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Frequently asked questions about Medical Assistance & Diabetic Alert Dogs



What is a Service dog and why does it have special rights for access?


Service dogs are individually trained to perform tasks for people with disabilities – such as guiding people who are blind, alerting people who are deaf, pulling wheelchairs, alerting and protecting a person who is having a seizure, or performing other special tasks. The Americans with Disabilities Act provides public access rights for these dogs and their disabled handlers.




What is the difference between a Medical Assistance Dog, a Diabetic Alert Assistance Dog and a Medical Response Dog?


Medical Assistance Dogs are service dogs that have been trained to respond to an identifiable element that is available to their senses in order to provide support to their handler, allowing the handler to address some aspect of that medical condition. Diabetic Alert Assistance Dogs are a specific type of Medical Assistance Dog that has been trained to use their highly sensitive scent capabilities to identify the changes in blood chemistry that occur during rapid changes in blood sugar levels.


Medical Response Dogs are another type of Medical Assistance Dog that has been trained to assist persons based on recognition of symptoms pertaining to a specific medical condition. The differences between medical alert and medical response training is the trigger that the dog has been trained to identify. In the case of a Diabetic Alert Dog, the trigger is the change in blood chemistry, allowing the diabetic to treat hypoglycemia prior to becoming symptomatic. A Medical Response Dog for diabetes responds to the handler as symptoms are occurring. A Pawsitive Approach testing and experience with its clients has shown that there is a 15 to 30-minute difference in this response.  Seizure response dogs are also trained using the Debby Kay Super Sniffer method to achieve maximum results.




How can dogs be trained to sense when glucose levels are dropping in people with diabetes? What kind of technique do you use?


Our dogs are trained to identify a scent obtained from a diabetic when the diabetic is undergoing a low (blood sugar generally below 70). The dog is trained to identify that particular scent from other scents that are presented to them. They must find the one that we are training them to identify. As the dog learns to recognize that particular scent, they are trained to react in a certain way to his handler.




How can the dog notify its handler when it senses a drop in blood sugar?


Our dogs will notify their handlers as we teach them to do so. It may be taught to sit and stare at the person, to touch the person with their nose, or to jump up on them. We also use a small soft toy, called a bringsel that hangs on the dog’s collar. The dog will reach down to hold it in their mouth to notify their handler that they have smelled the particular scent.




Can you explain how dogs can sense when the blood sugar is going to change?


Dogs, such as Labrador Retrievers, have over 200,000,000 sensors that can smell individual elements in parts per trillion, versus current technology’s ability to identify items in parts per million. Rapid changes in the blood sugar levels cause chemical changes in the body that are expressed through a person’s breath and skin, and include unique chemical elements that the dog can smell. Chemical changes through breath have been long been used to measure blood alcohol levels. Some of those devices can tell the difference between a disabled diabetic with hypoglycemia from a person suffering from alcohol intoxication. Our experience indicates that the identifiable changes in a diabetic’s chemistry derived from his breath or sweat precedes the measurable change in blood sugar currently measured by glucose meters by 15 to 30 minutes. The dog can be trained to identify the onset of these changes and react to his handler when it is smelled.




Is it hard and expensive to train these dogs? How long does it take?


The most highly trained service dogs are specially bred, socialized and trained from birth to 18 months when they begin their specialized service training. To properly train the dog to identify the scent and then work with a diabetic handler to properly alert, takes another 6 months to one year. That includes training the dog and the client to become a successful alert team and also so that the dog can be properly accessed in public places.


This training is expensive.  Our direct costs for training the dog and client amount to about $20,000. Accordingly, we estimate direct cost to the client could reach as high as $35,000 if unexpected medical issues arrive during the training process and this includes all grooming, food and special equipment that is billed back to the client. For insurance and legal purposes, we place a market value on these valuable dogs of $50,000. This value reflects all the direct costs as well as the significant value added by volunteer raisers, and the costs of training and supporting the medical alert client to develop a successful placement.


After placement, the client is responsible for all the costs of supporting the dog.  Additionally, A Pawsitive Approach Dog Training requires its clients to maintain health insurance on its dogs to support extraordinary veterinary expenses and requires a recertification of skills each year the dog is in service.




In what situations can these dogs help people with diabetes?


These dogs can be used in many situations and with all types of people, male, female, young and old. They are most valuable in situations where the diabetic is actively managing their blood sugar, with an insulin injections or a pump. These types of clients have more lows than persons using oral medications and they have the lows frequently. The dog is able to assist them in these situations. A diabetic that does not have frequent low blood sugar would not need a dog for this purpose. In the case of children, the dogs assist the parents in providing night time alert coverage. The parents must test multiple times during the night, and the dogs support the oversight beyond that testing. In the case of a new college student, away from home, the dog provides the support that parents previously did, to make sure that the student tests when low, day and night. Living alone is scary when you have this disease and the dog provides the support to make it manageable.




What type of feedback do you get from people who are paired with trained dogs?


Our feedback is almost entirely positive. Once our clients have gone through our intensive training, they understand what it takes to own a dog and have them as a constant companion. Some people do not see this as an attractive option; accordingly they would not pursue this program, so we generally do not get negative comments that might come from this type of person. However, some individuals that have entered the program have found that working with a dog is very difficult for a variety of reasons, and have not been able to develop a successful alerting team. Others have also found that that the dog does not fit into their lifestyle and have decided that this is type of support is not for them. For the right person, with an understanding of the effort required and the change in their life that the dog will make, this can be a very rewarding opportunity.




Do you think that with all the hard work required, do the dogs provide sufficient value to your clients to justify the time, effort and money spent to train them to help people with diabetes? Why is that?


Dogs have an incredible ability to help their human companions, and provide very positive feelings for them. With this great aptitude, they are providing something that current technology can not. These dogs have helped our clients improve their physical and emotional health. We realize that most diabetics will not have the opportunity to obtain a dog like ours. So, we believe that studying the partnership of our dogs and clients can help the entire diabetic community, particularly if the research can point to new ways to monitor and manage blood sugar in diabetics. We would like to see this research help develop a non-invasive device (no needles) to warn people of impending low blood sugar that is faster than current technology. In that way, our dogs will have helped the entire diabetic community. For all these reasons, our program is incredibly worthwhile.




Why does APADT limit its placement of dogs to persons living within a 3 hour commute from its training center; to prospective clients over 5 years old; and to persons who have had diabetes over 1 year?


After developing extensive experience in placing these highly trained trained dogs, we evaluated the successes and failures to determine how and why some teams were successful over a long period, and why others were not successful. There were three factors that were apparent in the most successful teams. First, the most successful teams stayed involved with our trainers and the program. When issues arose, they asked for support and did not let initial small alerting or behavior issues rise to major problems before taking corrective action. Two, dogs placed with families where the parent was responsible for the dog’s behavior and alerting could not sustain the positive reinforcement of the dog’s behavior over the life of the dog.

Therefore, the dog reverted to more pet-like behaviors and did not sustain its working skill over time. Third, our most successful clients understand their diabetes treatment well and use that knowledge in concert with their learned skills as a medical-alert dog handler to understand their dog’s alerting behavior and how it is helping their diabetes management.


The function these dogs preform is critical to the health and welfare of our clients. Additionally, these dogs are extremely valuable in supporting persons with diabetes. Due to the limited number of dogs that we are able to obtain, train and place, we want all our placements to be successful over their working lives, which last 8 to 10 years.  We take the health and welfare of our clients in very seriously and only place dogs that perform this work consistently and reliably.


Additionally, we place the dogs and provide lifetime support to help sustain their skills over their working life. In order to appropriately manage these critical and limited resources to achieve these goals, we have established criteria that point to the best potential for success. Even with these selection and placement criteria in place, long term success is not guaranteed. Any person seeking a dog for these purposes needs to understand the risks, rewards and variable issues that impact the potential for long term success. APADT’s mission includes a dedication to sharing these issues with the public and potential clients to understand these issues. 

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