Dogs with special training can sense when a serious hypoglycemia attack may be impending.

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Diabetes alert dogs spend a year or sometimes even more being trained. Getty Images

Another nod to man’s best friend comes from a recent study focused on the impact a well-trained service dog can have on the daily lives of people with type 1 diabetes.

This is something many patients have known for a long time — that even the best of today’s diabetes technology can’t quite compare to the safety and security provided by a “diabetes alert dog.”

The study from the University of Bristol in England reports that diabetes alert dogs alerted their owners to 83 percent of hypoglycemic episodes in more than 4,000 hypoglycemic and hyperglycemic events.

Nicola Rooney, PhD, a teaching fellow in animal welfare and behavior at the Bristol Veterinary School and a study author, says that while the value of a “medical detection dog” is well-known, this is the first large-scale study focused on using service dogs for detecting hypoglycemia.

Trained first as service dogs, diabetes alert dogs are then trained with a combined effort of the original training facility and their new owners to monitor an imbalance of glucose versus insulin on the breath and saliva.

During training, dog owners put cotton balls in their mouths to collect their saliva when their blood sugars are low or high.

Dogs then associate different blood sugar levels with certain alerts — such as nudging their owner with their nose or putting their paw on their owner’s knee.

“He really does catch the low blood sugars before they happen,” said Sarah Koenck about her service dog, Rio.

Koenck, a Colorado native and registered dietitian at Virta Health, has lived with type 1 diabetes for several decades and wears a continuous glucose monitor (CGM).

But Rio the golden retriever is simply better than her advanced technology.

“He’s always right,” Koenck told Healthline. “Rio will alert me before my blood sugar is low — even when my meter or my CGM says I’m still at a safe level of 100 mg/dL. But Rio knows I’m dropping and that my blood sugar is eventually going to be low.”

While she was hesitant at first to treat a 100 mg/dL as a “low” by consuming fast-acting carbohydrates, Koenck learned to trust Rio completely.

Low blood sugars — also referred to as hypoglycemia — can be a frequent occurrence for people with type 1 diabetes, including those with “tight” blood sugar control.

Aiming to keep blood sugars in the healthiest range as a patient with type 1 diabetes actually requires blood sugar levels to be just slightly above “low.”

This puts patients at risk for more frequent low blood sugars while they’re trying to prevent the high blood sugars that contribute to the development of diabetes complications such as neuropathy or retinopathy.

Koenck first sought a diabetes alert dog because she was going to be living alone for the first time after living with her parents and then her sister.

After Koenck experienced two severe low blood sugar events that left her unable to move and treat herself with fast-acting carbohydrates, her mother, in particular, was insistent that she apply for a diabetes alert dog.

Some patients with type 1 diabetes also struggle with “hypoglycemia unawareness,” which means their body no longer provides the signs and symptoms of low blood sugars like feelings of lightheadedness, irritability, shakiness, headaches, cravings, and confusion.

These patients are at a much higher risk for severe hypoglycemia — when blood sugars drop so low that the patient experiences seizure, coma, or death.

Koenck’s CGM — which measures the glucose in interstitial fluid rather than glucose in the blood — is generally about 15 minutes behind her dog.

While CGM technology has provided patients with far more data and security than testing with traditional glucose meters, it doesn’t replace a dog like Rio.

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Sarah Koenck with her diabetes alert dog, Rio, after a long mountainous hike. Image via Sarah Koenck

“You apply for a dog through one of the many organizations that train service dogs,” explained Koenck, who put her name on a year-long waiting list.

A diabetes alert dog can cost as much as $20,000, depending on what program you adopt your dog through.

There are also programs in nearly every state that help children with type 1 diabetes get alert dogs — sometimes for free — because children are not always able to sense, understand, and articulate that their blood sugar is dropping. This is especially concerning in the middle of the night when the child’s parents are asleep in another room.

Koenck encourages anyone with type 1 diabetes interested in getting an alert dog to research the options within their state to help offset the costs.

Rio was trained first as a service dog through CARES (canine assistance rehabilitation education and services) in Concordia, Kansas.

“CARES teams up with a couple of different prisons where the inmates train the dogs from an obedience perspective — everything from potty training, how to behave in public, in restaurants, not eating food off the ground, and so on,” said Koenck.

The dogs only stay within the prison training program for a month or two and then they return to CARES, which continues their in-depth training as a service dog.

The biggest part of the training — which you as the owner play a key role in — is when they are ready to learn how to alert for low and high blood sugars.

“It’s a big responsibility,” said Koenck, who was overwhelmed at first by the amount of work and discipline that went into preparing Rio for his duties. “You have to be very consistent about discipline and training and every interaction with your dog. Rio actually went back to CARES for two months for additional training because I was really struggling with my training responsibilities when he hit his ‘teenage’ years.”

“I set the parameters of when I wanted to be alerted — anything under 65 mg/dL or above 180 mg/dL, which I eventually lowered down to 130 mg/dL now that I’m using a low-carb diet for my gastroparesis,” she said.

Rio is trained to touch Koenck with his paw or lick her hand.

“Sometimes, if I’m not paying attention to him, he’ll even alert my husband to be sure he’s doing what he was trained to do: help me prevent severe low blood sugars,” Koenck said.

While diabetes alert dogs are trained not to bark as a form of alert, Rio did bark loudly once when Koenck had become unable to speak due to severe hypoglycemia and her husband was on a different floor of the house.

Rio did, ultimately, prevent Koenck from experiencing a seizure thanks to his ability to get Koenck’s husband’s attention.

It’s important to note, however, that there’s more to the success of a diabetes alert dog than training.

“Our research shows a dog’s effectiveness is affected by the individual dog and its connection with its human partner,” added Rooney.

“Since the usage of such dogs is growing, it’s important that any dogs used for these purposes are professionally trained, matched, and monitored by professional organizations like Medical Detection Dogs. It’s also vital that research continues both to assess true efficacy and determine ways to optimize their performance,” she said.

Additionally, not every dog or breed of dog is ideal for becoming a service or diabetes alert dog.

Golden retrievers and Labradors are often used because they are loyal and people-focused as opposed to a hound breed that might be more interested in something they smell 300 yards away.

Can you train a dog on your own? Possibly — with the help of in-depth guides like Veronica Zimmerman’s book, DOG A Diabetic’s Best Friend Training Guide.

The training itself is doable, but the amount of discipline, education, and consistency required from the owner may be daunting for many.

Ginger Vieira is an expert patient living with type 1 diabetes, celiac disease, and fibromyalgia. Find her diabetes books on Amazon and her articles on Diabetes Strong. Connect with her on Twitter and YouTube.