Hunting diabetes

For Abi Thornton, the promise of an independent life lies at the end of a leash.
The 16-year-old Aberdeen teen relies on her diabetic alert dog, a British lab named Mr. Darcy, to tip her off when her blood sugar starts to fall or rise rapidly.
“He never lets it get to the point where it’s scary,” said Abi, who can’t consistently feel her blood sugar dropping to dangerous levels.
The home-schooled high school senior, who hopes to someday work with kids with diabetes, drives on her own, takes two classes at Itawamba Community College-Tupelo campus and spends the night with friends with the 21- month-old canine nearby.
Mr. Darcy stays quietly by her side. When he senses a shift in her blood sugar, he alerts by picking up a bringsel – a soft rectangular cloth and rubber stick often used in search and rescue dog training – and takes it to Abi. When he has her attention, he’ll raise a paw and wave if her blood sugar is low, or bow his head if her blood sugar is high. He’ll wait until she pulls the meter out of a bag on his vest and test her blood sugar.
When Mr. Darcy alerts, he not only tells Abi, he’ll go find Mom, Dad, sisters – any member of the family who is nearby.
“He wants everyone to know,” Abi said.
Mr. Darcy comes by his keen sense of smell naturally. Both of his parents came from Oxford’s Wildrose Kennels owned by Mike and Cathy Stewart.
“We have genetics working for us,” said Abi’s mom Rachel Thornton. “He’s not looking for ducks; he’s looking for low blood sugar.”
The Thorntons started Mr. Darcy’s scent training as a 7-week-old puppy, but sought help from Wildrose in developing good obedience skills.
The resulting collaboration sowed the seeds of the Wildrose Diabetic Alert Dog Foundation, which has become a special project of Tupelo’s CREATE Foundation.
Wildrose is training diabetic alert dogs and hosting conferences where people with diabetes alert dogs and trainers can share best practices and further their training efforts. The June conference brought together 50 people and 20 dogs.
“I’d like to develop North Mississippi as a hub for diabetes alert dogs,” Mike Stewart said, not only providing training for dogs, but handlers and trainers as well.

The need
Type I diabetes – formerly called juvenile-onset – is an autoimmune disorder in which the body destroys the insulin-producing cells inside the pancreas. Without the ability to regulate sugar, it can climb to damaging levels.
Careful blood sugar monitoring and insulin injections, manually or through an insulin pump, let people with Type I diabetes control their blood sugar and reduce the risk of diabetes complications.
However, the insulin therapy also carries another risk. Most people have clear symptoms when their blood sugar starts to dip very low, like trembling and anxiety. If left unchecked, a person with diabetes can have seizures or slip into a coma.
“The biggest problem is unpredictable lows,” said Tupelo endocrinologist Dr. Jay Dey. “It can happen any time. It can be disastrous.”

Abi’s story
Abi Thornton’s experiences with diabetes have been terrifying for her and her family.
Her diabetes was diagnosed at age 11, when she spent days in the ICU in Northwest Alabama with diabetic ketoacidosis and a blood sugar over 1,200.
Months later, she had a grand mal seizure when her blood sugar plummeted.
In both cases, Abi was exceptionally lucky. A pediatrician finishing paperwork at the hospital recognized Abi’s life-threatening high blood sugar as she was about to be treated for something else.
With the low blood sugar incident, her parents heard the sounds of her seizure and found her before she slipped into a coma.
After these near misses, the Thorntons were focused on finding a solution that would catch the unpredictable lows. At the time, continuous glucose monitors weren’t very reliable and still aren’t officially approved for children.
“We’ll try anything,” Rachel Thornton remembers thinking. “She was fearful to go back to sleep.”

The caveats
A trained canine companion that could alert to lows, especially while a person is sleeping, could be very valuable, and Dey said he’s impressed with what he’s seen from Abi and Mr. Darcy.
“They have a very inspirational story,” Dey said. However, “there’s not a whole lot of research … you have to be cautious.”
Continuous glucose monitors have improved and are one option, but there are some worries that children especially will sleep through the alarms.
Exactly how Mr. Darcy and other diabetes alert dogs pick up changes in blood sugar isn’t completely clear, said Rachel Thornton, who has a diabetes alert dog blog.
“Nobody has it totally figured out,” she said. “The scent is a huge part of it. But there’s a real possibility the dog is picking up on some other subtle things.”
Mr. Darcy and Abi’s success didn’t happen overnight. And the Thorntons are quick to say a diabetes alert dog is not a quick fix to diabetes management.
The Thornton family has seen both the best and the worst in the diabetes alert dog world. Because diabetes alert dogs can cost $10,000 or more and there are no federal certification requirements, the industry has attracted less than scrupulous people.
On the other hand, some diabetes families mistakenly believe a diabetes alert dog will replace the need to frequently check blood sugar.
“It takes a lot of work,” Rachel Thornton said. “Initially, it’s more money, less sleep and more finger pricks.”
Although Abi loves Mr. Darcy, it does mean she always stands out from the crowd, which is not the easiest thing when you’re 16. Sometimes, it gets old, to always be the girl with the dog, she says.
“There’s the staring and pointing,” she said. “I can get negative attention.”
Along the way, Abi has to calmly, but firmly educate the public about service dogs and public access laws under the Americans with Disabilities Act.
Abi doesn’t mind explaining that Mr. Darcy is a diabetes alert dog, but she makes sure she tells people who ask that they can’t, under the law, question an individual about her disability or demand written proof of the dog’s status.
The training
The most effective training seems to start early. By the time he was 9 weeks old, Mr. Darcy was recognizing low blood sugar and alerting. By the time he was 4 months old, he was consistently alerting.
At Wildrose, Carissa Skipper, who oversees the Diabetes Alert Dog program, starts with the basics at about 6 or 7 weeks.
“You have to have a foundation of obedience,” Skipper said.
Because the training is long and intense to expose the dogs to a wide range of public and home settings, Wildrose anticipates training three to five dogs a year. They hope the foundation will develop to the point it can offset about half the cost of the training, which totals about $10,000 for the year.
“Public access is a very tall order,” Mike Stewart said. “We want to make sure the dogs are extremely obedient.”
Diabetes Alert Dogs have to be especially smart because they have to know the scent of a low blood sugar overrides the command to sit or stay, and if their handler doesn’t respond to them to seek help from others, Mike Stewart said.
“They have to be able to intelligently disobey,” he said.
The scent training is accomplished by having the person with diabetes take a sample during a time they have a documented low. A sample of saliva or sweaty socks will do the trick.
Skipper and the trainers start with games of “find the scent” and then move alerting when they smell the scent on a person. They use the bringsel as a way for the dog to alert clearly, but quietly.
But the training doesn’t end with the dog.
“The big piece is not just training the dog, but training the people,” said Cathy Stewart.
Although the dogs are most helpful at night, when they can wake their handlers from sleep when they scent a low blood sugar, to be at their most effective, they need to be with the person with diabetes 24/7.
“The idea of having an alert dog is exciting, but it’s a big commitment, too,” Skipper said. “The dog needs to go everywhere with them.”

For more information
Wildrose Kennels: www.uklabs.com/

Michael Gibson Morris/NEMS Daily Journal