Diabetes Management

What Does a Diabetes Service Dog Do?

A service dog is a canine that has been specifically trained to work with a person with a disability.

On occasion, we see a news headline featuring emotional support animals. An animal that provides “emotional support” is often utilized for disabilities such as depression and social anxiety.

While some claims and use of service animals seem farfetched, pertinent studies lend validity to the purpose.

There are many kinds of service dogs that are specifically trained to help people with their unique disabilities. The 4 categories of Medical Alert Dog include:

  • Hearing Dogs

  • Psychiatric Therapy dogs

  • Mobility Assistance Dogs

  • Guide Dogs (for the blind)

Currently, Service Dogs’ use is expanding. Within the last 20 years, this has included in the management of diabetes. In 2003 the first dog in the U.S. was reported as being able to detect Hypoglycemia. In 2009 the first service dog for diabetes was registered to a person with Type 2 diabetes in the U.K.

Who trains service dogs

If the dog is a puppy, some initial training can be done by the owner. One would start with obedience training with basic commands and leash training.

As the puppy ages, it can continue with special training. Special training refers to the particular tasks necessary for people with diabetes. While the owner can do the initial training, the well-trained assistance dog requires a specialized trainer.

You can find a certified dog trainer through www.ccpdt.org, the Certification Council for Professional Dog Trainers website. You can also find a trainer through the Association of Professional Dog Trainers. or the RSPCAM.D. dogs, a training in Kentucky, United States, have begun to pilot a program to provide a fully trained Diabetic Alert Dog.

How do you get a service dog?

Reaching out to one of the above organizations is the first step towards obtaining a guide dog, or medical alert canine. Finding a legitimate, accredited organization to train your dog is imperative.

Many organizations have standards that require that the owner be at least 12 years old. An application is necessary, validating medical necessity and often an interview.

As the dog progresses through training, there will be owner involvement and home visits. Once the dog has been properly trained, the dog is put into service. Although not required by law, some dog handlers have found it helpful if their canines wear a vest that states their medical use.

How are service dogs able to recognize hypoglycemia?

Type 1 diabetes is an autoimmune disease. In this disease state, the body begins to attack the beta cells of the pancreas. The beta cells are responsible for making insulin. The damage is, unfortunately, permanent. The body doesn’t produce insulin. Insulin is a pancreatic hormone that allows Glucose (food) to enter the cell’s tissues. 

Insulin resistance caused by central adiposity is the leading cause of Type 2 Diabetes. A slow deterioration of the pancreas and fat resistance to insulin leads to a diagnosis. 

Low blood sugar (also known as hypoglycemia) occurs as your blood sugar levels have fallen. If they are low enough, you need to act to bring them back to your target range. This is usually when your blood sugar is less than 70 mg/dL.

A low blood sugar level triggers the release of epinephrine, the “fight-or-flight” hormone. Epinephrine can cause hypoglycemia symptoms, such as rapid heartbeat, sweating, and anxiety. If blood glucose levels continue to drop, the brain does not get enough glucose and doesn’t function as it should. This can lead to blurred vision, difficulty concentrating, confusion, slurred speech, and drowsiness. 

Symptoms of hypoglycemia and hyperglycemia are unique to the individual and can go unnoticed. If they are unaware of their symptoms and cues, this is called Hypoglycemia unawareness. 

Diabetic alert dogs are in tune with chemical shifts that occur within the human body when hypoglycemia or hyperglycemia occurs.

A hypoglycemic episode can come on fast. It is more complicated when an individual has hypoglycemic unawareness. This state where a hypoglycemia alert dogs could be critical in alerting an individual of arising low blood sugar. This enables treatment to be administered quickly. This may possibly deter further negative side effects. 

Adequate Blood sugar levels are determined by the physician and differ from person to person. When blood glucose levels go out of range, the hormonal shift occurs, and the diabetic service dog can act to alert its owner. Both shifts are undetectable by the human nose. It is likely that dogs detect changes in the chemical composition of their owners’ sweat or breath (including products of ketosis) using their acute sense of smell. 3

Blood sugar changes elicit different odors that the dog detects. When the dog scents pick up the hormonal shift, they can jump into action. Such actions can include nudging, pawing, licking the owner, or yelping.

The dog may be able to fetch emergency supplies such as glucose tabs, insulin injections, or a telephone for the individual to call for help. If the owner is unresponsive, the dog is trained to seek out and alert others that the person requires aid.

A hypo alert dog goes through scent training. During scent training, samples of low blood sugar levels are provided to the dog by a dog trainer. This is done with a saliva sample. These are obtained from a person who is having low blood sugar. These can be frozen for future use.

Also helpful are samples obtained from the sweat glands of the underarms and feet. Essentially, the dog is trained to sniff it and be rewarded with a treat. 

What should you consider before getting a service dog?

Diabetes service dogs are not meant to replace blood glucose meters are but a secondary defense against readings that are out of range. Both the golden retriever and Labrador retriever are frequently used as medical dogs because of their intelligence.

Some poodles and sporting mix-breeds are also used as service dogs. Generally, a puppy is not recommended for training. The animal must reach adulthood to be able to withstand the intense training that comes along with it.

The best service dog is one that is comfortable in public. One that is social is preferred, but also attentive. One that is insecure about itself in public will not be an asset to an individual.

“Results show that optimal performance of glycemic alert dogs depends not only on good initial and ongoing training but also a careful selection of dogs for the conditions in which they will be working.” 4 

What are the benefits of a service dog?

Diabetes alert dogs are known to provide a tremendous amount of love and emotional support to its owner, resulting in an increased sense of security and balance in someone with diabetes’s daily life. One study measured the general effect of medical alert dog owners.

The majority of respondents reported decreased worry about hypoglycemia (61.1%) and hyperglycemia (61.1%), improved QoL (75%), and the ability to participate in physical activities (75%)6 In another study, the population, overall, reported reduced unconscious episodes and paramedic call-outs.3

What are the challenges of having a service dog?

The cost of an alert dog ranges anywhere from$ 8000-20000. One needs to have the financial means to be able to obtain the dog. In addition, as a diabetic handler, you are allowed to have your dog accompany you in public spaces such as grocery stores, gyms, restaurants, and hospitals.

As a person with diabetes, one must understand their rights, so if challenged in a public place, you can provide adequate justification and proof of need.

Diabetic alert service dogs must undergo extensive training. The International Association of Assistance Dog Partners5 has produced Dog training guidelines. Training a service dog requires a minimum of 120 hours of training for at least 6 months (depending on the dog and the required skills).

During that time, dogs also need to work a minimum of 30 hours in public settings to help them generalize their skills and teach them to be responsive and unobtrusive in a variety of public places.5 The amount of time and effort makes a medical dog an expensive but worthwhile endeavor.

Conclusion

Dogs offer those with diabetes people greater freedom to improve their quality of life by alerting ahead of time that a blood sugar decrease is impending.

Those that have the security of a dog report being more apt to be physically active and better quality of life. Beyond better blood sugar control, there is a positive bond between the dog handler and canine. 

Sources

  1. Jeffrey Youngren. (August 2019). Emotional Support Animal Assessments: Toward a Standard and Comprehensive Model for Mental Health Professionals . Professional Psychology Research and Practice . 51(2) DOI: 10.1037/pro0000260 A (4), 15-16.
  2. International Guide Dog Federation. (2020). History of Guide Dogs. Available: https://www.igdf.org.uk/about-us/facts-and-figures/history-of-guide-dogs/#:~:text=Dr%20Stalling%20started%20to%20explore%20ways%20of%20training,Hannover%2C%20training%20up%20to%20600%20dogs%20a%20year. Last accessed 10/28/2020.
  3. Nicola J. Rooney ,Steve Morant,Claire Guest. (Published: August 7, 2013). Investigation into the Value of Trained Glycaemia Alert Dogs to Clients with Type I Diabetes. Available: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069921. Last accessed 10/28/2020.
  4. Nicola J. Rooney. (2019). How effective are trained dogs at alerting their owners to changes in blood glycaemic levels?: Variations in performance of glycaemia alert dogs. PLoS One. 14(1): e0210092 (conclusion), 4.
  5. IAADP. (2020). IAADP International Association of Assistance Dog Partners. Available: https://www.iaadp.org/iaadp-minimum-training-standards-for-public-access.html#:~:text=%20IAADP%20Minimum%20Training%20Standards%20for%20Public%20Access,social%20behavior%20skills.%20It%20includes%20at. Last accessed 10/28/2020.
  6. Linda Gonder-Frederick, PHD1, Pam Rice, BA2, Dan Warren2, Karen Vajda, BA1 and Jaclyn Shepard, PsyD1. (2013). Diabetic Alert Dogs: A Preliminary Survey of Current Users. American Diabetes Association Diabetes Care. 36(4): e47-e47 (4), 1.

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