Service Dogs Pick Up Scent of Diabetes Danger
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.
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.
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.
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 LLY +0.99% & 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
