November is National Diabetes Month and I wanted to take this opportunity to raise public awareness by talking a bit about what diabetes is and how service dogs can play an important role.
WHAT IS DIABETES?
There are different types of diabetes. They are designated as Type 1 (insulant-dependent diabetes or juvenile-onset diabetes) and accounts for about 5% of all diabetes cases. Type 2 (non-insulant-dependent diabetes mellitus or adult-onset diabetes) which accounts for the majority of all diabetes cases covering 90%-95% of all cases. Its distinction is when your body produces insulin, but either doesn’t make enough or what it does make isn’t used well by your body which causes a buildup of sugar in your blood. Gestational diabetes is a form of diabetes that only occurs in pregnant women. If not properly treated, it can cause problems with mothers and their babies. This accounts for 2% – 10% of all pregnancies and usually resolves when a pregnancy is over. There are more rare types of diabetes that are caused by specific genetic syndromes, drugs, infections, surgeries, and other illnesses and may account for 1% – 5% of all diabetes cases.
In all cases of diabetes, blood glucose levels are higher than normal. Many of the foods we eat are turned into glucose, or sugar to be used by our bodies for energy. The organ that is responsible for making insulin is the pancreas, which lies near the stomach. If you have diabetes, it will be classified by one of the definitions above.
There is also Pre-diabetes which is described by raised levels of your blood glucose level, but not to the extent of being able to be classified as diabetes. One in three American adults have pre-diabetes and of those people, the majority don’t know it. Excessive weight is a major cause of pre-diabetes and diabetes. Of those people who do not lose weight and only do moderate exercise will develop Type 2 diabetes within three years.
Diabetes can lead to serious medical complications such as heart disease, kidney failure, blindness and amputation of extremities such as the toe, foot or even leg. Diabetes is the seventh leading cause of death in the United States.
GENERAL INFORMATION ON INVISIBLE DISABILITIES
I would like to cover one of the lesser-known types of service dogs that would fall under the larger umbrella of the Medical Alert Type of Service dogs. Since diabetes is an “ invisible disability ”, (a disability that is not readily apparent, such as by the use of a wheelchair or other medical apparatus which makes a disability self-evident). It is one that I would like to highlight here in the interest of public awareness and education.
Having an invisible disability myself, Post Traumatic Stress Disorder (PTSD), I see and sometimes hear what and how some people think about and react to me having a dog accompanying me into places of business. Their impression often seems to be that I am just bringing my pet dog into stores because I want her to be around me.I have found by talking to people, that they don’t automatically think of all of the different types of disabilities that are out there and how service dogs can and do play very important roles in either mitigating a person’s disability or alerting to them so that the person with the disability has the opportunity to take some kind of action, whether it is to take medication, get to a safe place, remove yourself from a situation or alert others of a medical problem.
The majority of people are very familiar with Guide Dogs, mobility dogs and sometimes even hearing dogs for those who are deaf or extremely hard of hearing. Those types of service dogs have been around the longest and are usually not given a second thought.
Having a disability that isn’t readily apparent can be much more difficult because for some reason, some people seem to find it necessary and even believe that it is their duty to approach/confront you and inform you that you shouldn’t be bringing your “ pet” into a place of business and this includes business owners and staff who are not always up to date on the most current laws pertaining to Service dogs who have been given special access rights through the Americans with Disabilities Act, as well as state and local laws.
You can see the ADA Laws and definitions by going to their website at ADA and Service animals. “ Beginning on March 15, 2011, only dogs are recognized as service animals under titles II and III of the ADA ”. The ADA does have a special provision for miniature horses as Service animals and can be found by following the same link above to the ADA. Certain limitations apply.
Service dogs in training definitions and access rights are not currently covered by the ADA and the ADA has left it up to the individual states to regulate the rights of service dogs in training.
Living in Oregon, I will use their laws as an example as each state has varying laws defining and pertaining to Service dogs and Service dogs in Training.
You can read the Oregon Laws pertaining to the definition of a service animal and a service animal in training and their laws as they pertain to public access by clicking on Oregon Laws on Service animals. I used the term “animals” instead of “dogs” because Oregon State allows for more than just dogs to be recognized as legitimate Service animals.
If a business owner or staff member tries to deny you access to their business where the public is allowed free access, they are in violation of either Federal and/or State Laws.
This is called a Public Access-Challenge, something that you, as the handler/partner of the Service dog need to be prepared to appropriately address by being very familiar with the most current laws, including federal, state and local laws pertaining to service dogs and service dogs in training.
It is very important for you to always be in control and calmly provide accurate information to the person or people that are creating the Public Access Challenge . Getting upset and ranting will not help you. Sometimes it is as simple as them lacking the knowledge of current laws and it can be extremely helpful if you carry information with you such as the cards I describe below to be able to provide to people in these situations.
There are business card size, double-sided cards covering ADA Laws which you can hand out and also plastic, credit card sized cards that you can carry in your wallet or use as a tag on a Service dog Vest that explains the most important aspects of the ADA Laws regarding access rights and what a business owner can and cannot ask you. Unfortunately, I have been unable to find such a handy resource for state laws as there would have to be one for every state and I have found that in numerous cases, the laws are lengthy and do not lend themselves to abbreviated versions that could be easily printed on a business card sized card. Having a copy of your state’s laws that pertain to Service animals can be very useful as a reference for people to look at. Keep in mind that some of these repositories are not always completely up to date as this takes a lot of time and effort when a state enacts new legislation.
CHOOSING A DIABETIC ALERT DOG
When choosing a Service dog for any given disability, sometimes it doesn’t matter what size or breed of dog is chosen. Basically, any breed, if they have the proper temperament, can be trained to be a Service dog.
Certain disabilities though are better suited for a particular size or breed. For instance, a Pekingese would not work very well for pulling a wheelchair or helping to stabilize someone with balance issues. A larger breed would be a better choice.
When looking at a dog for use as a diabetic Service dog, there are important considerations to keep in mind.
Since one of the main attributes that a dog possesses is their keen sense of smell. A dog can pick up on the subtle changes of a person’s body chemistry through scent. Dogs that are going to be used as Medical Alert Dogs for diabetes need foremost, after proper temperament, to possess a superior since of smell. Although most dog breeds can work in this area, there are some with naturally better abilities at scent work than others.
DIABETIC ALERT DOGS USE THEIR NOSE
Dogs inherently use their nose to explore the world they live in. This is evident from the very beginning, even before their eyes are open as puppies, to find their mother and the milk she provides. This continues on throughout their lives. They “see” the world through their noses before any other sense comes into play and they use their sense of smell more than any of their other senses.
This is what makes dogs good at tracking and why they are used so successfully for Search and Rescue or drug detection by law enforcement. The list is quite extensive, but this gives you the idea. There are many groups and organizations such as The National Association of Canine Scent Work (NACSW ) and K9 Nose Work that are specifically centered on a dog’s scent abilities. Some of them even use this attribute for games and competitions.
Besides these uses and activities, a dog’s scent ability plays a crucial role in detecting changes in a person’s body chemistry which, in the case of diabetics happens when their blood glucose level goes either too high or too low.
Before I go any further, I should continue what I had started about picking specific breeds for certain needs. Now, as it is true of all dogs, all dogs use their noses, but some are naturally better at using their nose than others. For instance, you might naturally think of breeds like Blood Hounds as having exceptional noses. There are many breeds that can be used as Medical Alert Dogs for diabetics. Sometimes within the same breed, some dogs are naturally better with their scent ability than other individual dogs of that same breed or even the same litter.
It is not necessary to have the dog breed that has the very best scent ability over all other breeds. What is necessary is that the specific dog you choose exhibits very good scent ability.
It is probably safe to say that brachycephalic breeds (dog breeds that have pushed in snouts) would not be a breed of choice for scent work because physiologically they do not have the same internal nasal surface area that a longer snouted dog naturally has, thus naturally limiting their ability in this area compared to other non-brachycephalic breeds.
Good scent ability is imperative for use as a medical alert service dog for use with diabetics. A dog can then be trained to alert to these changes so that the diabetic can either take medication which the dog can also help with by being trained to bring the needed medication to them or so that they can eat something that will mitigate the onset of a diabetic emergency which in the worst case can be life-threatening.
TRAINING A DIABETIC ALERT DOG
As I am sure you can imagine, training a dog to do scent work is not quite the same as teaching them to sit or lay down. This is a very specialized aspect of training that is necessary for a dog to be used as a Diabetic Alert Dog.
There are many different resources available to help you in training and honing a dog’s natural ability to work for the detection of body chemistry changes. There are individual professional dog trainers who specialize in doing this type of specialized training and of course, there are programs that teach your dog these capabilities. All of this depends on your comfort level in training dogs, financial ability and previous experience you have in training dogs in more familiar behaviors.
Some of the organizations I have listed above and many other similar organizations can be very useful in helping you to understand techniques to use to properly train your dog to alert to chemical changes in your body. They can also be something that you find you and your dog enjoys doing as a sport and anything that you can do to involve your dog in things where you are working together, strengthens the bond that is so important in a service dog/handler relationship.
I will include my Service dog Trainer, Suzanne Brean, CPDT-KA, APDT as a possible resource as she is specialized in training Service dogs for Invisible Disabilities which includes training dogs as Diabetic Alert Dogs. She might be able to assist you with your training or know of other resources that could be of help.
The method of training you prefer, whether it be by using the reward method, by giving a treat each time your dog performs the task you are training or Clicker training which involves clicking to mark the event and that is followed by a treat.
Those of you who have not tried or really even heard of Clicker training can learn a lot about it by clicking the link in the preceding paragraph. Those of you who are already familiar with Clicker training will already know how to mark the action and then follow the mark with a treat, gradually changing from a treat to praise and then by adding a word/command and finally you can start to phase out the use of the Clicker all together. In this case, however, your scent will be the “command” which will be addressed in the second part of this 2-part technique.
These are just two of the most common techniques used in modern, positive training methods commonly used today. Gone are the days of heavy-handed training methods that were primarily based on brute force and punishment. I am old enough to remember those methods from my childhood and training my first dog at the age of 13. It is not pleasant for your dog or for you. Positive training techniques are much more enjoyable and far more humane to your dog. You can even make games out of training that are both educational and rewarding.
A LITTLE BACKGROUND
DISCLAIMER: I want to stress that this is ONLY an example and I am not qualified to teach you to train your dog this behavior.
I will further preface this by saying that I am not a professional dog trainer, especially one that is so specialized. Most of this information was obtained from my Service dog Trainer, Suzanne, who I mentioned earlier. Although she is qualified to train this behavior and even though I got this information from her, do not try to do this on your own without a lot of your own research, by reading books specifically on this subject and/or watching DVDs specifically showing techniques like the ones that I am using as examples or others that you find useful.
I am not trying to give you an actual lesson on how to do this. I am just trying to give you an idea of the steps necessary to get the desired response. It is very important that you do not use this as your only resource for learning how to train behaviors such as this. You will need to either have very detailed books, DVDs or enlist the help of an experienced dog trainer who has a lot of experience doing this type of training.
It is very important when training behavior like this, you completely understand every aspect of it, because if you don’t you will not get correct and reliable results and in a case of medical issues such as diabetes, you cannot afford to make mistakes in training your dog to do such an important task.
The speed at which this goes will depend greatly on the individual dog, how young the dog is and how much you have already worked with him, training other commands/tasks.
This is not something that will be learned overnight. It will take weeks, if not months to go through all of the training steps properly, as you gradually head toward your goal of having your dog alert you to a variance in your blood glucose level.
Since diabetic Medical Alert Service dogs require training specific to this disability. I wanted to offer examples of techniques that can be used to train your dog to alert you when your blood glucose level is either too high or too low. Some people only want or need to be alerted to one of these conditions whereas others would like to be alerted to either variation separately.
You can decide to investigate these and other options further to decide which would work best for your situation. You can either train your dog to alert you to any variation and give you the same signal, which you can decide upon, or you can have them alert you with two different signals, one being for elevated blood glucose levels and the other being for lowered blood glucose levels. That would again be a personal preference and having been prediabetic myself, I know that you can pretty much tell whether your level is high or low, so if you are confident with monitoring your body and can differentiate the two, then you can choose to train just one signal and when alerted, you can test your blood glucose level to see how far it is from where it should be so that you can take the appropriate action.
ONE METHOD IN TRAINING A DIEABETIC ALERT DOG
There are essentially two parts to this training method, even if you are only going to train for one signal (four, if you are training for both a high signal and a low signal), although that might be unnecessarily complicated since you really just need advance warning of a potentially problematic change in your blood glucose level and you would presumably be testing your level whenever you are alerted, which would then definitively tell you whether you are high or low.
The first step in training this method is called targeting. This is where you are going to want your dog to signal you. As an example, your end goal might be to have your dog nudge your thigh to alert you.
There are, however many “baby-steps” in between the two larger steps. This involves getting your dog to first, look at your hand and when he does, (for the sake of saving space, I will just say) “treat”. If you are using a Clicker, you will know that the click comes first, to mark the event followed by a treat. When your dog looks at your hand, you treat. You do this for a number of times until your dog makes the connection that if he looks at your hand, a treat is coming.
After this is established, you move to the next phase, which is to have your dog touch your hand with his nose (it would be similar if you choose to have your dog “paw you”). You do this until your dog makes the connection that by touching your hand, a treat is coming. Then, you put a piece of tape on your hand and get your dog to touch the tape.
After that is established, you can put a piece of tape on your pants leg and work on getting your dog to connect the tape that he was touching on your hand that got him a treat to get that same treat when he touches the tape on your leg. Now you work to make sure that your dog completely understands that if he touches the tape on your leg, a treat is coming. After it is well established, you can remove the tape and do the same thing but now your dog is just nudging your pants leg/thigh.
The second part involves getting a container (ideally glass) with an inner lid with holes in it and a second outer lid to seal the container. Many spices come in containers like this. Make sure that whatever you use is completely cleaned and then thoroughly rinsed so that no scent is left in the container.
Now you want to get a couple of cotton balls and with one of them, you are going to swab your inner cheek. With the other cotton ball, you want to swab your underarm.
Whether you want your dog to signal you separately and in a different way or place on your body or you just want one signal for either variance, you will need two of these containers. One will contain swabs that you collect when your blood glucose level is high and the other will contain cotton swabs your collect when your blood glucose level is low. The difference comes if you want two separate signals or just one.
In either case, you need your dog to be able to identify both variations so he can appropriately alert you to the variance. These containers will last approximately a month before you need to change out the cotton balls with new ones you get from swabbing the same locations and be sure to swab only when you have a high and a low reading when you test your blood glucose level. Be sure to thoroughly clean out the containers and rinse them thoroughly before you put the newly swabbed cotton balls into the containers again.
Now that you have prepared the two containers. You want to have your dog sniff the container through the holes of the inner lid. You want to do this and then treat it. Continue doing this until he gets the idea that if he smells that scent he is going to get a treat. You want to do this with each container. You also want to concentrate on only one of the containers at a time so as not to confuse your dog. Work with the “high” one until he gets the connection. After he fully gets the connection, then do the same with the “low” container.
Then you are going to start putting these two behaviors together. What you want to do next is have your dog touch your pant leg when he smells the bottle. You can start by putting the bottle near your leg where he is used to nudging your leg. After a while, he will make the connection that if he smells that scent, he needs to nudge your leg. You train him to do this with both containers. Every time he does it right, you will give him a treat. After a period of time, you will start alternating between treats and praise. Eventually, you will give him only praise.
I hope that you have found this to be informative and helpful in understanding just a small part of what is involved in training a dog to do medical alert work for diabetes.
I hope that you understand that I am providing this information solely as general information and not as a lesson on how to train your diabetic alert dog. It is my hope that it will help you to better understand the process involved in this type of training. There would be certain similarities regarding other medical alert type service dogs, but the specifics would be specialized to them and the medical condition they alert to.
My best wishes to all of you and good luck in finding a well-suited diabetes medical alert service dog.