Noelle and I started working on her future as a diabetes alert dog shortly after her first birthday. My old service dog, Honey, I trained too hard too fast when she was a puppy and it interrupted our relationship in some ways. I expected too much too soon, and added a layer of frustration into our relationship that I've always regretted. I wanted to do things differently with Noelle. No hot house training her first year, just giving her a chance to be a silly puppy, with lots of bonding and practice training.
She's a natural born diabetes alert dog, and started alerting to low blood sugar spontaneously at about six months. However, that natural ability does not qualify as an "individually trained task" under the ADA. About a month ago, I introduced sniffing out low blood sugar scent on purpose. She's scenting out my low blood sugar scent despite five distraction scents. Distractions are hand lotion, soy sauce, vanilla extract, sesame oil, dish soap. She gets it right every time.
She can ignore 11 distraction scents and zero in on my low blood sugar scent in seconds. The first time I trained her on this scent, I went low while we were training. Noelle had selected the right container, and as I was praising her, she took a step backward, and then went bonkers, jumping and leaping all over me. I tested my blood sugar and it was in the low 60's. Nice catch, Noelle.
We've started going out in public together, and Noelle's manners are better than I expected.
This week, we're going to the store to practice sits and downs in high distraction. And not munching food off the floor.
I'll make a trail of low value treats on the floor and have high value treats in my hand. We'll walk back and forth past the low value food. Then I'll increase the value of the food on the floor, until we can walk past anything without her sniffing it. That's how I trained Honey and it worked really well.
Noelle is on her way to being Honey's successor. The relief I feel is overwhelming. Thanks Noelle. You're on your way.
When you feel lousy, puppy therapy is indicated.
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Capturing low blood sugar scent is easy. I only do this in the afternoon, because it would be a bad idea at night. When my blood sugar is around 100, I give myself a bolus of insulin for around 44 grams of carbs, which is the carbs in a bottle of Coke. Then, don't drink the Coke. i do nothing and wait for the insulin to drop my blood sugar to 70.
When my blood sugar hits 70, I gather plain cotton eye makeup pads and, um, spit on them. Saliva contains low blood sugar scent that dogs can detect. Spit on lots of them. Gather pads and put them in the freezer. Then, ahem, DRINK THE COKE RIGHT NOW!!! Guzzle a bottle of Coke, eat a cheese stick to prevent my blood sugar from dropping again. Good to go.
I only do this in the afternoon, because it could be a fatal mistake at night. Over the next few hours, I'll pay super close attention to my blood sugar afterward until it stabilizes. If I have a real, non-triggered low, I'll also gather saliva on pads, unless my number is below 70. I don't want Noelle to learn to alert me when my blood sugar is in the 40's and in seizure territory. Or the 20's, in coma territory.
I've been diabetic long enough that my body no longer recognizes low blood sugar until it's too late. I know I'm low when I'm hallucinating, or flickering in and out of absence seizures. When I get in the 50's, I will hold on tightly to a can of Pepsi, because I need it, but I won't drink it, because I need it, so I cling to it for dear life without opening it. And my blood sugar drops into the 40's, and lower. I can get so low that I can't help myself and it's terrifying. I want Noelle to tell me long before that happens, so I can respond. Between 65-70 I can always help myself, so I'm training Noelle to respond to 70.
Now that Noelle is scenting pads in plastic containers, I hide them on my body and wait. If she notices the scent, she gets super excited and jumps on me. I wouldn't recommend training a Spoo to jump on you as an alert, but Noelle is an oversized mini. Her hind legs reach just above my waist, so it's not a big deal to have her jump on me. And it is the alert she chose, along with frantically licking the inside of my elbow.
While Noelle is leaping and jumping and pawing at me, I give her 15 high value treats. I count out 15 pieces of chicken, or salmon. Needless to say, Noelle LOVES when I'm low. I throw a low party with lots of treats and joy, while I drink a little can of pop. They have 25 grams of carbs and are the perfect size for treating low blood sugar without over treating.
Once Noelle is doing low blood sugar alerts, I'll train for high blood sugar. I use an insulin pump. It's wonderful and I love it.
I have a tiny Teflon needle under my skin. I can't feel it and it doesn't bother me. This tiny needle connects through tubing to my pump. I move the needle every three days. Before my pump, I was giving myself six shots a day. Which, if given at once, looks like this.
That's an art project and a diabetic little boy. Those are glued on, and represent all of his insulin shots in a month if given all at once. Diabetes needs a cure.
Anyhow, I couldn't maintain good good control without a pump, and I really don't miss being a human pincushion. But, my pump is not perfect. Your pancreas delivers tiny drops of insulin every few seconds. My pump does the same. Should my pump get disrupted, my blood sugar goes up. If it's disrupted for long enough, I'm at risk for diabetic ketoacidosis. DKA can cause brain swelling and death. High blood sugar can be just as terrifying as low.
My meter was not saying hello. That was high, as in, too high for the meter to read. My pump tubing got dislodged and I had no idea for hours. To keep from seeing that number again, I'll train Noelle to scent out blood sugar at 250, the same way I trained her to find a low. Find the high. Smell it out. High blood sugar breath smells like nail polish remover. Even mere humans can smell it.
And I don't think I'll train a separate signal, either. Noelle can leap on me and get excited for both low and high. I'll be able to tell instantly which she is telling me by cluing in to how I feel. Thirsty, high. Fuzzy, low.
Low blood sugar alerts are far more urgent. I have good control and am almost never high. Lows happen more often. Miscounted carbs and gave myself too much insulin with dinner, low. Or, ate lunch and went for a walk, low. Or, gave insulin to cover a meal after a walk and the insulin went to work before the food started digesting, low. Or, it's Tuesday, low. Or, I just brushed my teeth and diabetes is having a laugh, low. Mmm, toothpaste and sweet, fruity glucose tablets, my favorite bedtime snack. Or not.
Type 1 diabetes is scary sometimes. Noelle is making it less scary and that matters to me, more than I can say.
When you feel lousy, puppy therapy is indicated.
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Thank you so very much for that wonderfully detailed and inclusive post. I see the DKA and terrifying lows from a different perspective and it is so enlightening to hear your side of it. I truly feel as if I have learned something and I thank you for that.
__________________ if you have a heart, you will know pain. if you don't have a heart, you will cause pain. you did good.
(stolen from patk - Thanks!)
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