Dogs: A Different Kind of CGM

By the time Max yanked the headphones off of Liam Kelly’s head, the teenager’s blood glucose level was 48. Engrossed in a video game, the boy hadn’t responded to a nudge, a paw in his lap, or a thrust. The dog’s fourth attempt to get attention, however, did the trick, forcing Liam to stop playing and test himself. The broken headphones were a small price to pay for avoiding a hypoglycemic event.

As you may have guessed, Max is a diabetes alert dog. Trained to use his superb sense of smell to detect changes in his owner’s blood glucose level, the black Labrador retriever is Liam’s constant companion. It is tempting to think of him as a canine CGM. Max is such an important part of his owner’s life that 18-year-old Liam includes paw prints in his “Type 1 diabetic alert“ tattoo.

According to Liam’s mother Lisa Kelly, who is founder of the Dogs For Cures Foundation (www.cureswithinreach.org), Max’s awareness of her son’s high and low blood sugar events is so remarkable that she often feels that the dog’s skills “are nothing short of miraculous.” Like other well-trained diabetes alert dogs, Max offers the big advantage of acting as an early warning system, since he senses blood sugar highs and lows well before Liam can.

One Style Doesn’t Fit All

Liam Kelly loves his
diabetes alert dog, Max, so much
that he had paw prints added to his
“Type 1 diabetic alert” tattoo.

Diabetes alert dogs are trained to recognize the scent changes in perspiration and breath that correspond to rising or falling blood glucose. How aggressively each dog alerts its owner differs according to the dog’s personality and training.

Max received early training from Ron Pace, of Tacoma, Wash., becoming the first diabetes alert dog that Pace had ever tried to train, before the dog underwent intensive diabetes alert training with Rita Martinez of Clickin’s Canines in Oakley, Calif. (www.clickincanines.com).  She taught Max to alert his owner with behaviors that are increasingly noticeable, until Liam takes action. “Teenaged boys…need a dog who is real, real demonstrative,” Lisa Kelly said. “Max is very aggressive.  A lot of people would not like that, but he is just right for Liam.”

Once Liam notices the dog’s behavior, he asks, “What is it?” and Max will respond by lying down to indicate a low and sitting up to indicate high blood sugar. Among Max’s many skills are unzipping Liam’s pocket to retrieve a blood glucose meter and place it in Liam’s lap. Max also knows how to retrieve meter kit cases that are kept around the Kelly home. According to Kelly, Max seems to “get it right about 90 percent of the time,” although he is not as keen a nighttime alert dog as are some. Nevertheless, during the four years Max has been in the Kelly household, “Liam’s highest A1c was 6.6,”Kelly said. “For a teenaged boy, that’s nothing short of a miracle.”

Searching For Standards

Kelly sees huge promise in pairing other diabetics with dogs like Max. But she also knows that one should be cautious when looking for these canine companions. While The Seeing Eye has refined training techniques for assistance dogs for the blind since 1929,  training and use of alert dogs to help people with diabetes is a new enterprise. Currently, effectiveness is mostly measured by experience and anecdote, rather than by hard and fast standards.

“We’re all like pioneers in covered wagons going out to blaze a trail and to find the right way,” Kelly said. “That’s why I founded Dogs for Cures. There is a need for a foundation that specializes not only in the training and awareness, but also in supporting families who are seeking service dogs for diabetics.” A major focus of Dogs For Cures is to fund research. “There’s a lot of experimentation, and no long-term evidence-based research,” she said. Training these dogs is “not an exact science. I would like to protect other families who want that dog so badly, to protect their child, that they are willing to drop their guard and not exercise due diligence.”

A Broad Spectrum of Options

Those who look for alert dogs will find a wide array of trainers, advertising dogs that they claim can alert diabetics to blood glucose changes. Sources of dogs, methods of training, behaviors taught for alerting, follow-up with owners, and prices all vary significantly.

Some trainers work with dogs that start in puppyhood to go through general assistance dog training to gain socialization and obedience skills before the dogs are scent-trained specifically to recognize blood glucose changes. Others train dogs that have been rescued from shelters. Still others take dogs that have been trained for other kinds of assistance, such as aiding the blind, and train them to alert for blood glucose changes, too.

Dogs may be trained to alert their owners using different behaviors, and to fetch glucose meters, juice boxes, and other items. The amount of training that is also offered to the diabetic-and-dog-pair varies among trainers.

 Dollars and Common Sense

There is no standard price for diabetes alert dogs. Some dogs are priced as high as $25,000, while others are available for a modest cost or even for free.

While training standards for diabetes alert dogs remain unestablished, Kelly offers the following list of questions any prospective owner of an alert dog should ask of trainers:

• Do they invite you to communicate with established teams of dogs and diabetics that they have trained? What is the experience of those teams?

• Is the trainer local? Can they help you with hands-on training and follow up?

• What is the dog’s alert behavior? How do they train for it? Do they use positive reinforcement, rather than punishment-based training?

• Can they provide a health clearance indicating the dog’s genetics and hips, elbows, and eye health?

• How do they assess public access readiness? Can the dog pass the Assistance Dogs International standardized public access test?

Kelly added, “If you start asking questions and they don’t want to answer, you should run! The training is not proprietary. Nobody owns the training. Some trainers are more gifted, but the training methods should not be kept secret. The best trainers are very happy and comfortable to share the information and support the team so they can reach their potential, the bottom line of which is improved health through tighter blood glucose control.”

Finally, once you have your dog, remember that relying on the animal alone cannot ensure good diabetes management. “There are a lot of mystical powers given to these dogs,” Kelly said. “They are amazing. But you still have to maintain your vigilance. The dog is another tool in your diabetes management toolbox, not the only tool. You still need to test frequently, wear your CGM, exercise, and eat well. Just like other tools may fail, dogs may fail from time to time. You still have to be responsible for management. And you still have to keep vigilance as a parent of a diabetic.”

To read Liam Kelly’s own thoughts on living with Max, watch this video.

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