Prerequisite to Having a DAD

Fellow T1 parent, blogger and Diabetes Alert Dog (DAD) owner, Frank Wisneski of A Guardian Angel for Stella recently published a Facebook post highlighting the importance of understanding diabetes management if you are going to have a DAD. It got me thinking of all the prerequisites a family should have before adding a DAD to its diabetes management tool box. Frank wrote the following:

"Don't believe the hype. All situations are different, but the posts that start off with "our puppy saved our child's life, he alerted and little Johnny was 120 (a perfect #) and had 2 units of insulin on board (IOB) that would have dropped him 160 points and he'd be dead" are at best exaggerating and at worst treating dogs for false alerts. The dog would be alerting CONSTANTLY, at which point is not an alert, you've become a treat dispenser. 

Many questions need to be asked. If a 6 year old has 2 units of IOB, that isn't basal insulin working in the background, that is a bolus that was given by the parent for a reason. High blood sugar, food consumption, etc. that insulin is serving a purpose. Most likely if left alone, the blood sugar would settle and the insulin would be working against the food like it's supposed to. The insulin on board example is not a great way to judge how well a dog alerts. Could the child drop? Of course. And the child could have been blouses and forgotten to eat. There could be delayed exercise burn off. But just saying that 2 units of IOB on board could have killed little Johnny is disingenuous. Why was it there? And how did it get there. If your dog consistently saves your child's life because they have IOB, you don't need a dog, you need a better understanding of diabetes management."

I echo Frank's sentiment and firmly believe a strong understanding of diabetes management is a prerequisite for having a DAD. I believe this because it's my experience that in order to truly benefit from the nose of a DAD you have to be certain you are reinforcing and rewarding only accurate alerts based on the thresholds you set. 

I share the following alert to demonstrate why an alert with insulin on board is not necessarily indicative of imminent danger and how understanding diabetes management allowed me to handle the alert for what it was. and nothing more.   

A few weeks ago, Bo stopped playing a game of tug with Austin to alert to me. Austin checked and he was 140 with insulin on board for the lunch carbs he just ate. This alert is not in Bo's reward threshold, so we told Bo we would watch. Exactly 15 minutes later, Bo alerted to me again. This time Austin's blood sugar dropped to 106. This is a quick drop but 106 is a safe number, so we left it alone knowing there was insulin on board but realizing that insulin was working on the carbs he had eaten for lunch. Bo settled again and didn't show any precursors to an alert. Twelve minutes after his second alert Bo was still settled and showing no signs of smelling a low. I re-checked Austin and his blood sugar was up to 114.   

I share this as an example of how important it is to understand Type 1 management when you have a DAD. The dogs smell fast drops and to a novice it may seem like with insulin on board a crash is imminent when blood sugar is dropping at two or three points a minute. It's important to understand how insulin works on carbs that are consumed. In this case, Bo smelled the fast drop but the lunch carbs countered it. If I would have given Austin 15 g of fast acting sugar, he would have likely ended up going above his target of 120.

So, in the scenario described above, Bo did not get rewarded for his alert. While it's evident he was smelling a fast drop in blood sugar, he did not alert within his reward range. He only gets a reward when he alerts within his reward threshold. Had I not understood how insulin works on carbs or how DADs may alerts on a fast drop or rise in blood sugar, I may have falsely concluded Austin was in immediate danger of going low. Had I come to this conclusion, I would have ended up sending him high by treating him with sugar when it wasn't necessary. 

What other prerequisites do you think a person should have before having a DAD?

Low Alert While Austin Was Playing in the Lake

Austin and Poppy enjoying the lake.

Yesterday, while Austin was playing in the lake with his Poppy, Bo alerted to a low of 82. Bo was about 30 feet from the shore line, eating his Kong, when he stopped eating and alerted. He alerted Austin's Meme, who was with him outside. He paw swiped her leg and bowed in front of her -- his alert chain for a low.  

All alerts within reward threshold are great alerts but some alerts are exceptional due to the circumstances under which they occur. I consider Bo's alert yesterday exceptional for the following reasons:

1. He alerted from a distance.
2. He stopped eating a food filled Kong to alert.
3. He alerted to the person closest to him at the time. 

Interview with Austin: What It's Like Having Bo at the Lake

Austin spends the summers, Sunday through Thursday, at his Meme and Poppy 's lake house. He has been doing this since he was six-years-old. They are informed, educated and trained on how to care for his Type 1 (Autoimmune) Diabetes and they are meticulous with his care. This is Bo's first summer with Austin at the lake. (Prior to this year, neither boy or pup were ready to work together without my assistance.) In order to document Austin's thoughts and feelings on the subject, I asked him several questions about what it was like having Bo at the lake with him. What follows are his unedited responses.

Why do you want to take Bo with you to the lake?
Because he is ready and it exposes him to new experiences being with other dogs and it's interesting to see how he does and to have him their because it gives me more responsibilities.

Do you have any concerns about having Bo at the lake?
Yes. We were on a walk and there were two dogs. One was on a hill about 10 feet above us and one was on a camp site next to us. One dog started barking and Bo was okay. But then the dog on the hill barked down on him and Bo had troubling handling it. Bo barked back. Then when we saw another dog, he started barking. I feel like he was trying to keep himself from being in that position again.

What is the best part about having Bo at the lake?
He is entertaining. He is always following me and he likes to lay down with me.

What is the most difficult part about having Bo at the lake?
Picking up poop. It's just not something I enjoy doing.

How do you work through the difficulty of picking up poop?
I just do it. I just get it done with or I walk as far as I can into the woods, off the side of the road, and cue him to go two.

What have you learned about yourself since having Bo at the lake?
I haven't learned anything about myself.

What has most surprised you about having Bo at the the lake?
How well he works in a different environment. For example, he alerted Poppy in the middle of the night.

What do your friends at the lake say about Bo?
That he is really cool and that he is doing a really important thing.

Do your friends at the lake ask you questions about Bo's job?
Not really.

Has anyone tried to pet Bo when he was working at the lake?
Yes but I just told the kid no and he stopped.

Would you recommend that a 13-year-old boy living with Type 1 (autoimmune) Diabetes get a Diabetes Alert Dog?
Yes, because it helps with responsibilities. Also, it's very helpful because a lot of times I feel fine and Bo alerts and I'll be low and I won't feel it. It's really nice to have that back-up.

Boy and pup napping at the lake.