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October 10, 2002

Hypoglycemia

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Question from Greentown, Pennsylvania, USA:

I have spoken to people who have dogs that seem to be able to let someone know when a person with diabetes has a low. A women with an elderly mother has a 10 month old dog that will come to her, bark, and growl when her mother is low. My son is eight, I fear night lows, and therefore do not get the rest I need. I wake up to check him several time a night, and my nerves are frazzled from lack of sleep. I really do not want to get a dog, but wondered if there is any evidence that a cat could detect lows.

Answer:

From: DTeam Staff

I don’t know of any objective way to determine if a particular animal will respond to low blood glucose in its human companion. However, I work with a diabetes nurse whose cat will detect her low blood glucose.

BS
Additional comments from Dr. Donough O’Brien:

It has indeed been claimed that dogs can detect hypoglycemia, but for someone who doesn’t particularly want a dog, I think that there are better alternatives.

One would be the new GlucoWatch 2. It is rather expensive, and, with an equilibration time of two hours, it is still somewhat cumbersome and not always easy to equilibrate.

Perhaps a better solution would be to reduce the chances of night time hypoglycemia would be to talk to the diabetes doctor about using bedtime Lantus (insulin glargine) for basal needs with Humalog or NovoLog to cover mealtimes which can be given after the meal to take account of the blood sugar and the actual number of ‘carbs’ consumed. As always the treatment of hypoglycemia is prevention, and a short period of building a good profile of 24 hour blood sugars should indicate any hypoglycemic vulnerabilities which need to be corrected. A final suggestion would be to consider one of the almost painless alternate site meters to make night time sampling even easier.

DOB
Additional comments from Lois Schmidt Finney, diabetes dietitian:

In fact, we were just looking into this for one of our patients. Leader Dogs is the organization that supplies the dogs. I do not know about cats being able to detect lows, but I think this organization can tell you if their dogs can do so. These are actually dogs trained for working with those who have sight limitations, but perhaps the organization has ideas for detecting someone who is experiencing a low. Probably though your best bet is to look at options you have.

I assume you had discussed your concerns with your son’s diabetes team and they have offered some solutions, if not, you need to do so.

LSF

[Editor’s comment: See Medical Assistance Dogs and Non-invasive detection of hypoglycaemia using a novel, fully biocompatible and patient friendly alarm system in the BMJ; 2000 321:1565-1566.
SS]

[Editor’s comment: There was a follow-up comment in the BMJ from a trainer:

We have recently trained a hypoglycaemia alarm dog who is successfully alerting his owner to hypoglycaemic episodes. However, our experience in training this dog and other dogs trained to provide warnings of epileptic seizures suggests that caution must be exercised in promoting the use of dogs in this way.

In the absence of specialised training a dog is likely to respond unpredictably and may even behave aggressively towards its owner, resulting in potentially disastrous consequences for both dog and owner.

The British charity, SUPPORT DOGS, trains dogs to assist people with a variety of disabilities. Our experience suggests that dogs must be carefully selected and then specifically trained for the work they do. In training dogs in these specialised roles, we must initially condition the dog to overcome his/her instinctive survival strategy towards a hypoglycaemic episode or epileptic seizure and teach the dog to provide an appropriate warning to his/her owner. It typically takes six months of training to ensure that a dog can perform this specialised role. A specially trained dog can offer people who experience unpredictable hypoglycaemic episodes or epileptic seizures the chance to live a relatively independent life. However, careful selection and specialised training are essential for the dog to assist the owner in achieving this goal.
WWQ]