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Service Dogs and Diabetes

Type 1 diabetes and the risk of hypoglycemia

When you live with type 1 diabetes (T1D), the risk of hypoglycemia (low blood sugar) is ever-present and stress-inducing. It can also impact your daily life by disrupting, for instance, your sleep and physical activity.

Symptoms of hypoglycemia (e.g., sweating, shakiness, confusion) will usually alert you that something is not right and that you need to address it. 

However, you might not feel these symptoms anymore (e.g., if you have frequent hypoglycemic episodes) and/or you might not feel them as strongly (e.g., when you sleep). If that is the case, your risk of severe hypoglycemia (leading to coma, seizures) is significantly higher, and it is crucial that you put strategies in place to avoid hypoglycemia or be alerted in case of hypoglycemia. 

Detecting hypo and hyperglycemia by smell 

Did you know that dogs have an exceptional ability to detect certain illnesses? A British study has found that some dogs are able to detect hypoglycemic and hyperglycemic episodes in people with T1D.

With their naturally acute sense of smell, dogs make for excellent hunters. Some professional trainers use that ability to train dogs in detecting certain smells associated with diabetes, for instance, the fruity smell caused by ketones during a hyperglycemic (high blood sugar) episode, or the unique smell that a person gives off when they are having a hypoglycemic episode. 

It is still unclear what the dogs smell exactly. In 2016, a study from Cambridge University found that during a hypoglycemic episode, the level of isoprene (a natural chemical compound that is exhaled through the breath) is sometimes twice as high.

Researchers from the University of Bristol have assessed how 27 dogs could detect some diabetes-related issues. The dogs were trained to alert their human in case of low or high blood sugar. The study found that they detected 83% of hypoglycemic episodes and 64% of hyperglycemic episodes.

Four of the 27 dogs in the study were able to detect 100% of those episodes.

Training centres in Canada

The Lions Foundation of Canada Dog Guides has been training dogs to detect hypoglycemia since 2013. Canadians over 10 years of age who have hypoglycemia unawareness can get one of these dogs, free of charge. The different breeds of dogs (e.g., Labradors, golden retrievers, standard and miniature poodles) undergo intensive training before they are handed over to a patient with diabetes. However, the Foundation is not currently accepting any new applications due to the pandemic and long waitlist.

There are currently no such organizations in Quebec (there used to be the Fondation Corazõn). 

Limitations and barriers

Service dogs not only provide T1D patients with an extra layer of protection, but they also help improve quality of life, well-being, autonomy and level of physical activity.

However, people who would like to have a service dog should keep in mind that owning an animal implies some responsibilities, and that the training process is long (about two years) and complex. For those reasons, few organizations are willing to provide this service. The Lions Foundation of Canada Dog Guides reported that it trains about ten dogs every two years, which is, unfortunately, very little.

Service dogs may need regular training sessions to maintain their ability to detect hypoglycemia and hyperglycemia and to alert their owner, along with regular follow-ups. 

Service dogs provide T1D patients who have hypoglycemia awareness or who live on their own with an extra layer of protection, but they cannot replace blood sugar measurements or prevention and treatment strategies. There are no accuracy standards, and it may be difficult to interpret the dog’s signal when it detects hypoglycemia or hyperglycemia. 

Other strategies like the use of a continuous glucose monitoring (CGM) system can help someone to be alerted in case of problem. A study has found that CGMs generally detect hypoglycemia a lot earlier than service dogs. 

The RAMQ now covers the Dexcom CGM, which sends alerts and has been shown to reduce the risk of hypoglycemia and hyperglycemia.

It is also important for you to know how to measure your blood sugar levels, how to adjust your doses and what situations pose the highest risks. That’s why we have created the SUPPORT online platform for people with type 1 diabetes. Learn more »
We also host webinars on diabetes-specific topics. Learn more »

References:

  • Wells, Deborah L et al. “Canine responses to hypoglycemia in patients with type 1 diabetes.” Journal of alternative and complementary medicine (New York, N.Y.) vol. 14,10 (2008): 1235-41. doi:10.1089/acm.2008.0288
  • Los, Evan A., et al. “Reliability of Trained Dogs to Alert to Hypoglycemia in Patients With Type 1 Diabetes.” Journal of Diabetes Science and Technology, vol. 11, no. 3, May 2017, pp. 506–512, doi:10.1177/1932296816666537.
  • Service dogs assist with diabetes care, consulté le 1er juillet 2021, mayoclinic.org/diseases-conditions/diabetes/expert-blog/diabetes-service-dog/bgp-20148062
  • Gonder-Frederick, Linda, et al. “Diabetic alert dogs: a preliminary survey of current users.” Diabetes Care 36.4 (2013): e47-e47
  • Les lions du Canada, consulté le 1er juillet 2021, https://www.dogguides.com/
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