When diabetes nurse Claire Pesterfield - herself a Type 1 diabetic - realized her condition was starting to affect her work, she knew it was time to act. “It was getting to the stage where I was falling into a diabetic coma in front of my patients, and that wasn’t a good look,” says Claire. “I even considered retiring on medical grounds. But then I got Magic.”

Magic came in the shape of a yellow Labrador trained by UK charity Medical Detection Dogs. “He completely transformed my life,” adds Claire. “I was able to carry on working and I had much better control of my blood sugar levels. Magic has changed not only my health but my whole life.”

In fact, Claire was so impressed by Magic and the work of Medical Detection Dogs that she started volunteering for them before joining full time as Medical Liaison Coordinator, pairing others with an alert dog to help them manage their diabetes. Despite recent advances in wearable technology which alert the user to hypos (low blood sugar levels), she believes the dogs still have a vital role.

“The technology has got to the stage where it is probably nearly as good as a dog, but a dog has many benefits besides telling you that you are hypo. I can turn off alerts on my sensor but I can’t do that with Magic, he will just keep going until I react - that’s a huge benefit. And a dog will also do things like fetch the kit, fetch help and keep re-alerting, which technology can’t do.”

Some experts predict that recent advances in continuous glucose monitoring (CGM) technology could reduce the demand for diabetic alert dogs in the future. “We have a staff member who was also a client, and when her diabetic alert dog died, she actually made a choice not to have another dog,” says Denise Yokom, Client Services Manager at Can Do Canines in Minnesota. “Her technology had progressed to the point where she was feeling more confident. But we also have clients who say the technology doesn’t work so well for them, and they still prefer a dog.” 

Beyond technology

In addition to alerting for low blood sugars, one recent study found that clients with ‘hypoglycaemia unawareness’ reported reduced anxiety and fear of hypos, as well as an increase in overall quality of life, when paired with a diabetic alert dog. Another concluded that the dogs’ sensitivity and specificity to ‘out of range’ episodes are even better than was previously thought. Dogs are well known for their highly acute sense of smell, and are the best “biosensors” for scientific research. They have around 300 million smell receptors, compared to just 5-6 million in humans, and 12 percent of their brain is dedicated to interpreting smell - 40 times more than a human brain.

Magic is just one of hundreds of diabetic alert dogs trained each year around the world by member programs of Assistance Dogs International (ADI). “We get applications from all over the world,” says Carol Edwards, Executive Director of Early Alert Canines, an ADI member program based in Concord, California. “I got a call just yesterday from the Philippines wanting one of our dogs. The demand is there. In the last 10 or 12 years the technology has changed - but it’s still not as good as a dog’s nose. I think there will always be a role for the dogs.”

Early Alert Canines has trained and placed more than 80 dogs with both adults and children since the program started in 2010. Like most organizations specializing in diabetic alert dogs, it favors Labradors, Golden Retrievers or a mix of the two breeds. Most are ‘career change’ dogs which started out being trained as guide, hearing or mobility dogs before switching to medical detection.

However, Carol says the benefits go way beyond simply alerting their partners to changes in blood sugar levels. “The dogs provide emotional support, and that’s huge. There’s a lot of depression associated with diabetes, but it’s hard to be depressed when you are woken up by a wet nose and happy face! The dog also helps people get up and get moving - you can’t lie in bed all day because the dog needs a walk, has to be fed and taken care of. Diabetics are often unfairly judged - you didn’t eat the right thing, you didn’t take your medication - but the dog doesn’t care about that, it gives unconditional love. All the dog cares about is taking care of you.”

However, despite the scientific studies and evidence, there are still skeptics. Belgium-based ADI member Os’mose faced considerable barriers from the medical establishment when it started its diabetic alert dog training program three years ago. “Compared to the UK and US, Belgium is behind the curve on diabetic science,” says Os’mose Director Vanessa Wey. “The doctors are quite conservative and many don’t think that dogs are good for helping to manage diabetes. They ignored us, and we had to fight to prove the dogs worked.”

Vanessa knew that scientific credibility was key to overcoming skepticism, so Os’mose set up a joint project with a university teaching hospital. “It was very important for us to be in partnership with them, to be recognised as a credible organization,” she says. “If the doctors say yes, it’s a good project, then other people will see that it works. There’s an increasing demand for diabetes dogs, so we want to expand. We also want to fund a scientific study - I want scientific proof that it works, so I can convince the Belgian doctors!”

Highs and lows

Unlike many other ADI programs, Os’mose trains its dogs to detect both low (hypo) and high (hyper) blood sugar levels. “We train our dogs to be very clear when they detect a hypo - they will push or nudge until the client takes action,” explains Vanessa. “That’s very important because we work a lot with children, who may be playing or studying and in their own world. We want the dog to be very precise and very proactive when they alert. Hypos are obviously more important because the client will go into a coma if the dog doesn’t alert,” she adds. “When it comes to hypers, we ask the client at what level they want to be alerted - it’s different for everyone.”

In one recent example, a doctor looking at the blood sugar levels of a ten year old patient was able to pinpoint the exact date the family got its diabetic alert dog. “Prior to then, the girl’s levels were spiking dramatically both high and low,” says Vanessa. “From the moment the dog arrived, they were much smoother and better controlled.”

Many diabetic alert dogs will alert for hypers of their own accord. “We only guarantee a dog will alert to the lows, and we don’t train for the highs,” says Denise. “We don’t want to risk a dog stressing out, especially if someone is dramatically swinging from hypo to hyper. But we have some clients who say their dog also alerts for highs - it picks up on them even though it’s only trained for the lows.”

Other programs report similar anecdotal evidence. Carol says that many dogs alert to both hypos and hypers, even though they have only been trained to detect hypos. “The dogs themselves will start alerting on highs. They seem to do it automatically.” Claire agrees: “The dogs act like a diabetes nurse - they want to let us know about both lows and highs. They just seem know what should be normal!”

All in the training

Can Do Canines has trained around 70 diabetic alert dogs since the program started in 2003. “As well as Labradors and Retrievers, we train poodles for clients with allergies,” explains Denise. “Our dogs don’t really pick a career until they are really close to their final training age - around 18 months old. We play games with them to see if they are interested in buried food or finding a hidden toy. It shows their interest in scent detection work. If it looks like they want to find things by scent, they can start training with real saliva samples from diabetic clients.”

For Os’mose, it was a case of trial and error. “Our first dog was a Springer Spaniel - they are well known for their acute sense of smell. They are great dogs but they are very intense and very hard work for the foster families, who are all volunteers. So now we only use Labradors and Golden Retrievers, which are just as good but less demanding,” says Vanessa.

Many trainers say that the best scent detection dogs are those which would be unsuitable for other types of assistance work such as guide or mobility dogs. As Denise puts it, “Diabetic detection dogs have to think outside the box. They have to be able to say, ‘No, I’m not going to lie down or stop nudging you, because your body is telling me otherwise.’”