Diabetes is Ruff: Diving into the World of Diabetes Service Dogs

When you think of tools to help you manage diabetes, you likely think of therapies and devices – but what about dogs? We spoke with Mark Ruefenacht, who trained the first diabetes service dog in the world, to learn how these special animals can support people with diabetes.

There are many reasons to love dogs. Because they are cute, because they are smart, because they are the furry best friends you didn’t know you needed, and they love you unconditionally. But did you know that some dogs can also save your life and help you manage diabetes? Just one more thing to add to the list. 

In diabetes, severe cases of high or low blood sugar (hyperglycemia and hypoglycemia, respectively) are dangerous and can lead to serious long and short-term health complications. Diabetes service dogs are trained to help, specifically when the owner’s blood sugar is too low or too high. 

There are two kinds of diabetes service dogs, Medical Response Dogs and Diabetic Alert Dogs. Medical Response Dogs are trained to respond to the symptoms of severe low blood sugar such as fatigue, loss of consciousness, and seizure-like behavior to help notify you and others of hypoglycemic events. Medical Response Dogs can also retrieve “low” supplies such as food, drinks, or an emergency kit. Diabetic Alert Dogs, also referred to as DADs, are trained to smell the compounds that are released from someone’s body when blood sugar is high or low. Because of this, Diabetic Alert Dogs are able to alert their owners of dangerous levels of blood sugar before they become symptomatic. A variety of breeds can be trained to be diabetes service dogs, including golden retrievers, Labrador retrievers, mixed-sporting breeds, and poodles. 

Nobody knows more about these dogs than Mark Ruefenacht, founder of Dogs4Diabetics (D4D), one of the leading diabetes service dog training organizations in the world. Ruefenacht  has lived with diabetes for over 30 years and got involved with service dogs for the blind due to his family history of diabetes-related eye disease (retinopathy). After an incident of severe hypoglycemia, Ruefenacht started training Armstrong, the world’s first diabetes service dog, to recognize and respond to the scent of hypoglycemia in his sweat and breath. Through training and testing, Ruefenacht found that there might be a scent associated with hypoglycemia that is common among people with diabetes and could be taught to other dogs. Since then, he has helped train hundreds more dogs with D4D. In our interview, Ruefanacht shared his insights on the benefits of Diabetic Alert Dogs and how to know if they are right for you. 

How are Diabetic Alert Dogs trained? Who are they trained for?

Diabetic Alert Dogs are typically trained for people with type 1 diabetes or insulin-dependent type 2 diabetes. This is for two reasons. As Ruefenacht describes, people with type 2 diabetes who are not dependent on insulin typically do not have life-threatening low blood sugars. Because of this, Diabetic Alert Dogs are most helpful for people who are insulin-dependent. Furthermore, under the Americans with Disabilities Act, service dogs can only be given to people with a recognized disability, which could cause barriers to getting a service dog, especially for people with type 2 diabetes who are not insulin dependent. There are additional requirements and limitations for public service dogs under the Americans with Disabilities Act, so diabetes service dog organizations also train dogs in various support skills to help people with diabetes at home (and not in public). Dogs4Diabetics refers to these dogs as “Diabetes Buddy Dogs.” If you are wondering whether you could qualify for a service dog, talk to a service dog organization.

As for the training these dogs receive, the programs typically focus on scent discrimination. This means that the dogs are taught to detect smells in the air associated with blood sugar changes and to ignore smells associated with normal, safe bodily functions. Ruefenacht said, “The big myth is that dogs are smelling blood sugar. But the dogs are actually sensing the compounds that come out of the liver when the blood sugar is either dropping rapidly or is low.” Though humans can’t detect these smells, dogs likely can. Scientists are not sure what exactly the dogs identify, but research suggests that it’s ketones (for high blood sugar) and may be a natural chemical called isoprene (for low blood sugar). Ruefenacht uses low and high blood sugar breath samples to train the dogs; after about six months of intensive training, they can distinguish these scents in people.    

Can diabetes service dogs reliably alert their owners to changes in glucose levels? It depends on the dog and it’s training – but research shows that diabetes service dogs can often be effective, and that quality of life and diabetes management tends to improve in owners. According to Kim Denton, who works for Dogs4Diabetics and has had type 1 diabetes with hypoglycemia unawareness for over 40 years, having a Diabetic Alert Dog “changed my life for the better by helping me keep my blood glucose in a much tighter range, which means fewer health complications and I feel much better both physically and mentally.”

How can diabetes service dogs help their owners?

Denton says that her dog, Troy, “has saved my life so many times by alerting me before my glucose dropped to a life-threatening level, that I can't keep track anymore. Troy tells me long before my CGM detects a rapid drop or rise in my glucose levels, and he does it without that annoying beeping! If my sugar starts dropping while I am sleeping, Troy jumps on me to wake me up and will continue licking my face if I start to fade off.” In addition to alerting owners to early changes in blood sugar so that they can act to stabilize glucose levels, there are other skills that diabetes service dogs can learn. Here are some examples, though every organization has different training programs: 

• Alert the owner to audio signals from insulin pumps, continuous glucose monitors (CGM), and other devices. This is especially helpful for people with impaired hearing, for children, and for diabetes management while sleeping.

• Alert people nearby to help the owner in cases of severe blood sugar changes, or retrieve a cell phone.

• Retrieve medications and other necessary supplies in an emergency.

• Provide emotional support. 

It is important to know that diabetes service dogs are an additive tool to help people manage their diabetes. A service dog should never replace CGM, self-monitoring blood glucose with fingersticks, hypoglycemia prevention methods, or healthy lifestyle efforts; a diabetes service dog can be an additional form of support for people with diabetes.

How do service dogs provide emotional support? Why is this important?

The majority of diabetes service dogs are also trained with emotional support and wellness skills. This means that in addition to helping people manage their blood sugar, these dogs can also help improve their owner’s mental and emotional wellbeing. This is especially important for people with diabetes because of the stress that often comes with long-term management of a chronic condition – learn about diabetes distress and how to reduce it here. People with diabetes are also two to three times more likely to experience symptoms of depression than the general population, according to the CDC. 

Ruefenacht is keenly aware of the relationship between diabetes and mental health, and he has worked to address this through his diabetes service dog training programs. Ruefenacht says his clients appreciate the diabetes management component of the service dog training, “but they value the companionship and emotional support more.” Like most other dogs, diabetes service dogs are companions and become part of the owner’s family. Many owners appreciate the stress-relieving experience of walking, playing, or just being with a dog, which can be incredibly helpful for people with diabetes. Denton says “Troy understands not only my need to have normal glucose levels but also my need for comfort and companionship when my diabetes gets me down.” Dogs can also be trained to cater to specific mental health conditions such as depression and anxiety. 

Could a diabetes service dog be right for me? 

Diabetes service dogs are a great option for some people, but not for everyone. There are several ways that people can get support in managing their diabetes, and it is important to think about what works best for you – for example, Diabetic Alert Dogs are trained to sense blood sugar changes in their owners, but for many, this can be accomplished using a CGM. Diabetes service dogs can be a helpful option for people who frequently experience episodes of hypoglycemia, experience hypoglycemia unawareness, need help regulating their blood sugar at night, or need additional support. According to Taylor Johnson, who has type 1 diabetes and a Diabetic Alert Dog named Claire, “Having a service dog is the best decision I’ve ever made regarding my diabetes management. I love gadgets and tech but they are not foolproof, and Claire is the additional piece of mind I need to sleep at night.” Talk with your healthcare professional to assess your need for a diabetes service dog if it is something that you are considering – and remember, a diabetes service dog will not replace the need for careful glucose monitoring and hypoglycemia prevention efforts.

There are a few more important things to think about:  

• Cost: The process of getting and training diabetes service dogs and their owners can be expensive. There are some organizations that provide training services for free or for a reduced cost for those who qualify. Other organizations offer financial assistance or payment plans for those who qualify. For example, as a 501(c)(3) nonprofit that relies on charitable donations, D4D does not charge its clients for the dogs or other program services which significantly reduces the costs of owning a diabetes service dog. 

• Time: Owners also need to put a significant amount of time into training and maintaining the skills of their diabetes service dog outside of the formal training the dogs receive. This includes participation in some of the initial training of the dog, giving the dog time to acclimate to your specific needs as a person with diabetes, and follow-up training throughout the dog’s lifetime. 

Want to learn more about diabetes service dogs?

• You can look for accredited service dog organizations by state and country on Assistance Dog International

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