Type 1 diabetes, the kind children get, is a frightening diagnosis for any parent, with the threat that an undetected drop in blood sugar could cause a seizure or even a coma during the night when everyone's sleeping.
It's a double threat for the family of third-grader Nicole Rieser of Sand Lake because she is also autistic, and can't sense the changes as they happen even when she's awake.
Autism is a brain-related disability that interferes with a person's ability to communicate with others and interact socially.
Debbie and Mike Rieser have gotten the latest equipment for their daughter, frequently monitor her even into the night, and give her as much training as she can handle.
Now, the Riesers are turning to a dog for an added edge. The family is awaiting arrival in May of a new type of service dog trained to detect when Nicole's blood sugar gets high or low and alert the family, a German shepherd from Adobe Kennels in Amarillo, Texas.
"I worry about her all the time," says Debbie Rieser. "Will she be able to live independently with having autism and diabetes? Having the dog will help us get through her teenage years."
Nicole, a thin kid with long, curly brown hair, is quiet with people she doesn't know well, but demonstrates that she can test her own blood sugar and operate the insulin pump she wears. She loves performing on stage, her mother says. She dances ballet, tap, hip-hop and Irish dancing. She does gymnastics. She goes to friends' houses. She rides horseback.
The dog will go everywhere with her but school, where nurses and teachers help look out for her, said the Riesers. Later, in middle or high school when she's old enough to control the dog alone, maybe it would go along.
While dogs have long guided blind people, sniffed out bombs and drugs, and lent a helping paw to people with different disabilities, the idea that they could use their superior noses to read a diabetic's blood sugar level is relatively new. Like other service dogs, dogs for diabetics are raised to be well-behaved, unafraid of their surroundings and responsive to commands. Then they are trained to detect by scent whether a diabetic is headed for crisis one way or the other -- a fruity smell if blood sugar rises too high. Dog trainers say there's a faint scent like fingernail polish remover when a person's blood sugar is low.
Debbie Rieser says they will be the first in Alaska to get one of these dogs. Rieser first heard of diabetic alert dogs about three years ago at a speech therapy session for Nicole. She and her husband investigated and found long wait lists, in some cases a requirement that a child be at least 12, and in one case, a kennel with a reputation for badly trained animals. None of the outfits claiming to train dogs for diabetics are regulated. And the idea that a dog can successfully pick up the scent when a particular diabetic person reaches an unhealthy low has not been scientifically tested.
A lot of research brought the Riesers to Adobe Kennels, a small, for-profit kennel where Mary Westbrook, 75, raises German shepherds.
Westbrook had been teaching her German shepherds narcotics detection until a friend got her interested in training therapeutic dogs.
TRAINING THE DOG
The training goes like this: From puppyhood on, Westbrook teaches her dogs "100 percent strict obedience" and trains them to be unflappable -- exposed to loud noises, for example, and taught not to get distracted. "They don't go to pieces ever, ever, ever."
Discipline is key, said Westbrook. "A German shepherd is either the boss of the family or the family is the boss of the German shepherd."
When a dog is mature enough, Westbrook asks the client to send some clothes the person was wearing at the time his blood sugar dropped to an unhealthy level.
She then teaches the dog to find the garment with that smell attached, and raise a fuss about it.
Dogs can naturally smell high sugar levels, which are so obvious as to be detectable by humans, too, Westbrook says.
"The only treats I use is when they detect the lows. But I don't want them to learn on anybody but who they're going to belong to. ... Once in awhile you'll have a dog that alerts to every diabetic they come to. They'll burn out too quick. You want them to alert on their children."
Westbrook has two 2-year-old female litter-mates who are ready to begin specific low-sugar alert training, she says, and she just needs to pick one. It should take a few weeks to train the dog to Nicole's scent. Then Westbrook and the dog, either Josie or Darcy, will travel to Anchorage in May to join the Rieser family. Westbrook will stay a week, and come back as needed, she says.
The dog costs the family $10,000 plus travel expenses. However, a nonprofit sled-dog fund created by musher Blake Matray of Two Rivers has already donated $1,000 toward that expense.
Diabetic dogs are so new that the medical community appears to be supportive but awaiting more study.
Linda Lau, Nicole's nurse practitioner, sees maybe 250 diabetic children in her practice, and says most children can begin to be able to tell when something's off with their blood sugar at the age of 4 or 5.
"They might say, 'Check my blood sugar,' or they may say, 'I'm low,' " she said. Nicole's autism probably interferes with her ability to do that, Lau said, and a dog might well be able to help.
Everyone agrees that high sugar levels -- which, over time, can lead to other problems like damage to kidneys and eyes -- come with a distinct fruity odor that a dog should be able to smell.
Low sugar levels, which raise more acute problems -- a person can faint or have a seizure -- produce symptoms such as acting shaky or spaced out or dizzy, that a dog should be able to recognize, Lau says. But Lau is unaware of any scientific studies pinpointing a specific odor for diabetics experiencing sugar lows.
"I'm not saying it doesn't exist." It's just not something you'll find an AMA study on, she says.
Even Westbrook warns the dog diabetic alert system can break down. Two of the 10 diabetic alert dogs she placed haven't worked out with their owners, she said, a fact that she attributes to the owners not following through on training.
In Nicole's case, Westbrook at first thought the situation was iffy -- Nicole, at 9, is young. Plus, it's a long trip from Amarillo to Anchorage for Westbrook. But Debbie Rieser's persistence won out. "Debbie just kept on and on and on. I saw that she would stick to it."