I hear this a lot: “My child was just diagnosed last week, I want to get a DAD to help him out”. While I completely and totally understand the fear of facing this disease, the willingness to do anything to help your child, and the need for tools, medicines, and technology to make things easier, safer, and better, a DAD is not for everyone, and especially not for the newly diagnosed.There is so much going on in the home of a newly diagnosed person, and if that person is an infant, toddler, or child, there is even more so. When my daughter was first diagnosed, we were in the hospital for 4 days. During those 4 days, we met with Endo’s, nurses, a nutritionist, a CDE, there were countless people that walked through the door, explained a few things, asked if we had questions, showed us some tips and tricks and moved on. But the truth is, our heads were spinning. I was scared to death for my baby. My whole understanding of what diabetes was had been upended, and a scary new reality took its place. When we left, there was very little information retained that wasn’t handed to us on a piece of paper or a pamphlet. There is a steep, enormous learning curve that comes with type 1 diabetes, and it doesn’t include a one size fits all version. A lot of what we know today, and the way we do things, is based on trial and error. And we are still learning. There are scenarios that come up all the time that are new to us, and that force us to reexamine what we are currently doing. Puberty, new foods, different types of exercise, it almost seems like some tweak is being made daily. A lot of what we learn in the diabetic world doesn’t wind up coming from our Dr’s. They tend to deal strictly in black and white, “eat 60 carbs, take x units of insulin” when in reality, the type of carbs, or the particular food, or what they did the hour before or plan to do the hour after, all come together to make that particular persons absorption rate different. You don’t learn those things at the quarterly Endo appointment. We are learning from other families, from some great books, from on-line communities and bloggers, and from trial and error. When you think about it, that’s kind of scary. We are dealing with a medicine that if dosed incorrectly can lead to serious issues and possibly death.

So why do I bring all of that up? Because prior to bringing a dog into the mix, regardless of how well trained (and particularly more so if the dog is a puppy, you are self training, or the dog is from a poor program) you need to have a high level of understanding of the disease, a grasp of the fundamentals, already practicing a high level of management, and being extremely proactive in your diabetic care.

These dogs do not “fix” anything. They don’t draw insulin into a syringe and dose our children. They don’t know how many carbs to give to “fix” a low of 60, they can’t operate the glucagon syringe in the case of a severe low. As a matter of fact, during some of the scariest events that these dogs have alerted us to, they are happy and excited because they want their treat or a favorite toy, regardless of what you are doing to help little Billy.

When a family with a child is newly diagnosed, as horrific as it sounds to some of us dealing with this for awhile, the Endo may have the family purposely keeping the child at a high blood sugar level. The Dr may say things like “don’t correct a BS under 250 in the middle of the night” or “before going to bed, make sure the BS is 180 or above”, or even “there is no need to check at night”. These things change over time, as the families become better equipped at diabetes care, as the honeymoon period wears off, as the knowledge and experience is increased. But in the context of a dog coming in that is trained to alert to BS above 175, what do you think happens if the BS is ALWAYS over 175? If the dog is trained to smell changes in the “normal range” what happens when the normal range (which is supposed to be 80-140 roughly) is 180-300?  Eventually the dog will no longer be effective at it’s job. And this makes the huge assumption that you have a dog that is already trained.

These dogs work extremely well in this scenario: You have a good grasp of diabetes care, your management can already be described as meticulous and well above average, you test more than the average, and you have an excellent understanding of how different things affect your BS. A good candidate for a DAD doesn’t always feel lows or highs (hypo/hyperglycemic unaware) and doesn’t wake up at night due to lows. For the most part, newly diagnosed families don’t know a lot of this yet.

If you are newly diagnosed and are considering self training a puppy, or are buying a puppy along with some training built in to the deal, this really seems could be a recipe for disaster. Training a DAD to the extent that it is giving accurate alerts for 75-80% of the alert-able episodes, while training and maintaining public access level obedience, all the while dealing with a child with type 1 can be a tremendous burden, and requires an amazing level of support, a large knowledge of dog behavior and training techniques, and an understanding that what you are doing today with that dog is not instantaneous, but being done for a future version of that dog.

Again, the dog won’t “fix” anything. The dog will hopefully alert to an issue either currently existing or coming soon. The handler will need to know how to fix it, and reward the dog properly to get them to continue, and if the dog is in training, then when all of these high/low BS issues are happening, the handler must take on the added responsibility of working the dog through the alert while simultaneously  caring or the type 1 child. And often times that is several times a day. Concurrently there will be a regimen of daily obedience training sessions, potential group classes, exercise, and maintenance that takes place. Even with good, solid working dogs, the amount of work can be overwhelming when overlapped with caring for a type 1 child.

If you come into this with the understanding that getting in with a good, reputable organization that provides quality dogs could take anywhere from 18-24 months or longer, and fully aware that even then the work will be daily and constant for the rest of the service dogs working life, then starting early on research is great.

And some things to keep in mind which may stop you from wanting one all together.

1. These dogs do NOT eliminate the need for night time checks. In most cases they may require more waking up at night, as they alert to the 250, then 30 minutes later to the 227, then again 45 minutes later to the 185 etc. If you or your child has the included bonus of dawn phenomenon, this could be every single night.

2. These dogs do not reduce the amount of testing blood sugar. As a matter of fact, in most cases the dog INCREASES the amount of testing that takes place, as you still test at the normal times (before meals, before bed, at wake up, after a low) and then when the dog alerts. On average, we test 14-18 times a day.

3. These dogs are not 100 percent accurate. They occasionally miss. Sometimes when it is glaringly obvious.

4. These dogs require an extra effort for all tasks. Everything from going to the grocery store, to the movies, and to daily tasks like school or work require even ,ore forethought and planning, and often involve being stopped repeatedly to answer questions.

5. If you are shy or reserved about your disease, a dog will be like a huge neon sign drawing attention to you or your child

These DAD’s don’t cure anything. The don’t fix anything themselves. But if you already have great diabetic protocols, they can be a wonderful addition to a healthy, successful diabetic lifestyle. A well trained DAD can provide additional data that can help tighten down an already well managed regimen.

Just a couple of things to think about before heading down the road towards getting a DAD.

Team Blackdogsrule

 

 

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6 Comments

  1. I just want to say how much I appreciate your candidness and the way you are so real about this. I admit I’m a DAD skeptic…. but everything I read from you is well-balanced and calm, without wild claims of miracles. You are helping many.

  2. Betty Cordoza

    It is ironic that this appeared in my Facebook today. It was 55 years ago today that I was diagnosed as a Type I Diabetic, four days before my 13th birthday.

    The next day, our family doctor got me admitted as in inpatient, to the Diabetes Teaching Unit, at the Joslin Clinic in Boston. It was covered by our medical insurance.

    In those days, every day for five week days, once in the morning from nine to noon, and in the afternoon, from one to four; my parents and I attended classes taught by different doctors and staff members of the Joslin Clinic. Each class had a different topic. There was a small group of us and we interacted with the “teacher” asking questions that came up for us during the class.

    Other things like self-injection and food weighing, were taught in the Diabetes Teaching Unit, by the Registered Nurses. I gave myself my first injection on the morning of my 13th birthday. Today I use insulin pens and take two injections in the morning (one Lantus and one Humulin) and other injections of Humulin at mealtimes or bedtime, based on my blood sugar levels.

    At the end of the five day cycle, we had a notebook with information, plus the opportunity to purchase the latest edition of the JOSLIN DIABETES TEACHING MANUAL. We also had the opportunity to purchase all the recommended (and needed) supplies to take home with us.

    When I went home, we were still a bit overwhelmed but had the security of our own notes, the notebook and the JOSLIN MANUAL to lead us through the “transition process.” Also we had the phone number and a follow-up appointment with my physician at the Joslin Clinic.

    The following two summers, I attended a camp for girls, for three weeks, affiliated with the Joslin Clinic in Oxford, MA. There was a similar summer camp for boys in Charleton, MA.

    Today so much is dictated by insurance companies, hell-bent on keeping costs down. It’s 15 minutes with the patient, throw as much information as possible at the patient, and move on. I know that our local Sonora (CA) Regional Medical Center offers education programs for Diabetics in the form of weekly meetings. Better than nothing.

    I wonder, do any other facilities offer similar education programs for Type I Diabetics? Does the Joslin Clinic, in Boston, now part of the Deaconess-Beth Israel Medical Center, still offer such education programs?

    My recommendation to anyone faced with a recent Type I Diabetes diagnosis is to contact a local hospital or larger medical center and ask about “Diabetes Education Programs.”

    • Frank Wisneski

      First, let me say that as a parent of a type 1, I love hearing from adults living successfully with this disease, that ALWAYS makes me happy.

      The Joslin center is still a world wide leader in Diabetes care, and their summer camps are still happening every year, and during the summer camps they are testing out the bionic pancreas. There is still a lot of information and innovation taking place there.

      We are in Southern California. We are lucky to have Camp Conrad-Chinook here, a camp strictly for diabetic children. Stella will be attending for her 3rd summer this year, and always comes back with a lot of knowledge and information. The local JDRF hosts many parent coffee nights, and normally has a speaker there to talk about a particular diabetic topic. The Childrens Hospital also offers support and hosts informational events for diabetics. We have Kaiser, and while they offer many educational diabetic classes, they tend to be geared towards type 2 lifestyle classes (exercise, cooking, etc) and not necessarily aimed at type 1’s. There are a tremendous amount of resources available on line though.

  3. Betty Cordoza

    I apologize for going on about myself. However, I agree 100% with what Frank had to say about dogs not being a solution, but rather a “tool” to be added to the array of “tools” used to help control Type I Diabetes, especially in a juvenile.

    Like any fine instrument, the dog should be added after the routine is well-established. Like any fine instrument the user should be educated on how to use the instrument most effectively. Like any fine instrument, the dog must also be maintained and fine-tuned to keep it operating at peak efficiency.

    My personal DAD is a Black Lab that I bought my husband for his birthday, in 2009. Without any formal training, Beau started alerting on my blood sugar if it “crashed” or was low while I was asleep. If he can’t wake me, Beau barks until he gets my husband’s attention. For us, it is enough.

    However, a DAD must be matched perfectly to needs of the Diabetic on whom it is alerting and the Diabetic’s lifestyle. Therefore, until the needs and routine and life style are established regarding the newly diagnosed Type I Diabetic, a dog cannot be matched or work best for the person with whom it is matched.

  4. I appreciate your candidness on what it takes to have a DAD. It is not all sunshine and roses all the time. It is hard work. People do need to know that. HOWEVER, I do not agree with your judgments as to who should and who shouldn’t get a DAD and what qualifies one to have a DAD. That’s not for you to say. If so, I do not and will not ever fit into your box. I fully admit that I do not have a handle on my child’s diabetes and may not ever. My child has down syndrome, graves disease, eating issues, heart issues, sleep issues, and T1D to just name a few things we deal with. I have a DAD and everyday I realize more and more how much I NEED a DAD and have no regrets about it. You don’t know me and my situation. You cannot determine if I have what it takes to handle the demands of a DAD on top of what I deal with. I do not agree that until you have a good foundation and your diabetes under control you shouldn’t get a DAD. Really, how many people really have a handle on it? If it was that simple, DADs wouldn’t be needed. Other than that, I can agree with your post wholeheartedly….just leave off your judgements about who you think is DAD worthy and I’m good. 🙂

    • As a service dog trainer and a DAD trainer, I whole heartedly agree with what you have said…

      I take it a step further…
      1. They child must be at least 1 yr into the diagnosis, before I will place a DAD with them.
      2. No protective breeds.
      3. I do not train for highs. They can be so easy to manage, and plus the fact that in many instances you want a high sugar before bedtime….that being said, most dogd will eventually alert on their own.
      4. I teach the dogs to alert at 70 to 80. Nothing higher on lows. Unless it is a special situation where the child collapses from 120 to 45 in a matter of 5 minutes, it just isn’t necessary…and, yes I understand that some bristles can drop that quickly

      The other thing that I tell folks, these dogs are not “Lassie” and owning a service dog is a ton of work and can be stressful…..if you can’t deal with that stress then don’t get one….

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