Perspective/Type 1 Diabetes

After 2.5 years living with type 1 diabetes (T1), our 8-year-old son Casey wistfully asked for a diabetic alert dog (DAD). We quietly began the process of getting one 2 months ago and recently gave him our happy news: he will receive Elvis, a red retriever DAD, in December! Elvis will be Casey’s loyal companion, and help him weather the physical and emotional demands of T1. But Elvis’s first duty is to protect Casey from extremes in blood glucose (BG) by alerting us to imminent or deepening hypo- or hyperglycemia.

But why would Casey need a DAD when he’s already outfitted with sophisticated, electronically integrated diabetes devices designed specifically to do that, and which improve BG control? Because the complexity of this wondrous technology leaves it vulnerable to diverse sorts of technological failure and human error, some potentially deadly. DADs provide a second line of defense when the stakes are high.

To illustrate, five months after Casey’s diagnosis, his first endocrinologist handed me a new insulin dosing regimen that had us administering up to 5 times too much insulin. A panicked call from a nurse reviewing it spared us finding Casey unconscious in the camp swimming pool, where water impedes transmissions of BG readings from his Dexcom continuous glucose monitor (CGM). Earlier this year, the Dexcom Follow App we depend on for loud nocturnal warnings failed to sound. My mother happened to open the app near midnight, saw Casey’s BG heading quickly toward coma territory, and called to wake me, probably saving Casey’s life.

Failures that leave us blind to Casey’s BG level provoke anxiety, because he doesn’t recognize when he’s hyperglycemic and not always when he’s hypoglycemic, and his BG often goes low because he’s so active. Being blinded is a frequent problem with many causes. For instance, the CGM attached to Casey’s arm periodically detaches or gets knocked off during play, and the cell phone he carries loses signal when he’s not within the 20 feet necessary for it to transmit glucose readings to our cell phones. Additionally, CGMs can be less accurate in their first 48 hours and in the final days of their designated 10-day lifespan.

CGMs are erratic when inserted too close to muscle, and prone to giving false but alarming low readings (compression lows) when wearers lie on them.

If the CGM can’t transmit BG readings or its readings are wrong, then Casey’s insulin pump can’t properly calculate the amount of insulin he needs, so administers too much or too little. Further, the insulin his pump sends for delivery sometimes never enters Casey’s body, causing hyperglycemia, which is especially dangerous while sleeping. This has happened when the coupled thin plastic tubes that deliver insulin became disconnected or the needle into his thigh became dislodged. Nor can pumps do their job controlling BG when users don’t input the data and directions they need. For instance, Casey sometimes forgets to dose insulin for meals, despite reminders, and to reattach his pump or turn insulin delivery back on after showering or sports. Both lapses cause his BG to skyrocket. In all instances, a DAD, by alerting Casey and us sooner, would allow us to more quickly and effectively restore control.

Dogs can smell scents undetectable to humans, including chemical changes in the bodies of people living with T1. A dog’s nose is 100,000 times more sensitive than a human’s. They have around 250 million scent receptors vs. a human’s roughly 5 million, and 40 percent more of their brain is devoted to the olfactory bulb. DADs not only smell low and high BG, but also when BG is rising or falling rapidly.

Scientists suspect that they detect hypoglycemia from changes in isoprene and other chemicals in humans’ breath, saliva, and sweat. For hyperglycemia, they believe DADs detect ketones. This detection enables DADs to alert owners to out-of-range blood glucose levels 15 to 30 minutes before they become symptomatic. Moreover, they can detect BG crossing the threshold into hypoglycemia or hyperglycemia up to 20 minutes before CGMs do. This is because CGMs don’t take readings from blood, but from fluid just under the skin, a lagging indicator of BG. By signaling current glucose levels, DADs improve owners’ ability to keep BG under control and avoid seizures, coma, ketoacidosis, and long-term complications.

The CDC reports individuals with T1 are 2 to 3 times more likely to suffer from depression and 20 percent more likely to have anxiety than those without T1. Those with DADs report fewer health complications, and increased independence, life satisfaction, and confidence in managing T1. According to a 2013 report in Diabetes Care, 61 percent of respondents reported reduced worry about hypoglycemia and hyperglycemia, 75 percent an improved quality of life, and 75 percent an enhanced ability to participate in physical activities.

DADs stay by their owner’s side day and night, and may enter all public accommodations. Highly intelligent, friendly, energetic breeds such as golden retrievers, Labradors, and poodles make ideal DADs. They begin basic training in obedience and socialization as pups, then for behavior in public places and sensing and alerting skills. DADs can be trained to alert in various ways, such as jumping on you or pawing your leg, and to bring your diabetes bag, treatment food, phone, or a caregiver. Getting a DAD involves finding a reputable agency, usually fundraising to afford a well-trained DAD (average cost around $35,000), and sending freezer-stored saliva samples on sterile organic cotton balls to the trainer to teach the DAD its future owner’s scents for specific BG levels. The entire process can take 1 to 2 years.

DADs require money, time, attention, love, intellectual stimulation, exercise, grooming, and veterinary care, plus lifelong training by their owner to keep their skills sharp. They are recommended for individuals like Casey who aren’t fully hypo- or hyperglycemia aware, frequently experience hypoglycemia, and are on insulin pumps. DADs are especially helpful for young children, who are less able to sense, understand, and articulate symptoms of highs and lows.

Casey is only 8 years old, yet contending with an especially demanding medical condition. We can’t wait to welcome Elvis into our family. We look forward to him enriching Casey’s life, while enhancing his health and safety—and our peace of mind too!

Lisa Seitles

Hammonton

Lisa Seitles and her husband Sam are the owners of READ Preschool and Camp Tuscaloosa. They have four children and are active members of the community.