Hope and hype
Gibson says she was influenced by the online marketing campaign of Diabetic Alert Dogs of America, the Nevada company that sold Rocky.
“They have their stories on there about the dogs theyve trained and the people theyve placed them with. And, you know, it [seemed] sound to me,” Gibson says.
If you research diabetic alert dogs, youll find a lot of hope for their role in managing Type 1 diabetes. And youll find a fair amount of hype.
Television news stories about the dogs often uncritically accept their abilities, using words like “incredible” and “amazing.” In fundraising campaigns, would-be alert dog owners position them as critical solutions to their disease.
NPR reviewed nearly 500 active GoFundMe campaigns that mention “diabetic alert dog.” More than a third used phrases like “lifesaver” or “lifesaving.”
Dog training companies make similar claims. Several of them have faced lawsuits or complaints recently from consumers who bought diabetic alert dogs that they say dont work.
In Texas, a group of more than a dozen dog buyers sued a trainer for fraud and won a judgment for $800,000. In Virginia, the attorney general sued a service dog vendor after customer complaints about its dogs, which were marketed as “backed by science” and “100 percent effective.”
The Virginia attorney general claimed that the company, Service Dogs By Warren Retrievers, deceived consumers about the animals abilities and cost, in many cases simply selling “a $25,000 pet.” Company lawyer Glen Franklin Koontz tells NPR his client denies the allegations and calls the lawsuit “baseless.” He stands by the “backed by science” claim and adds: “A fully trained dog is 100 percent effective.”
The reason it might take a lawsuit to fight back against perceived or actual shortcomings in an alert dog is that trainers and dogs generally arent required by any authority or regulator to perform to any particular standards.
While Rocky was marketed as a “certified” alert dog, the certification came only from the company that sold the dog. Soon after Gibson got Rocky, it was clear to her that he wasnt cut out to be a service dog in public, especially in the windy high country of North Carolina.
Gibson says Rocky is easily frightened by common noises such as umbrellas opening and motorcycles passing, and cant work as an alert dog while hes scared.
“The first day that I had him out on my own, the wind blew up. He got so scared that he couldnt run fast enough to try to hide,” Gibson says. “It was just pure fear.”
That was in April 2017, right after she had to sign a series of disclaimers as a condition of getting the dog. One document said Rocky “met her expectations as a diabetic alert dog,” even though she had only two days experience with him.
Another document said Rocky has a “free will” and wasnt guaranteed to do what Gibson and her community paid $15,000 for: alert her to blood sugar changes.
“I answered everything because I was so excited that he was there and I was positive,” Gibson says. “I was hoping everything was going to be wonderful and then after the dust settled, everything wasnt wonderful.”
One paper she signed said Rocky wasnt guaranteed to “perform any specific action at any specific time.”
The sweeping disclaimer might sound at odds with an expensive purchase that people trust with their lives. But research on alert dogs suggests it might also be a reality check about the abilities of diabetic alert dogs in general.
Its a small trial, so lets wait for further research before we get too excited. But whats really cool about this research is that it opens up the possibility for scientists to replicate dogs abilities with medical sensors – which could then provide early warning systems for diabetics without the need for blood testing.
“Magic was just over 18 months when I got him and weve been together now for just over two and a half years and in that time hes alerted over 2,500 times,” says Magics owner, type 1 diabetic Claire Pesterfield, in the video. “Which is amazing when you think hes only doing it for a biscuit.” Aww, what a hero. width=”700″ height=”414″ allowfullscreen=”allowfullscreen” seamless=”seamless”>
“It provides a scent that could help us develop new tests for detecting hypoglycaemia and reducing the risk of potentially life-threatening complications for patients living with diabetes,” said lead researcher, Mark Evans. “Its our vision that a new breath test could at least partly – but ideally completely – replace the current finger-prick test, which is inconvenient and painful for patients, and relatively expensive to administer.”
While this change would be too subtle for us humans to smell, dogs have the ability to detect odours at concentrations of around one part per trillion, which is like the equivalent of us detecting a teaspoon of sugar in two Olympic sized swimming pools, as George Dvorsky explains for Gizmodo.
Medical detection dogs work by alerting or waking up their owners whenever their blood sugar level drops to the point of hypoglycaemia – a condition that can cause shakiness, loss of consciousness, and, if untreated, death. But researchers have never understood exactly how they pick up these blood sugar changes.
The small study has prompted inaccurate headlines like We Finally Know How Dogs Sniff Out Diabetes. But the research only shows that isoprene rises during a hypo — it doesnt prove that dogs detect that particular chemical. Whereas humans dont seem sensitive to the presence of isoprene, dogs are able to detect the chemical, but it remains to be seen whether thats what they actually smell.
Nonetheless, the discovery of the rise in isoprene is useful, says Dr Mark Evans of Cambridges Institute of Metabolic Science. “It provides a scent that could help us develop new tests for detecting hypoglycaemia and reducing the risk of potentially life-threatening complications for patients living with diabetes.”
The results show that levels of isoprene spiked during hypoglycaemia, and would almost double in some patients. Isoprene is common in our breath, but its unclear how the chemical is produced or why levels rose (one possibility is that its a by-product of reactions that make cholesterol). There was no significant rise in other volatile organic compounds such as acetone, ethanol and propane.
Dogs have an uncanny ability to detect changes in human physiology, and can even draw attention to diseases like cancer. As our canine companions have a powerful sense of smell, its thought this is achieved through the nose.
One thing dogs seem to smell is an abnormal drop in blood sugar level, which occurs in people with type I diabetes.
How dogs can sniff out diabetes
The chemical could lead to new tech to help people keep track of their blood sugar
Imagine if your dog could sense when you’re about to pass out – and do so in enough time to stop it.
This scenario is a reality for hundreds worldwide, including Claire Pesterfield, a pediatric diabetes nurse at Addenbrooke’s Hospital in Cambridge, United Kingdom. Pesterfield has type 1 diabetes, a form of the condition in which the pancreas is unable to produce any insulin and cannot regulate blood sugar. Her sugar levels can fall dangerously low – known as hypoglycemia – causing shakiness, confusion, disorientation and potentially unconsciousness.
But her golden Labrador retriever sidekick is ready to alert her before it kicks in, day or night.
“If he smells a hypo coming, he’ll jump up and put his paws on my shoulders to let me know,” Pesterfield said.
Her dog, Magic, is one of 75 medical alert assistance dogs trained by the UK charity Medical Detection Dogs to help people monitor a range of health conditions, including type 1 diabetes. About 10% of all people with diabetes are estimated to have type 1, in which the risk of hypoglycemia is far greater.
The dogs have been in service since 2009, trained to detect changes in their owner’s breath when blood sugar declines, but the precise scents they’re picking up have remained largely unknown – until now.
“We’re interested if there are messages coming off the body at different blood sugar levels, either on the skin or breath,” said Dr. Mark Evans, a consultant in diabetes and general medicine at Addenbrooke’s Hospital and a lecturer in general medicine at the University of Cambridge.
In a recent study, Evans explored 10 chemicals released on the breath of eight volunteers with type 1 diabetes when sugar levels become critical. He found that one chemical almost doubled in quantity: a compound called isoprene.
Identifying the compound could lead to its use in technologies, such as a breathalyzer, to monitor blood sugar on the breath of people with diabetes, just like a dog does.
“Humans aren’t sensitive to the presence of isoprene, but dogs, with their incredible sense of smell, find it easy to identify,” Evans said.
Patients currently test their blood sugar using a prick test, but new technology could offer a noninvasive means of tracking changes to benefit patients without dogs like Magic at their side.
The findings are also limited, as patients were monitored in the lab, and only eight people were tested, all women. “The caveat is, we’ve done this in a very controlled setting… We need to do real-world testing,” Evans said.
The study “is well-done and presents a possible biomarker that we could measure on human breath to indicate hypoglycemia … [but] in addition to isoprene, there may be other physiological and behavioral responses in people that they are picking up on,” said Nancy Dreschel, an animal behavior expert at Penn State University.