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A Mother’s Letter (and, An EAC Success Story)

Laura and Darwin

Laura and Darwin

Early Alert Canines has just finished another team training where two adults with diabetes were placed with blood sugar alert dogs, as well as one family with a four year old daughter with diabetes.

The young family has been home with their dog, Darwin, for almost one week.  Face Book postings are telling the wonderful story of how Darwin is reveling in his job of alerting to high and low blood sugar changes.  Sometimes when a dog first goes home with his new partner, it takes a while for the dog to adjust to the new routine, new people, and new environment.  NOT DARWIN!  In the few days he has been in his new ‘forever home’ he has alerted the mother of his new young charge, Laura, at pre-school, at home, during soccer practice and during dance class.  Good boy, Darwin!

I would like to share this ‘post’ written by Laura’s mother, explaining how difficult it is to regulate a young child’s diabetes, and what a gift Darwin has already been in their lives:

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It was brought to my attention that with all the posts recently about how great Darwin is at helping us manage Laura’s type one diabetes, as well as posting about highs and lows, that people might perceive it that we didn’t have control without him. First of all, T1D Managment is an art, not a science. The body is always changing and so do insulin needs. When Laura is getting sick, we know ahead of time from wacky numbers. When she’s stressed, we can tell from the numbers. We are constantly changing insulin ratios to try to match her insulin needs. As you can imagine, it’s a daily battle that is hit and miss. Large swings in the numbers is normal, while not ideal. One has to be most concerned about lows and chronic highs.

Prior to having Darwin we would have to rely on trying to read the signs of highs and lows from Laura’s behavior and mood. She’s 4. Sometimes a 4 year olds behavior is similar to a diabetic having a low. With Darwin, he smells a difference and he can let us know. Laura can tell us if she’s low if she’s relaxed. But in the soccer situation, she showed no visible signs of a low nor did she mention anything. Darwin helped us intercept that before it got very dangerous.

We have also used a continuous glucose monitor that works with her pump. The CGM can give us an indication if she’s on the way up or down. It’s not 100% accurate and there are delays in the readings. There is a 20-30 minute lag time generally. Darwin will, in most cases, be able to catch a low before it happens. The CGM is also one more piece of equipment Laura has to have punctured into her. As a mom, if I can get similar or better information from a black fuzzy doggie rather than a sensor stuck in her I will use the dog.

That being said, new technology is always in the pipeline for T1D management. When the new stuff comes out, Laura will have it.

In future posts I will be more clear about how Darwin has changed the way we handle things.

Type one diabetes sucks. I will use anything and everything to make sure Laura is as happy and healthy as she can be. For now and for ever.

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T1D means Type 1 Diabetes.

Type 1 diabetes (T1D) is an autoimmune disease in which a person’s pancreas stops producing insulin, a hormone that enables people to get energy from food. It occurs when the body’s immune system attacks and destroys the insulin-producing cells in the pancreas, called beta cells. While its causes are not yet entirely understood, scientists believe that both genetic factors and environmental triggers are involved. Its onset has nothing to do with diet or lifestyle. There is nothing you can do to prevent T1D, and—at present—nothing you can do to get rid of it.  (Juvenile Diabetes Research Foundation)

A person who has been diagnosed with T1D must take insulin in order to say alive.

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Rainie’s Been Sick

DSCF0817Rainie’s been sick.  A ‘hot-spot’ had gone awry, blooming into a huge systemic infection.  My rambunctious, energetic, smiling girl had become a small ball of fur with her tail tucked, holding her ears flat, hiding in any small space, lethargic, not following me as she usually does, not wanting to go for walks, and not alerting – just sleeping and watching with those big, brown, questioning eyes.

Finally, she’s coming back to life.  She must be feeling better. Late last night she brought me one of her dolls, and this morning she ‘tossed’ a ball in my direction and scampered to get it after I rolled it across the floor.  And, she’s beginning to alert again.  It’s so nice to have her back!

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(2 days later)  With every day, more of her personality appears.  She’s becoming her true impish self.  This morning I was awakened at 5a.m. with ‘the tigger pounce’.  This is when she wakes me up by jumping on me, thus, letting me know I need to check my blood sugar.  And, of course, she was right.   (My blood sugar was 85.)  Sometimes I feel like I want to be annoyed, being woken up so early; but how can I?  She’s doing her job with a big exuberant smile.

And on our walk, more of a gentle stroll, really, Rainie raised her nose high in the air to smell the breeze.  I could see her nostrils twitching as she caught whatever scent she was zeroing in on.  She slowly followed her nose, turning her head, then body around, until she looked straight at me, bounded to me, and alerted.  Yep, I was dropping.

As I sit here typing, someone with a wagging tail is coquettishly flaunting her favorite ‘stick’ at me, trying to inviting me to play.  Oh, it’s good to have her back!

( If you haven’t met Rainie yet, she is my diabetic alert dog.  She has been trained to identify the metabolic odors a diabetic produces when their blood sugar drops rapidly. ~~~~~~~ And her favorite ‘stick’ is actually a 2-year-old Nylabone chew bone that she carries around with pride and joy.)

How do you teach “Compassion” and “Empathy”?

IMG_2538When I was working in the hospital as a nurse, I was always misplacing my stethoscope, only to find it hanging around my neck.  Now, with Rainie in my life, I am perpetually doing the same thing with her leash.  I’ve discovered that the neck is a very handy place to put it – so I’ll always know where it is.  Except I usually forget it’s there.  I was reminded of this as I was hurriedly trying to put everything in order to go talk to the local nursing program’s class that is studying pediatrics and chronic illnesses.  As I was attempting to get Rainie and the gear into the car, I couldn’t find the leash because it was around my neck!

 In preparation for my talk on “the psychosocial impact of choric illness on the individual, family and society” (as well as diabetic alert dogs), I asked the students to read “How Does It Feel” from this blog site.  I wanted to try to show the students the impact a nurse can have if he or she tries to put herself/himself in the position, or shoes, of the client, and look at issues from that orientation.  I discovered this is much easier said than done.  “Empathy” is something one develops with maturity and experience.

Here are some of the topics we talked about in class:

I asked what issue do they (the students) think is the biggest fear of having diabetes, or having a child with diabetes in the family.  The major response I heard was the fear of going blind from long-term complications.  This is not what I was expecting from a class that had already covered the biology of diabetes.  But, at the same time, I could see where they got this idea from – I remember the doctors talking to me about ‘maintaining my diabetic regime’, or I might go blind!!  The doctors were using the scare-tactic on me in order to get me to follow their rules.  This must be what the students are being taught in this program.  I told them I had hoped they would talk about the daily problems of the diabetic’s blood sugar of going too low.  Low blood sugar (hypoglycemia) will quickly cause altered thinking, poor judgment, dizziness, accidents, unconsciousness, and, ultimately, death.  We explored what it might be like living with this constant fear, and the life changes that must be made in order to avoid hypoglycemia and long-term complications.

Next we talked about diabetic alert dogs, and how one might fit into a diabetic’s life, and why.  (Rainie was a star!)

We discussed how the first thing a nurses must assess (measure) when meeting with a client is the client’s fear and degree of acceptance of a diagnosis, and find out what ‘burning questions’ they may have.  Without doing this first, no other teaching can happen – especially if the client is truly anxious, agitated or angry.  And, the diagnosis of “Diabetes” tends to bring with it a lot of fear and anxiety, especially if it is in a child.  We explored how, in a perfect family, the whole family might adapt to the new food requirements and exercise plans, as well as be involved in learning what diabetes is all about.  The family and the patient are the nurse’s client.

I talked about how the patient may have an appointment to meet with a nurse in order to learn or review a myriad of information, but, even though the patient may look ‘fine’, their body might be in a bad metabolic/chemical state due to blood sugar problems.  This makes the nurse’s job of teaching more difficult, and possibly frustrating for both the nurse and client/s.

There was so much we could have covered, but I only had an hour, and the instructor had asked me to show how a nurse would teach someone (a family member, a teacher, a school nurse, etc.) how to give a Glucagon injection.  (Glucagon is a hormone that should be injected into a diabetic if the diabetic’s blood sugar goes so low that she/he is not able to eat, becomes combative, is having seizures, or becomes unconscious.)  I brought two expired glucagon kits with me so the students could actually handle them, and mix the two ingredients together as if they were going to teach someone how to inject the Glucagon.  The example I gave was for the students to teach a grandmother how to give a Glucagon injection to her 3-year-old granddaughter, who was having seizures due to low blood sugar.  Before we cracked the cases open, I asked the class if anyone had ever given himself or herself an injection.  All the faces, but one, dropped with an expression of horror!  “NO!”  I asked, “Why not?”  I suggested that the next time they had to get a flu shot or tetanus shot, to ask to give it to themselves, then imagine what it might be like for a parent to have to learn how to give their first insulin shot to their child, or, as in this case, what it would be like for Grandma.  The room became very quiet … Next, we figured out how to break open the plastic box the glucagon kit comes in, uncap the syringe and needle, inject the fluid from the syringe into the glass vial containing the powdered glucagon, agitate the bottle to mix it, and now teach “Grandma” how to give the injection.  I believe my asking the nursing students to imagine doing this to themselves must have “freaked-them-out” because most of them were “all thumbs.”  After much giggling and dropping of the bottles, my time was up.

For me, this opportunity was priceless.  I haven’t “put my nursing hat on” for a long time.  As for the students, I hope they took away a slightly different perspective of life and the teaching process.

Three New Teams Graduate at Early Alert Canines!

"Lucy" and her boys

“Lucy” and her boys

Yesterday, Early Alert Canines celebrated another major milestone.

Three diabetic alert dogs teams were officially ‘handed their leashes’ in an emotional graduation ceremony.*  One team consisted of “Mr. Brooks”, a petite, yellow Labra-doodle and his new mistress, a long-term diabetic, soon to be retired, who lives alone.  However, for two of these celebrated teams, the ‘clients’ are actually families with multiple diabetic members.  In one family, “Lucy”, a happy and energetic yellow Lab-golden retriever mix, watches over a family with three young boys, two of whom have diabetes; and in the other family, “Bender”, a mellow, loving, gigantic black Lab/golden retriever mix alerts to three home-schooled children and their father.

All of these dogs are alerting to both high and low blood sugars.  Lucy and Bender have been trained to alert one of the parents if their charges’ blood sugars are dropping at any time, day or night.  One of Lucy’s ‘guys’ cannot sense his blood sugar at all (called hypoglycemic unawareness), and her special skills and talents are especially important for this ‘human partner’.  In the five months since the dogs have been placed in their new homes, there has been a decrease in the number of ‘dangerous lows’ and ‘unbelievable highs’, and an overall improvement of the diabetics’ blood sugar levels.  These are very busy dogs!

We like to say that diabetic alert dogs (DADs) are life-saving dogs and a diabetic’s best friend.  They are trained to alert when a diabetic’s blood sugar drops rapidly so that steps can be taken to prevent serious situations.   And low blood sugar can lead to unconsciousness and death.   So, yes, they can literally help save lives.

They also help to save lives in a more figurative manner. Their warnings help to bring a sense of peace of mind and security by providing yet another ‘warning system’ to keep the diabetic’s blood sugar in check.  The dogs can often sense the fact that the blood sugar is going to drop, before it actually does, thereby giving a truly advanced warning of impending danger.  They provide a sense of companionship for the diabetic, and another “set of eyes and ears” (and nose – in this case), for parents of diabetics.  For the parent of a young diabetic, the dogs help allow for a more restful day and secure sleep, knowing the trained DAD will alert them, even waking them up at night, and bring the parent to the appropriate child if there are multiple diabetic children; and for parents of older diabetic children, say, in college, it is a comfort for the parent to know that, even when away, their child has another ‘early warning system’.  And for the ‘more mature’ single person with diabetes, the DAD helps provide the same physical security and companionship, peace of mind for self, family and friends, and the knowledge, to all, that self or loved-one has another helping ‘nose’ and is never alone.

CONGRATULATIONS to all the teams, old and new.  May you continue to have a life of fulfillment and happiness, and peace of mind.

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* To achieve “graduation status”, the new teams must demonstrate an 85% or better alerting accuracy rate.  This means that the dog must correctly alert t >85% of the blood sugar changes tested and recorded by the diabetic client, in multiple and various situations; and the client must recognize the alert and respond appropriately.

 

 

But, Does She Ever Get To Play?

IMG_0042Not long ago, Rainie and I went to talk with a Cub Scout troop about diabetes, service dogs and diabetic alert dogs.  I had completed my presentation and soon the group of 50 scouts was bombarding me with questions.  They were pretty standard queries for a 2nd to 4th grade crowd: “Where does she sleep?”  (Mostly on the floor next to my bed.), “Does she always have to wear her jacket?” (No.  She wears it when we’re in public), “Can service dogs have other dogs in the house?” (Yes.  However, the service dog needs to know that he/she is the most important dog in the house in the eyes of the person that he/she is taking care of.), “How much do they cost?” (Early Alert Canines does not charge for placing a dog.), “How can I get one?” (You have to be diabetic and been on insulin for at least a year.), “Does that mean taking a shot?” etc., etc.

Then came a question I’d never been asked before. “Why is she lying down?”  I’d never considered thinking about it – especially from a child’s perspective.  Yes, she had been active and alert moments before, and now she was lying on her side with her eyes open.  So, I decided to explore the possibilities with the scouts.  We agreed that a few reasons could be that she was lying down because it was getting towards evening.  And it was possible that she was tired.  But then I explained that Rainie was “always making sure that each one of their blood sugars was safe, and that was a big job.”  I told them that Rainie did not know that they were not diabetic, but she did know that there were at least two diabetics in the room.  She was continually monitoring everyone, all the time; and although she looked like she was resting, she was actually alert and taking her job seriously.  Then there were many nods and ahh-hahs.

After the meeting was over, the boys came to pet Rainie.  I felt a young scout name Jeffery tap me on the shoulder to ask, “But, does she ever get to play?”

Yes Jeffery.  She does get time off to play!

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IMG_0409     photo    DSCF0694

Service Dogs Pick Up Scent of Diabetes Danger

Here is an incredible article posted by the Wall Street Journal (December 10, 2012) that does a phenomenal job explaining the life saving role and purpose of Diabetic Alert Dogs.

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Service Dogs Pick Up Scent of Diabetes Danger

By KATE LINEBAUGH

About two times a night, Shana Eppler wakes up to an alarm and slips into her daughter Abbie’s room to test the 8-year-old’s blood sugar.

The growing field of diabetic-alert dogs that save their diabetic owners’ lives by sniffing out when blood sugar levels get out of whack.
 

 Diagnosed with Type 1 diabetes at the age of 4, Abbie experiences low blood-sugar levels, a potentially dangerous condition known as hypoglycemia that can cause the loss of consciousness.

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Celeste, a yellow Labrador, has been at the side of 15-year-old Type 1 diabetes patient Dylan Calamoneri for about a year.
 

The alarm Ms. Eppler uses to avoid a health emergency is a furry one named Gracie, an 70-pound, 3-year-old British Labrador retriever trained to sniff out high and low blood-sugar levels. When Abbie’s sugar level rises or falls below a certain target at night, Gracie rings a bell and Ms. Eppler gets up.”The scenting part comes naturally,” says Ms. Eppler, of Colorado Springs, Colo. “They are hunting blood sugars instead of ducks.”

Diabetic, or hypoglycemic, “alert dogs” are a growing class of service dogs best known for guiding the visually impaired, sniffing out drugs and bombs, or providing mobility assistance for people with severe disabilities. Most recently, they have been trained to sniff out cancer and oncoming seizures. Toni Eames, president of International Association of Assistance Dog Partners, estimates there are over 30,000 assistance dogs working in the U.S., including dogs that have been trained by individuals.

The dog’s accuracy and speed can beat medical devices, such as glucose meters and continuous glucose monitors, according to doctors, owners and trainers. With their acute sense of smell, the dogs—mostly retrievers—are able to react to a scent that researchers haven’t yet identified.

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Eight-year-old Abbie Eppler has avoided health emergencies thanks to Gracie, a 70-pound British Labrador retriever who wakes up Abbie’s mother when the child’s blood-sugar level rises or falls below a certain target at night.

For centuries, doctors diagnosed diabetes by identifying sweetness in the urine of a patient. That scent comes from glucose that isn’t absorbed when a person lacks insulin, but the chemicals produced during low-blood-sugar incidents have yet to be identified.

“Whatever is being secreted in that drop in blood sugar…we just don’t know what it is,” says Dana Hardin, a pediatric endocrinologist who works for Eli Lilly & Co. in Indianapolis. Her goal is to identify what chemical compound the dogs smell, “not only to train dogs but to possibly make a device,” she says.

Most of the interest in diabetic-alert dogs comes from people with Type 1 diabetes—and parents of children with Type 1—because they are more susceptible than people with Type 2 diabetes to serious problems of low blood sugar. Type 1 diabetes is an autoimmune disease characterized by the absence of insulin production, and requires daily insulin injections. People with Type 2, which is brought on by a combination of genetics, inactivity and obesity, have trouble processing insulin but don’t necessarily require external insulin.

Incidence of Type 1 has been rising in the U.S. by about 2.5% to 4% a year for reasons scientists can’t explain, according to several large-scale studies published in peer-reviewed medical journals. The number of people with Type 1 diabetes in the U.S. is between 1.3 million and 2.6 million, accounting for 5% to 10% of the total diabetic

Type 1 diabetics work to balance their daily intake of carbohydrates with external insulin. Prolonged high sugar levels can lead to complications such as heart disease, kidney failure and neuropathy. But trying to keep sugars at a low level raises the risk of hypoglycemia, which can be lethal, particularly if a patient loses consciousness while driving or alone.

Many people develop a condition known as hypoglycemia unawareness, meaning they no longer feel the hunger, listlessness and irritability that typically alerts diabetics that their blood-sugar level is falling.

“They don’t get the signs. They just can be having a normal conversation, go from feeling fine to passing out,” says Dr. Hardin.

Diabetics can use technologies such as continuous glucose monitors to help prevent these episodes, but these don’t record blood-sugar drops until after they happen. So hypoglycemic-alert dogs can be lifesavers, says Dr. Hardin, who presented the first scientific research on the dogs at this year’s annual American Diabetes Association conference in Philadelphia.

Using perspiration samples from patients whose sugars were below 65 milligrams a deciliter—normal is 80-120 mg/dL—she trained a two-year-old Labrador/Golden retriever mix to recognize low blood-sugar samples placed in blinded containers on a Lazy Susan-like wheel. Modeled after how police sniffing dogs are trained, trainers around the country use similar techniques. Dr. Hardin’s dog was then paired with Dustin Hillman, a 36-year-old patient who suffered severe hypoglycemic unawareness.

Before he got the dog, Mr. Hillman lost consciousness due to hypoglycemia more than six times over the previous two weeks, requiring emergency services. In the three months after, the owner only lost consciousness once and never required emergency service, according to the study.

Since having Tippy—short for Tippecanoe—Mr. Hillman has finished his dissertation and will receive his Master’s in Chemistry on Sunday from Purdue University. He had been on the verge of dropping out of school and moving back in with his parents, he says.

A fully trained diabetic-alert dog can cost as much as $20,000. Many families conduct fundraisers to afford them. Nonprofit training centers offer dogs free of charge, or ask for a nominal fee, but the waiting lists are long.

Andrea Calamoneri, whose 15-year-old son Dylan has had Type 1 diabetes for nearly a decade, said she was initially skeptical. “I wasn’t about to trust my son’s life to something that is voodoo,” she says. Seeing a dog respond to a low sugar reading convinced her. “It gives you chills when you see it happen.”

Celeste, a 60-pound yellow Labrador, has been at Dylan’s side for about a year. A few weeks ago, when Dylan got home from a 2½-hour wrestling practice, Ms. Calamoneri expected his sugars to drop. By bedtime, they hadn’t. In the middle of the night, Celeste nudged the Danville, Calif., mother of three awake. Dylan’s sugar level was 56, well below the target of 80.

“Your first reaction when you wake up is you almost want to say go back to bed, but you have to trust her and, sure enough, she’s right,” Ms. Calamoneri says.

She says the dog has alerted them of a pending drop in blood sugar well before the drop occurred. Celeste has missed an occasional alert, she says, which she attributes to a busy day when the dog got overly tired. Mostly, the dog naps whenever she is able, and typically the smell of a dropping sugar level will jolt her awake, Ms. Calamoneri says.

Interest in diabetic-alert dogs is rising, says Ed Peebles, president of the Las Vegas-based National Institute for Diabetic Alert Dogs, who says he gets up to 20 applications for a dog daily.

A family business his mother, a nurse, started a decade ago, the for-profit group has four locations, is hiring trainers and can’t prepare enough dogs to keep up with demand, Mr. Peebles says. He charges $18,000 for one fully trained dog between 10 months and a 1½ years old.

“We have seen a huge, huge spike in interest,” Mr. Peebles said. “I am five dogs behind.”

Ms. Eppler’s dog, Gracie, is always working. She bows to signal a low blood sugar and waves a raised paw to show a high level. When Gracie waves and then bows, it means that Abbie’s sugar is high but falling. “Rarely will Gracie let Abbie get below 90,” she says. “We joke that they are angels with fur.”

Write to Kate Linebaugh at kate.linebaugh@wsj.com

The “Mobile” of Life with Diabetes

IMG_1021“What is diabetes?” and “Why do diabetics need service dogs?” These are questions I’m often asked and have lectured about many times.  Until I read the lead article in the last edition of Early Alert Canines “The Scentinel”, I’d never thought of talking about diabetes in terms of what life with diabetes entails.  I had always spoken from the scientific or physiological orientations of diabetes – describing what is physically wrong with the body, and what a diabetic needs to do in order to take care of  themselves from a medical perspective.  Although I’ve lived with diabetes my entire life, and know every aspect as well as anyone can, I’ve never thought about describing diabetes from the “psychosocial” perspective.  (Psychosocial is a fancy word that means the psychological, social, and non-biological impact a disease has on an individual, family, and the society.)

Beyond the fact that the diabetic body does not produce insulin (or enough insulin), life with diabetes is a difficult and complex balancing act – for some reason, I’ve always visualized it as a mobile.  We must try to balance the insulin we give ourselves (for type 1 diabetes, or deal with not enough insulin if you have type 2), with the food we eat and exercise we get.  Some of the other factors influencing the balance are illness, growth, emotions, stress, medications, amount of sleep, hormones, etc.  And, if that isn’t enough, part of taking care of the disease includes constant monitoring with finger sticks, gathering data, counting carbs, pumping or injecting insulin, and/or taking other medications, calculating ratios, thinking backward while projecting forward, and correcting imbalances, as well as talking with doctors and reaching for support.  Oh, and I forgot to include trying to lead a “normal” and active life.  Keeping the ‘mobile’ of life with diabetes is, to say the least, challenging.

Another aspect of life with diabetes is less apparent to the observer. It is the stress and fear of living with this chronic disease.  There is the fear of “losing control” or having low blood sugars.  Untreated low blood sugar can lead to loss of balance and coordination, confusion, impaired thinking, bad decisions, vision changes, agitation, loss of consciousness and possibly death.  Friends and family members share these concern about the diabetic – especially parents of young diabetics.  Parents often wake-up multiple times a night to check their child’s blood sugar to ensure the child’s safety (and to try to increase their own peace of mind).  Diabetes affects the child because she knows she “doesn’t feel good” but may not realize it is because her blood sugar is out of control.  And children are often ostracized for having  diabetes because they are ‘different’.  We often check our blood sugar because of “feeling funny” or before driving, taking tests or doing physical activity to try to avoid problems and ensure everyone’s safety  Also, there are the physical discomforts (which makes me cranky) and ever-present fear of long-term complications which come from the blood sugar’s varying highs and lows.  All of these affect the diabetic and those who love and care for this person.

I am amazed to write all of this!  I feel like I should be overwhelmed; yet, for me, everything I’ve written about is part of my daily life

Rainie love

Rainie love

Now, to attempt to explain why someone like me (someone with diabetes) would have a service dog:  A diabetic alert dog’s fundamental job is to alert the diabetic, or diabetic’s care-taker, to sudden changes in blood sugar so that precautionary measures can be taken.  My diabetic alert dog, Rainie, alerts me to both highs and lows in any location – in the house, while I’m asleep, while we’re out and about, on airplanes, in restaurants, hospitals, libraries, at the movies, etc.  When she warns me, I am able to take steps to avoid the situation worsening and becoming dangerous.  I tell people that when Rainie alerts me, she is warning me to pay attention to my blood sugar – it is changing quickly.  With her, I feel safer.  I have another ally and tool to assist me in monitoring my diabetes.  She is my constant companion.  I no longer feel alone, or as overwhelmed in dealing with this disease.  Parents who have alert dogs for their diabetic children have another way to monitor their child.  Since parents have no physical sense of their child’s blood sugar levels, the dog’s alerts give them advanced warning, insight, and, hopefully, peace of mind.

I’d like to repeat what Devin stated in her article:  “Though it is critical for every diabetic to understand the underlying cause of his or her condition, we might generate greater public understanding if we start talking less about what doesn’t work in our bodies and more about everything we do to set that right. The next time someone asks about your diabetes, try telling them what you are doing to take care of yourself (sic). It might give them a better understanding of diabetes, and it will certainly clue them in to how totally awesome you are.”