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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.
 

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She's a smart cookie - and lucky for you she is really good at exactly what you need her to do - alerting to your low blood sugar.
 

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Your new samples have been sorted, labeled, and stuck in an envelope. Tomorrow, they go in the mail to you. :)

You guys are doing a phenomenal job with training! I am so happy for you.
 

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Discussion Starter #8
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.
 

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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.
 

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Thank you for the explanation about how you capture the scents, that's really interesting. So how does this work at night? Does Noelle sleep with you in case you go low at night? What do you do when she is sleeping and can't alert you? I'm not trying to be nosy, just curious how this all works :)
 

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Thank you for this fascinating and informative thread. It has given me a much, much better understanding of what is involved in monitoring and managing blood sugar levels, apart from the complexities of training an alert dog. Noelle sounds like a natural, and I love that you let her get through the silly, distracted puppy stage just having fun before teaching her what must be for her the best game ever.

We have a young friend who has developed serious epilepsy. YOu have inspired me to look more closely into whether an alert dog might help him.
 

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You are really brave, this illness is terrifying ! And very complex. I have an auto-immune disease and sometimes, rarely, I get hypoglycemia and I don't know why. It happens so little that I don't recognize it until many hours later. And of course I am not good at managing it.

What you are doing for yourself is incredible. I know you don't have a choice, but still.

I suppose you know a lot about managing your symptoms through diet and I am curious to know if you have tried such diets as paleo or Seignalet or any low carb ones ? And does it help or is it just good for type 2 diabetes ?
 

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What an awesome description of the training you are doing with Noelle. I will be very interested in following the progress of the awesome teammate you have there. Noelle you rock it. Good girl!
 

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Dechi, Paleo is more a type 2 thing, although I usually go carb free in the morning because of dawn phenomenon. What's dawn phenomenon? Every morning when people get up, their livers dump the glucose equivalent of two cans of Coke into their bloodstreams. Then a surge of hormones flood your body. This is the body's way of waking itself back up, and giving an energy boost to start the day.

Unfortunately, this plays against people with diabetes. The liver dump causes blood glucose to rise quickly. And the hormonal surge makes insulin not work properly. Before I got an insulin pump, I would go to bed with normal blood glucose (90-180 is in range for a diabetic) But, I'd wake up in the 220's to 250's every morning. And I'd be furious because I'd spend until noon trying to repair it.

Now, my pump delivers more insulin at 5 AM, keeps giving more insulin until noon, and then my insulin requirements drop by half for the afternoon. It's wonderful to wake up with normal blood sugars and not be so upset all day. And not crashing every afternoon is good, too. I love my pump!

Eating low carb does keep blood sugars stable, but as an insulin user I can eat anything and compensate for it by giving insulin to "cover" the carbs. There's a math formula that helps people with type 1 figure out how much insulin to use based on the grams of carbs.
We'll use a 1:10 ratio, because it's easy. 1 unit of insulin will "cover" 10 grams of carbs. Eat 10 carbs, 1 unit needed. Eat 20, 2 units. Eat 50, five units.

That's an easy one to calculate in your head. Ah, but life is not easy. I have 5 different insulin to carb ratios throughout the day. Everything from 1:8 for breakfast to 1:15 at lunch. My pump keeps track of all this so all do is press some buttons and get the right dose at the right time, assuming I counted correctly.

Because of wicked dawn phenomenon, I generally avoid carbs in the morning. Eggs, ham and cheese is better than a bagel. Cereal is evil, no matter what time of day. Huge surge in blood glucose followed by a crash. It's not worth it. Last time I ate cereal, my blood sugar went up to 399. I felt horrible. No thanks.
 

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Discussion Starter #16
Training breakthrough today. I was wondering if Noelle could tell the difference between low blood sugar and normal blood sugar scent. So, I got two samples, one normal and one low, and put them in containers.

I let Noelle sniff the low scented pad, and gave her some cheese. Then I set both little containers on my bed.




Noelle sniffed out the low container instantly. I treated her to some more cheese. I switched the containers positions. No fooling Noelle, she got it right again. And again, and again.



OK, Noelle, last time. I set the containers down between her paws. Noelle picked up the normal sample container and flung it off my bed! Then she tossed the low scent container in my lap.

All righty then. There's no fooling that nose of hers. This right here is evidence that Noelle has received "individual training" to recognize low blood sugar. And when I actually am low, she does the dance of the wild dog. Her alert signal has not changed. It's bounce on mom, and frantically lick Mom's hands like her fingers are mini ice cream cones. She goes nuts and it's amazing. Since she only weighs 20 pounds, her leaping all over me is no problem.

Today we went on a mission to Walgreens. The automatic doors scared her badly and she jumped, which is weird, because we've seen automatic doors all the time. Maybe these were louder? She backed up and jumped.

OK no big deal. Back up and desensitize. We watched people open the doors, and I gave treats when the doors opened. We just watched for a minute or two, until Noelle realized, those are just magic doors, not poodle squishers. Then we went through the doors.

We walked through Walgreen's drug store and Noelle did fine. I couldn't find what I was looking for, so I had her do a down/stay. She was down, and up, and down, and up, and down, and up, and... oh my. Stay with shopping carts and kids, and people, and weird noises, this is tough stuff. And it's OK, because she's still learning, so I gave up my quest, grabbed the pinochle cards and waited in line. Sit. Right next to the candy bars and lollypops. Sit. Stay. Perfect. Good girl!

I paid for the cards, and we left. We went to a different Walgreen's looking for rechargeable batteries. A lady cooed over Noelle, but I ignored her completely, and didn't let Noelle say hi, even though Noelle got supper wiggly. We did some short recalls and eye contact games and she calmed down quickly.

I was looking for batteries and Noelle did a perfect down/stay, even when the clerk came up to talk to us. Wonderful! Good girl! Well, that store didn't have the batteries either, so we went for a training walk down some aisles.

No sniffing, wandering, or problems, even when a talking Santa spoke to her. Which was pretty funny, because Noelle cocked her head to the side like, what is going on? All in all, it was a successful outing.



We just need to practice. More single mission trips. Go to the store, buy one thing, leave, and practice down/stay in busy places. I'll bring her to our local mall soon. Mid morning on a weekday when it's not too crazy. That would be good because she could ride an elevator.

Noelle is totally different from Honey in so many ways! In some ways, Honey was harder to train because she was more distracted by movement and wanting to chase things. Noelle doesn't care about things that move, but she's less automatically obedient. Down/stay right now means, down, stay until something more interesting is going on and then I'll check that out. A lot of this is maturity. Noelle really is 75% puppy. And exposure. Down/stay at home is totally different than down/stay in a store while crazy things are happening.
The more exposure she gets, the better she'll be at it.
 

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Discussion Starter #17 (Edited)
oshagcj914,
Noelle sleeps with me. I don't expect her to be 100% on finding overnight lows, so I am proactive. There is a a syndrome connected to type 1 diabetes called "dead in bed." Dead in bed is exactly what it sounds like. Whether it's due to a sudden drop in blood sugar during sleep, or nerve damage leading to some unknown problem, dead in bed is real and it is beyond terrifying.

I pay close attention to my blood sugar levels before bed. If my number is below 130, I'll eat a snack with carbs, protein and fat. Will Noelle alert me during my sleep? Hopefully, she'll never have to because I work hard to make sure I don't go low at night. I have had overnight lows and they just scare the hell out of me.

I woke up bawling in the middle of the night. I was sobbing like I did when my mother died, only there was no obvious reason. I got out of bed and fell on the floor. I crawled to my meter and my blood glucose was 42. That's a sugar reaper low. You can die from that. I ended up sitting on my kitchen floor eating just about everything in the world.

Sometimes, you treat low blood sugar with 15 to 25 grams of carbs like your doctor says. Sometimes, you treat it with an unknown number of carbs and just eat until the shaking stops. The lowest I have ever been was less than 20. I remained conscious, and was aware enough that things had gone completely out of control. I think I drank a six pack of Coke. 39 grams of carbs per can, that was 234 grams of carbs. My blood glucose rebounded sky high, but at that point, I was glad I survived. Had I been asleep, I'd have died. So, I pay close attention to how things are going at night.

Would Noelle alert in my sleep? She woke me up at 4 am today and was crazy bouncy, but I took her out instead of testing. Was she trying to tell me I was low? Maybe. I miss lows sometimes. I know I do. Because I don't "feel low" until I'm dangerously low. So, a 70's-60's low feels normal. I've trained Noelle to alert to 70. Could I have been low? No idea. Next time I'll test and let you know.

Next year, I'm getting a new insulin pump and continuous glucose monitoring system. This monitor will give me blood glucose feedback in real time. I'll train Noelle to alert me to CGM alarms because I've slept through them before. There's nothing like waking up and seeing a graph that says, Hey dummy, you've been low for six hours.



That freaked me out. What good is a monitoring system if you sleep through alarms? Next year I'll get a much louder system which will be a lot safer for me. If Noelle and Francis are given treats every time they hear alarms, they'll make the connection and get me up. I'll give them snacks, and treat my low and hopefully we'll all go back to sleep and wake up fresh in the morning.
 

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This is an educational and thought provoking thread. You must be so proud of Noelle and her training. Your diabetes struggle sounds so scary but the way you manage it is so masterful. You and Noelle are the best of partners. Continue on with your great work at training both inside the home and on your shopping expeditions. Best of luck.
 

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Discussion Starter #19
So, I gave myself too much insulin for dinner. Wasn't as hungry as I thought, and ate half. I've been waiting to see if I'd go low. I tested and I was low. I wondered what Noelle would do. So I said hi to her. Noelle walked over to me, and then she sniffed the low blood sugar container. She bumped the container twice, walking between me and the container, and then did wild dog jumping when i blew in her face.

This tells me I need to train a response along with the scent, and quit the discrimination tasks. Smell this, do this. Clearly Noelle recognizes the scent . Typing while low is hard. More later.
 
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