Wherever Kathleen Simmonds goes, her service dog, Emma, isn't far behind. Emma - also known by her Instagram handle, "Type 1 Wonder Dog" - has been trained to sniff out dangerously high and low blood sugar levels and alert Simmonds so she can take action.
Simmonds, 48, has had type 1 diabetes for more than three decades, but she reached a point where she was no longer able to feel dangerous swings in her blood sugar levels.
"I got the dog for the security of my family. Things had gotten so bad that my husband was afraid to travel and my kids were afraid to go to school. They were worried they'd come home and find me passed out," Simmonds said.
Emma - a border collie - has brought Simmonds and her family peace of mind, as having the dog has significantly improved Simmonds' blood sugar management.
"She's like a big security blanket for all of us," Simmonds said.
Detecting highs and lows
A new British study confirms that dogs can detect dangerous variations in a person's blood sugar.
The researchers reviewed owner records on 27 dogs that had been trained by the same charity group. During more than 4 000 out-of-range episodes, the dogs were able to pick up an average of 70% of the episodes.
The dogs were slightly better at detecting low blood sugar levels, picking up on 83% of the low blood sugar episodes. For high blood sugar levels, the dogs were correct an average of 67%of the time, the study found.
Study author Nicola Rooney said these dogs "have immense potential to increase the quality of life of their companions, reducing health risk and even saving lives."
But, she said, there are a number of factors that can affect the dog's performance, such as the dog's individual temperament, its training and its relationship with its human partner.
"Just as we've seen in pet dogs, those dogs whose owners who consistently and positively reward their dog tend to have dogs that do the best," said Rooney, who is a teaching fellow in animal welfare and behavior at the Bristol Veterinary School in England. The study was published recently in the journal PLOS One.
Not everyone is convinced that diabetic alert dogs are consistently effective, particularly when measured against the latest technology: continuous glucose monitors (CGMs). These devices measure blood sugar levels every five minutes or so, and most will sound an alarm when a person has blood sugar levels that are too high or too low.
Linda Gonder-Frederick, from the Behavioral Medicine Center at the University of Virginia, has also done research trials with diabetic alert dogs. "There have been a number of studies and there are a lot of mixed results," she said.
Her conclusion? "The jury is still out, but a diabetic alert dog is definitely the most user-friendly glucose monitor we have. It's much more user-friendly than finger sticks and CGMs. But we expect these dogs to work 24/7, and that's a lot of ask of a little creature."
"Dogs have incredible olfactory ability, and I believe they can do this, but we're lacking hard scientific data," Gonder-Frederick said.
If you're thinking about getting an alert dog, there are a number of things to consider. One is how comfortable are you with getting a lot of attention?
"When you have a dog with you 24/7, you have to get used to people coming up to you," and folks have mixed reactions, Simmonds said.
Another is whether you are willing to put in the time to train the dog, and then consistently reinforce and reward the dog for alerting you?
Not every dog is a service dog
Claire Guest from Medical Detection Dogs, the UK charity Rooney used in the study, said people who "show a high willingness to reward their dog when it correctly alerts them to their blood sugars tended to have especially well-performing dogs."
Jennifer Cattet, the owner of Medical Mutts in Indianapolis and Emma's trainer, said there's no specific breed that's best-suited to being a diabetic alert dog.
"It really comes down to the dog's temperament. You need a dog that's naturally social, confident and very food-motivated. You also need a 'Velcro dog' - a dog that tends to stay close to a person naturally," she explained.
Cattet selects and trains dogs from young ages, but she also trains family pets. However, she said people need to be aware that this doesn't always work out.
"Most service dog organisations have about a 50% failure rate because dogs are living creatures, and there's a lot of work that goes into being a service dog. Just alerting to blood sugars naturally doesn't make a dog a service dog," Cattet said.
Diabetic alert dogs don't come cheaply, either. Simmonds said Emma cost $14 000 (more than R190 000) and that price was one of the lower ones Simmonds found in her search. The dogs in Rooney's study cost around $38 000 (more than R515 000) to raise and train, but Medical Detection Dogs is a charity and the dogs are given to people with diabetes for free.
Simmonds and Cattet both said it's vital to investigate any organisation that offers these trained dogs. Because there is a lot of money involved, there's also a potential to be scammed. Simmonds recommended doing a lot of internet searching, as well as checking with the Better Business Bureau.
Gonder-Frederick pointed out that there are currently no regulations or standards for training and performance when it comes to diabetic alert dogs.
Still, all the work has been worth it for Simmonds. "Emma lets me live a more normal life. I don't have to spend my days worrying about my blood sugar anymore," she said.