I still remember the very first diabetic alert dog I placed. It was for a young 30 some years old man, Dustin, who suffered from loss of vision and mobility issues. A hyperglycemic episode caused him to have a car accident and put him in a coma. I didn’t know much about diabetes at the time, but as I worked with him, I quickly learned how difficult Type 1 diabetes can be to manage. Since then, my experiences with so many diabetic patients have led me to feel compelled to do as much as I can to help with this complex and debilitating condition.
Diabetes is so common, that we have unfortunately become somewhat desensitized to its severity. But despite modern technology, Type 1 diabetic patients still endure much stress and many limitations every day of their life. And it’s not only the patient who suffers – the entire family has to become involved in the management of the constant ups and downs of the person’s unruly glucose levels.
At 17, Amy thought she might never be able to leave her parent’s house. George, a 65-year-old veteran, would only fall asleep once he couldn’t fight it anymore, out of fear that he might never wake up again. Martin, an 8-year-old, was so traumatized by his hospital emergencies that he stopped talking to anyone else but his parents. Stories like these are everywhere. Yet, even with state-of-the-art continuous monitoring systems, diabetes remains scary and dangerous.
So why a dog? What could a dog possibly do better than modern medicine? First of all, a diabetic alert dog will never and should not replace medical technology for managing one’s glucose levels. But a diabetic alert dog can offer another layer of safety and peace of mind with a few extras that technology will never provide.
Dog training for medical detection
When it comes to the alerts, dogs can be trained to react to a particular smell that is released during a hypoglycemia episode. We know that because we were able to verify it through a study we published in 2015. With skin swabs and breath samples that we collect from our clients, we can teach the dog to let them know whenever their glucose levels are out of range. In training, we focus on the hypoglycemic episodes, but after placement, the dog will be encouraged to alert to both hypo and hyperglycemic events. The dogs learn to give vigorous nose pokes to whatever area of the person’s body they can reach. This is a unique and distinct behavior that their person will recognize. It’s also a behavior that the dog can keep up and even escalate if the person is asleep.
We in fact found that many of our dogs would start alerting 5-15 minutes before the continuous glucose monitors (CGM) detected a change, which can give some additional time to prepare and adjust to the imminent event. But even when the dog’s alert is synchronized with the CGM, the dog’s demand for attention and need to be reinforced for its alert is much more difficult to ignore than the CGM. A child involved in a video game or a person focused on their work might be tempted to put off reacting to the CGM. When seconds turn into minutes, that can lead to a medical event. With a dog, you don’t have the option to put things off. The dog will insist and become pesky if you don’t react fast. The dog’s training will also be affected if his person ignores the alerts, so there is more at stake – putting off an insulin boost or a snack is no longer an option.
Glucose levels are difficult to predict and control. If food alone was the determining factor, calculating the calories and glycemic index of everything ingested might be enough. But in reality, there is much more that can impact the rise and fall of glucose levels. Lack of sleep, exercise, emotions, stress … Not to mention the endless temptations of a birthday cake or doughnuts at a staff meeting. And a person with Type 1 diabetes can experience a sudden drop or a dangerous spike in glucose levels. Living with diabetes is not a walk in the park!
Sleep can be particularly difficult for a person with Type 1 diabetes. Some don’t wake up to the sound of the CGM, while others can’t tolerate the permanent presence of a catheter and must set an alarm to wake up and prick their finger in order to get a reading. Many will choose to reduce their insulin injection to avoid a dangerous drop in glucose while they sleep. As a result, their glucose levels might stay high for many hours, leading to long-term health consequences. Dogs can help wake up a person or get help in the middle of the night. A dog can poke, lick or tug on the person’s sleeve to wake them up. When that doesn’t work, a dog can run to the other room to get help or press a button connected to a cell phone or 911. Diabetic alert dogs are also trained to fetch objects, such as glucose tabs, a drink or a phone when the person is not feeling well.
It’s important to note that night alerts can never be guaranteed 100% with dogs either. But combined with the other protocols in place, a dog can provide significant peace of mind and better sleep.
A diabetic alert dog (DAD) also comes with some other advantages. That is of course only if you love dogs. If you don’t enjoy their company and might be burdened by the extra work, a service dog is not a good option. In the long run, the relationship is bound to lead to tension and both you and the dog will suffer. But if you’re a dog lover and see dogs as a positive in your life, despite the hair on your clothes and furniture, the forced walks, the trips to the vet, and added costs, then a diabetic alert dog could help you in more than one way.
Dogs have been shown to help reduce stress levels. Having a dog not only forces us to get up and move, which is always a good way to burn off some steam but just being in the presence of a dog elevates our mood. Studies have shown that petting a dog can reduce blood pressure and increase oxytocin (Odendaal, 2000) and that animal-assisted therapy can have as many benefits as cognitive behavior therapy (Nepps & al, 2011). Therapy dogs can contribute to reducing anxiety and stress and, overall, dog owners are healthier than non-dog owners. They score lower for psychosomatic symptoms and stress and higher for general health, vitality, and absence of pain. So in addition to alerting to changes in glucose levels, a service dog can and often does make a difference in a person’s overall health and well-being.
Overall, a well-trained diabetic alert dog can make a big impact in the life of a person with Type 1 diabetes, serving as an alert system, but also a helper and companion. Many diabetic patients report healthier A1C levels after living with a DAD and more independent life. After getting her diabetic alert dog, Amy was able not only to go to the university of her choice but also to travel abroad with Juniper.
At Medical Mutts Service Dogs Inc., we specialize in training diabetic alert service dogs. We provide fully trained dogs as well as teaching owners to train their own dogs as their diabetic alert dog.
For more information, visit medicalmutts.org