The story of a boy living with Type 1 and his family's journey to raise and train a diabetic alert dog.

Sunday, July 26, 2015

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?

No comments:

Post a Comment