be a service dog but cannot serve a particular group or function for some reason. For instance, some dogs have a weak trachea, which makes them cough when they wear a guide dog harness. That would be unacceptable in a guide dog for the blind, but it would not be a problem for a diabetes alert dog, because alert dogs don’t need to wear harnesses.

Certified diabetes alert dogs do, however, wear jackets that show the public they are working dogs. As such, they are permitted by law in places that serve the public, such as restaurants and movie theaters. “I think everyone who has an assistance dog or is a puppy raiser for an assistance program runs into someone who doesn’t understand the law, but that is an opportunity to educate. People in our program carry information so that they can give it to people who don’t know about the dogs,” says Harris, who takes her dog everywhere.

Because there are not enough dogs for everyone with diabetes who wants one, most programs place dogs with people who use insulin, since they are at higher risk of developing severe hypoglycemia. Harris says that D4D gets at least 10 applications for every service dog it trains.

“Our dogs are literally lifesavers [for people who] are insulin dependent,” Harris says.

Diabetes alert dogs are initially trained to behave correctly in public and to cope with noise, traffic, crowds, traveling, etc. According to Sharon Scott, director of training at Paws for Diabetics, Inc., in Australia, “All service dogs can handle the noise and stress of a busy shopping center or workplace. Special training goes into dogs who attend school or an office every day to be quiet, patient, and out of the way of fellow students and work associates. The dog’s temperament, breed, and health are important, so that they are in the best position to cope with the rigors of their job.”

The actual training methods used by various organizations are intellectual property, says Scott, who was reluctant to give particulars, but the training is similar to any sniffer dog training. “Much of the reliability for the dogs to alert comes from the bond that develops between the dog and its handler, as evidenced by pet dogs learning when their owners are not well without any training at all,” she says.

At D4D, dogs come into the program when they are about 18 months old, already knowing how to behave in various public situations and around all types of people. D4D teaches the dog to sniff out low blood glucose. Once the dogs are ready, their new owners with diabetes receive two weeks of training with the dogs. “It is a fairly intensive training class,” says Harris. “We work with people who have all types of experience with dogs, from none to a lot. You have to learn to think like a dog.”

The owner is expected to continue to work with the dog when they go home. “Dogs are not machines,” Harris says, “so they may miss a certain percentage of low blood glucose incidences at first, but as the bond grows between the team members, the dog will begin to alert more and more accurately. Usually, they start alerting very well once they get comfortable in the new surroundings, the home, the school, work. And as they get more comfortable with their person, it gets very accurate.”

Costs of ownership
A trained diabetes alert dog is worth about $25,000 when you tally up the costs of breeding, veterinary visits, training — both before being placed and with the new owner — and follow-up services after a dog has been placed. Few health insurance companies cover the costs of diabetes alert dogs, because their effectiveness has not been proven in scientific studies. Harris hopes that the research D4D is doing will change that. D4D does not charge for the dogs it places, but it does charge an application and service fee of about $150. However, D4D currently serves only a handful of western states. Other dog-training organizations have different policies, and some charge a fee for the dog.

Even if the dog is free, there are still costs associated with keeping it. Dogs need food, for example, and regular veterinary care. They also need to be walked and taken care of generally throughout their lives. In the United States, the expenses of buying, training, and maintaining a guide dog or service animal can be deducted as a medical expense on one’s tax return. But, as with human medical and dental expenses, only the dollar amount that is more than 7.5% of a person’s adjusted gross income can be deducted.

Choosing a trainer
A handful of trainers currently train dogs to sense hypoglycemia, and some say their dogs are trained to sense high blood glucose, or hyperglycemia, as well. But because this type of dog training is relatively new, and because most organizations will not divulge exactly how they do it, people interested in acquiring a diabetes alert dog must do some careful research before paying for or adopting a dog. Breanne Harris offers the following suggestions:

  • Look for organizations that are either accredited with Assistance Dogs International or members of the International Association of Assistance Dog Partners. Read up on what each organization requires from its members, and see how the organization or trainer in question compares.
  • Look for organizations that use positive reinforcement training methods.
  • Don’t get a dog from a trainer or organization that will not allow you to visit the training facility (and kennels, if they use them).
  • Spend time with the trainers and staff, and ask questions.
  • Meet or speak to other clients or customers, if possible.
  • Search the Internet to see what other people’s experiences have been with a group or trainer.
  • Ask the trainer about follow-up support: What is provided, and how?

Here is a list of organizations that can help answer your questions and start your search.

Living independent lives
Harris received Destiny, a small black Lab, four years ago while she was attending the University of California, Davis, where she was studying neurobiology, physiology, and behavior. Originally, she wanted to be a physician, but now she is thinking about graduate school for nursing. In the meantime, she works at D4D helping to support studies to demonstrate the effectiveness of the dogs.

“At first, I thought she was just this goofy dog, but after the first two weeks, I realized that she was stubborn just like me. She’s smart, she’s feisty, and she loves to play. She’s the perfect dog for me.”

Originally from Texas, Kristen Beard attends the University of North Carolina. She is a professional musician who plays the viola. She says her parents were very concerned about her attending school so far from home, but Montana has helped her live an independent life.

Both women talk about how scary it is to have “a really bad low,” and how the dogs have changed their lives.

“I don’t have trouble feeling low blood sugars during the day, but my blood sugar would drop really low at night, and I would pass out. He has definitely saved my life several times,” Beard says.

“Before I got Destiny, I could expect to have a blood sugar in the 40s every other day. Since I got Destiny, I hit the 50s maybe once a month. I was diabetic for so long, I was often unaware when my sugar was falling. During the days, I feel my lows better now,” Harris says, adding that Destiny also tells her when her blood glucose level is too high.

An unexpected benefit of a diabetes alert dog, adds Harris, “is you have this unique support system. It is especially nice for teenagers. When mom or dad tells you to check your blood sugar, it is a nagging thing; it is a negative thing. But when it is a dog telling you to check your blood sugar, it is a training exercise for the dog. It is a positive thing because you get to be excited for the dog.”

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