Could Devin Grayson’s world was shrinking. The 36-year-old California a comic-book author and video game writer had been diagnosed with type 1 diabetes when she was 15, and like many people with insulin-dependent diabetes, she Dogsuffered wild swings in her blood glucose. Over time, she’d also de- veloped hypoglycemia unaware- ness, the inability to recognize symptoms of severe glucose lows. “One night I woke up and my ave blood sugar was 17,” she recalls. “It’s amazing I woke up at all and didn’t die in my sleep.” By the summer of 2005, Grayson was restricting her activi- ties because of her fear of hypo- S glycemic episodes. She gave up many of her favorite pursuits, like hiking in the redwoods north of San Francisco, and became reluc- tant to go out alone. She even moved into a house with friends because she worried that her dia- betes made it dangerous to live alone any longer. And still she felt trapped. “There’s a real psychic burden attached to diabetes,” she says. “You never get a break. (Your Life?) Every meal, every day, you have to monitor. It’s lonely. There are No one knows for sure how they do it, but a growing days when you would do anything number of canine companions are helping people with just to have a weekend off.” diabetes avoid dangerous hypoglycemia. Then Grayson met Cody, and everything changed. It was an By Amanda Spake Internet hook-up, of sorts: Online, Grayson had discovered Dogs for Diabetics, a Concord, Calif.–based organization that trains dogs to respond to serious blood glucose drops in humans. She registered for classes in the summer of 2005,

40 Diabetes Forecast | march 2008 photograph by robert houser

Devin Grayson and

goldenCody retriever

Diabetes Forecast | march 2008 41 and in six months she was teamed will be to identify the sensory cue insulin-dependent diabetes, one up with Cody, a male Golden the dogs are reacting to. with type 1 diabetes and two with Retriever. Not only has Cody saved Part of what is so uncanny about type 2, whose pet dogs predicted Grayson’s life, he’s given her a life these dogs is their reliability: the onset of a hypoglycemic epi- to enjoy, she says: “For the first Trainers say they are right 90 per- sode. The dogs dramatically time since I was diagnosed, I feel cent of the time. They also seem to changed their behavior when they this enormous burden has been have a skill that no test kit or piece sensed their owners’ drop in blood lifted. I’m not alone with it of machinery offers: the ability to glucose—jumping up, running anymore.” sense a dangerous drop in blood around the house, hiding under a glucose before the drop occurs. chair, rousting them out of bed, As s i s t a n c e d o g s , such as guide Some dogs become so good at pacing, or putting their heads or dogs for blind people, dogs that sensing low and high blood glu- paws in their owners’ lap until their “hear” for the hearing impaired, or cose that they “diagnose” people owners ingested carbohydrates to dogs that retrieve items for the around them. At Grayson’s office, normalize their glucose levels. wheelchair-bound, have been help- for example, a coworker men- “The three patients who I wrote ing humans for decades. But Cody tioned that Cody had been anx- about in the British Medical is part of a new trend in which iously pawing the woman’s knee. Journal paper all had impaired dogs are trained to identify the “Wait a minute,” Grayson said, and awareness of hypoglycemia,” says onset of hypoglycemia in people went to get her glucose monitor. Gareth Williams, MD, a professor with insulin-dependent diabetes. When she checked the woman, her of medicine at the University of For the dogs, it’s a game. Once blood glucose was 180. She was Bristol in England. “Their lives they alert, they receive their treat, later diagnosed with type 2 were made miserable by their fear plus lots of positive reinforcement diabetes. of going hypo.” That is, until their from their owners. But for the hu- dogs began to help them out. mans they live with, the results are A s t u d y p u b l i s h e d in Diabetic Still, many people who experi- nothing short of miraculous. Medicine in 1992 showed that as ence hypoglycemic episodes may And yet science tells us nothing many as one-third of the pets living do well to try further diabetes about whether dogs can really do with people with diabetes—usually education on how to safely adjust this. Or how: “We believe the dogs dogs, but also cats, rabbits, and insulin and diet to activity, and are picking up on scents that are even birds—exhibit dramatic to talk to their doctor about new created by chemical changes going changes in behavior when they regimens including insulin-pump on in the person’s body before we sense a drop in their owners’ blood therapy or continuous glucose humans see the actual symptoms of glucose. A British Medical Journal monitoring, counsels Diabetes the illness,” says Darlene Sullivan, article in 2000 further piqued the Forecast Editor-in-Chief Paris executiveA director of Canine interest of both dog trainers and Roach, MD, of the Indiana Partners for Life. But the scent has diabetes experts. It reported the University School of Medicine. not been identified. In fact, the first experiences of three women with “While these dogs apparently academic study to evaluate how well dogs detect hypoglyce- mia is being done by Deborah Wells, MD, at Queens Uni­ versity in Belfast, Northern Ireland. If she verifies that dogs can alert to blood glu- cose drops, her next project

42 Diabetes Forecast | march 2008 “This dog is incredible. She’ll come running to us in the middle of the night with the test kit in her mouth.” —Donna Cope

Hunter Cope and

german Divashepherd

photograph by brian smith

Diabetes Forecast | march 2008 43 A

Mark Ruefenacht and

lAabrrmstrongador retriever

photograph by robert houser 44 Diabetes Forecast | march 2008 Animals Who Need Help, Too

Does the famously rotund cartoon cat Garfield need a shot of insulin? have an amazing ability, much We may never know, but the fact of the matter is that many household remains to be learned about how pets have diabetes, and fat cats are at higher risk for diabetes than sensitive they are in detecting leaner ones. “Type 2 diabetes is associated with obesity in people, and hypoglycemia,” he adds. it’s the same story in cats,” says Margarethe Hoenig, DVM, PhD, profes- sor in the College of Veterinary Medicine at the University of Georgia in A f o r e n s i c s c i e n t i s t who has Athens. She says that 45 percent of cats are overweight or obese, and as type 1, Mark Ruefenacht had they have gotten bigger, feline diabetes has increased three- to fivefold trained dogs for law enforcement, over the past 30 years. and worked as a volunteer “puppy Canine diabetes, on the other hand, appears to be closely related raiser” and supervisor for Guide to human type 1 diabetes. Pancreatic antibodies, the hallmark of Dogs for the Blind in Northern human type 1 diabetes, are found in diabetic dogs, indicating that an California. While on a business trip autoimmune war is being waged on the pancreatic cells that secrete to New York, Ruefenacht ate a insulin. Diabetic cats, meanwhile, maintain these cells, but produce chocolate doughnut one night be- less insulin and have reduced insulin sensitivity. fore bedtime, and took extra insulin Overall, 0.5–1 percent of cats and 0.2 percent of dogs are diabetic. to compensate. But he didn’t check Certain breeds—including Burmese cats and Golden Retrievers— his blood glucose. He happened to are more prone to diabetes than others. This indicates that there may have brought along Benton, a dog be genetic factors that predispose certain animals to the disease. Ahe was training to be a guide dog, The signs that a pet may have diabetes are the same as in people: and that night Benton recognized They drink more, they urinate more, they want to eat more, and that Ruefenacht’s blood glucose they may become weak. If you suspect diabetes in your pet, make a had plunged, and frantically tried to veterinarian appointment as soon as possible. Diabetic wake him. “He had difficulty get- dogs will need to be administered insulin indefinitely. ting me up, and getting me going. For cats, insulin may be required, but a high-protein diet But he stayed with me until I got up and exercise are also good ways to help keep blood and ate something to raise my glucose levels in check. Oral medications blood sugar,” Ruefenacht says. may also be included in care regimens. “This was not a dog that knew me, There’s another way their human or my diabetes. I started thinking, companions can help cats, by the ‘Can I train a dog to do this?’ ” way. It’s believed that one problem Ruefenacht was given Arm- contributing to the increase in feline diabetes strong, a yellow Labrador Re- may be the cuteness factor: As Hoenig says, triever, from Guide Dogs for the “Cat owners like their cats obese.” Of course, fans of Blind. The organization felt Arm- a certain lasagna-loving feline already know that. strong had a great nose for scents, —Erika Gebel, PhD but his penchant for walking she had experienced low blood symptoms. “But what we found is around puddles made him inappro- glucose. When she walked in, that dogs were not alerting to a priate as a guide dog. Ruefenacht Armstrong alerted. “That was our static number. They may alert at trained Armstrong to alert consis- bingo day,” Ruefenacht says. 150, but within 20 or 30 minutes, tently to drops in his own blood Ruefenacht founded Dogs for the person is down to 70 or lower. glucose, but could he sense oth- Diabetics, or D4D, as it is known, They are recognizing a scent emit- ers’? He asked Kaiser Permanente in 2004. At first, he tried to train ted when a diabetic begins to expe- diabetes educator Jeanne Hickey, the dogs to alert to a specific blood rience a rapid drop in blood sugar.” who also has diabetes, to come glucose number, one at which Ruefenacht realized that this was over wearing clothing from a time many people have hypoglycemic far more useful. It allows time to

Diabetes Forecast | march 2008 45 “If I don’t wake up right away, Kay-Dee will stand on me. Then I say, ‘Show me,’ and she runs to Brianna’s bed, nudges her, and looks for her treat.” —Tammy Mountain T

Brianna Mountain and

GoldenKay-Dee retriever

photograph by Robbie McClaran

46 Diabetes Forecast | march 2008 To Learn More… Training groups mentioned in this article

treat the condition before it turns Dogs for Diabetics Concord, Calif. into a crisis. Now, after three years Dogs for Diabetics (D4D) is a certified member of Assistance Dogs of placing trained dogs, he says, International, an organization that sets standards for service dog training. “Clients are coming back saying D4D is the only ADI member that trains dogs primarily for hypoglycemia ‘I have never had better control alert. The group accepts clients only in Northern California at present. of my blood sugar in my life as E-mail: [email protected] I have since I got this dog.’ ” Canine Partners for Life Cochranville, Pa. Th e n u m b e r o f people using alert Canine Partners for Life trains alert and assistance dogs for people suffering dogs is limited by the expense and seizures or loss of hearing, sight, or mobility, often resulting from diabetes. time it takes to train both dog and The group has placed two dogs trained specifically for hypoglycemia alert. client. Training may require two Phone: (610) 869-4902. E-mail: [email protected] years and costs at least $20,000. “It’s very time-consuming and All Purpose Canines, Inc. Aberdeen, S.D. intense to get the dog to be at least All Purpose Canines trains hypoglycemia alert dogs for children, although the 85 percent accurate,” says Beverly company’s primary focus has become training dogs for children with autism. Schwartz of All Purpose Canines. Phone: (605) 225-1131. E-mail: [email protected] Most assistance dog organizations are supported by grants and dona- tions, so funding limits the number episodes. “It’s like she’s had a That felt safe to me, because the of dogs they can provide, and most stroke,” her mother, Tammy, says. alternative of going low was so ask the clients to cover a portion of “She can’t speak or move the right frightening.” But chronic hypergly- Tthe costs. side of her body.” Two months ago, cemia has caused Grayson to de- “The first time that dog gets you the Mountain family got Kay-Dee, velop proliferative retinopathy, a up in the middle of the night be- a Golden Retriever trained by All severe form of eye disease. Laser cause your child is dropping into a Purpose Canines. Already Kay- surgery may stop progression of serious low, rapidly,” says Donna Dee has saved Brianna at least the condition, but will not restore Cope, of Miami, “you realize it’s once from this ordeal. “If I don’t lost vision. “I’ve had to do laser worth every penny you spent and wake up right away, Kay-Dee will treatments six times, already,” every minute you had to wait.” Her stand on me,” Tammy Mountain Grayson says. “But with Cody, I daughter, Hunter Cope, 11, was di- says. “Then I say, ‘Show me,’ and don’t feel the need to hedge my agnosed with diabetes when she she runs to Brianna’s bed, nudges bets by keeping my blood sugar was 7 years old. Diva, Hunter’s her, and looks for her treat.” The too high. I can try to maintain a German Shepherd, was trained by dog also alerts when Brianna’s healthy blood sugar now.” All Purpose Canines and placed glucose is too high. “At about 200, And as Grayson is speaking, with the Copes last year. “This dog Kay-Dee gets restless, and paces. Cody begins licking her hand, and is incredible,” Donna Cope says. If Brianna gets over 250, Kay-Dee pacing. Grayson gets her glucose “She’ll come running to us in the pants so hard she heaves.” monitor and tests. “It’s 211,” she middle of the night with the test As important as the dogs can be says. She pops a piece of dried kit in her mouth.” for the parents of insulin-dependent liver in Cody’s mouth, and gets out Brianna Mountain, a 10-year-old children, they offer something her insulin. “In the past, I wouldn’t ges with diabetes in Walla Walla, equally significant to adults like have checked for hours.” A y Ima

Wash., suffers from a condition Devin Grayson: a new chance at etty/G called hemiplegic migraine, which health. Before Cody, Grayson says, Amanda Spake is a freelance

coincides with her hypoglycemic “I let myself run high, around 170. writer from Churchton, Md. P eteele r Daz

Diabetes Forecast | march 2008 47