Guide Dog flunkies earn kudos in their second life as diabetes coma alarms
This article reprinted from sfgate.com.
By Sam Whiting
Sunday, November 5, 2006
Mark Ruefenacht was unaware that a Guide Dog for the Blind could
also save the life of a diabetic until he was jolted awake in a
New York hotel room by two paws on his chest.
Ruefenacht, who raises Guide Dog puppies but is not blind, was
probably in a seizure brought on by dangerously low blood sugar.
This alerted the puppy to try to wake him, which took some determination.
Groggy and confused, Ruefenacht got himself some hard candy, which
brought his sugar up. By the time he awoke the next morning he had
a life's calling to befit his last name, which means "to alert
in the night" in Swiss German.
Ruefenacht, 45, is a forensic metrologist who works with crime
labs. He began pursuing a hunch that a Guide Dog could smell a chemical
imbalance on a diabetic, much like a Breathalyzer can discern alcohol
from hypoglycemia (low blood sugar).
"If a machine can do it, I can train a dog to do it,"
he recalls thinking. Five years of tests and trials later, he'd
pinpointed a scent common to insulin-dependent (Type 1) diabetics
experiencing low blood sugar.
A human can't pick up the scent but a dog can, so he trained a
yellow lab named Armstrong to watch over him. Then he founded Dogs
for Diabetics, a nonprofit based in a warehouse complex in the industrial
end of Concord, near his home in Pittsburg. The glass door is marked
only D4D, "Beware of Dogs." Behind it are a few volunteers
at desks, processing applications.
The working staff can be found lazing under a ray of light coming
through the door -- retrievers in three colors. These are washouts
from Guide Dogs for the Blind in San Rafael, which doesn't mean
they are failures. The Guide Dogs standard is stricter than that
for fighter pilots and astronauts. Hesitation on an escalator and
they are labeled "career-change dogs" to be shipped over
to Ruefenacht and re-tooled.
Nobody knows how or why a dog can pick up the scent of low blood
sugar on a human. "It is probably some process in the breakdown
of fat that they are able to pick up through their olfactory sense,"
says Mary Sullivan, diabetes clinical nurse specialist in at UCSF
Medical Center. Sullivan would like to see a clinical trial, but
in the meantime she has seen it work at a diabetic kids' camp, and
referred one patient to Dogs for Diabetics.
So far six dogs have been placed, but Ruefenacht is just getting
started. "Guide Dogs for the Blind, they place dogs all over
the United States and Canada," he says. "That's my goal."
The market is there. Estimates on numbers of Type 1 diabetics in
America run as high as 3 million, as opposed to 1.3 million who
are legally blind.
Type 1, also known as juvenile diabetes, is a genetic disease that
causes the immune system to destroy insulin-producing cells in the
pancreas. A Type 1 diabetic must inject insulin or die. High blood
sugar is a slow death. Low blood sugar, often brought on by an accidental
overdose of insulin, can kill in a night, as Ruefenacht almost didn't
In order to maintain a normal count, between 80 and 140 on the
glucose meter, a Type 1 must calculate the carbohydrates in each
meal and measure out an appropriate dose of insulin. What the calculation
cannot accurately figure out is the mysterious behavior of the body's
own metabolism, and the effects of stress, exercise and sleep quality.
A dose that works one night will be too much the next, even after
eating the same foods. It's a constant balancing act. That's why
Type 1s who are supposed to avoid sugar must keep candy or fruit
juice at arm's reach.
Low blood sugar causes stomach cramps, disorientation and a sweat,
but after awhile the system gets accustomed to the lows and stops
sending out danger signals. That's where the dog earns the right
to sleep in the room with its owner. Everyone's different, but 3
a.m. seems to be the favored time for a crash.
"My blood sugar suddenly goes low and I don't wake up. I don't
feel anything and suddenly there will be a 130-pound golden retriever
jumping on me," says Devin Grayson, who is 36, lives in Oakland
and has been Type 1 for half her life.
Once rousted she checks her blood sugar to make sure Cody is right.
A diabetes dog does not get its owner out of a finger prick to draw
blood and test. Grayson goes low at night three times a week, and
Cody hasn't been wrong in six months. He's a more accurate predictor
than the meter, because his nose picks up a trend downward in blood
sugar that the meter won't.
If Grayson were to become non-responsive, Cody has been taught
to find help and lead it back, which Grayson describes as a "Timmy's-in-the-well
All the Lassies lodge with foster families while they are being
trained. The curriculum is a simple reward system. The hypoglycemic
scent is captured on the shirt of a hypoglycemic diabetic and hidden
among trainers. Detect the smell on the right person and the dog
gets a reward.
The humans take more training than the dogs. "We start with
Puppy 101," Ruefenacht says. Applicants must have control over
their diabetes and fill out a questionnaire available at the Web
site dogs4diabetes.com. They are looking for a perfect match between
woman and best friend, and would seem to have found it in Breanne
Harris, 21, a UC Davis senior who is who wears a black page-boy
to match the coat on her lab, Destiny.
As soon as they moved in together, Destiny saved Harris from a
hypoglycemic episode on a bus going to work. "She was looking
at me like, 'you're low but I'm not quite sure how I'm going to
do this on a moving bus,' '' says Harris.
Harris lives off-campus, so a dog isn't a problem. If she lived
on-campus in a dorm it wouldn't be a problem either, because certified
diabetes dogs have all the federal rights of Guide Dogs, meaning
they can go wherever you go. The dogs must be kept on leashes, wear
state-issue tags and blue jackets, which can double as saddlebags
hauling the requisite gear.
A big blue backpack on a dog might be more publicity than some
diabetics need. "Oh, yeah," says Harris, who enhances
the black motif with a Clash T-shirt. "I've had people think
I'm blind or that I'm training her," she says, "but most
people are just interested in 'ooh, dog, puppy.' "
E-mail Sam Whiting at firstname.lastname@example.org.
This article appeared on page CM - 6 of the San Francisco Chronicle
This article reprinted from sfgate.com.