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 discover.

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 episode.''

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 swhiting@sfchronicle.com.

This article appeared on page CM - 6 of the San Francisco Chronicle

This article reprinted from sfgate.com.