Alternative Forms of Glucose Monitoring (CGM)
There have been several blogs (including mine) about hypoglycemia and seizure dogs. I knew it would be a matter of time before I would actually be able to "download" data from a living continuous blood glucose sensor. Last Wednesday, upon entering the waiting room of a Children's National regional outpatient center, I noted a clump of patients and families surrounding an adorable two-year-old golden retriever dog. As I weaved in and out of the waiting room, I sincerely could not wait to meet my new four-legged assistant to my young patient and his family. "Gunner" had arrived from Texas after receiving his training as a service dog. Gunner is a hypoglycemia service dog and his trainers in Amarillo, Texas, taught him to sense both low and high blood sugars in his young friend.
When it came time for my patient's appointment, the new family member sauntered in with his young friend and mother and immediately scoped me out. I am a dog-friendly person and after a few whiffs (and a lick), Gunner decided I could stay. He rolled over and his "mother" told me to tickle his belly, which I immediately obeyed. He then put his head on my foot. I did not want to move as I could immediately feel my blood pressure drop. Imagine how my patient and family members must feel in Gunner's presence! After discussing my patient's insulin regime, downloading blood sugars (from the meter), and performing a physical examination, I made my diabetes recommendations and proceeded to discuss how our new CGM worked.
Not only was Gunner able to sense high and low blood sugars in his family members, but in strangers as well. His mother told me about a time during a church service that Gunner began to demonstrate behaviors indicating a problem. The blood sugar was checked in my young patient, and he was in range. However, a lady close to the family, who later acknowledged that she had diabetes, was low. I was fascinated! How does Gunner alert his "parents" or change when his buddy is high or low? According to Gunner's mother, each hypoglycemia dog alerts his or her owner in a manner unique to the dog's personality. Gunner will either lick, put his paws on shoulders, or become disobedient when his young charge is either high or low. He is able to sense blood glucose changes acutely. When he accurately assesses either hypo or hyperglycemia (confirmed with a blood glucose meter check), he is immediately rewarded with a treat to positively reinforce the behavior.
During the office visit, Gunner simply lounged on the floor. According to his mother, he is potty-trained and rarely has accidents. My patient's blood sugar must have been stable throughout the visit because Gunner barely moved under my feet (we did check and confirm this during the exam).
What are the advantages of a hypoglycemia dog?
- In my opinion, the biggest advantage is having a mobile sensor at night that could either wake up the person with diabetes or alert family members. I have learned of this behavior in family pets that have not received special training. One of my patients had a German shepherd dog that would literally pace in front of her bedroom all night. No one was allowed to go in unless he alerted family members that she was low.
- There is no need for a sensor to be attached to a body that beeps (or barks) sometimes falsely (false alarms). It is much more pleasant to be "kissed" by your buddy when you are high or low.
- The animal is allowed to be with you at all times.
- Emotional attachment and care by a person with diabetes and therapy dog is a bonding experience. Physiological changes may occur including a decrease in blood pressure and less blood glucose variability along with improved sense of well-being and self-esteem.
- Family support and reassurance.
- Improved mood of your doctor and less irritable people in the waiting room.
What are the disadvantages of a hypoglycemia dog?
- Can't download blood sugar every minute (no up/down arrows indicating trends). But you could manually track the dog's behavior correlated with blood sugars.
- Expensive (but so is the navigator, dexcom, and minimed).
- Training for one week and living in another city (time) possibly out of state.
For more on diabetes guide dogs, check out Ann's post!