…. except when my blood sugar is too low and she’s keeping me from driving.  I take a deep breath and do my blood sugar.  It had dropped 50 points.  I was too low to drive.

 GOOD GIRL RAINIE!

Rainie
belly up with her friend “Hoops”

While Rainie and I were shopping at Trader Joe’s, we were hesitantly approached by two of the store supervisors who asked if they could pet my service dog.  My darling girl truly loves men, and as they cooed over her, telling her what a pretty girl she was, Rainie assumed took her favorite position as she melted into the floor and rolled belly up for tummy-rubs.  Soon we were enveloped in a circle of people (mostly elderly, since the local retirement community’s bus was parked outside), all sharing dog-stories and memories, while laughing and petting Rainie’s tummy.

A good time was had by all.  And  Rainie’s smile stretched from ear-to-ear.

http://www.bittersweetdiabetes.com/2012/09/life-with-diabetic-alert-dog-part-1.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+Bitter-sweetDiabetesBlog+%28Bitter-Sweet+Diabetes+Blog%29

http://www.bittersweetdiabetes.com/2012/09/life-with-diabetic-alert-dog-part-2.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+Bitter-sweetDiabetesBlog+%28Bitter-Sweet+Diabetes+Blog%29

Life with a Diabetic Alert Dog

Rainie is my diabetic alert dog, and even though I’ve experienced lots of changes and advancements in diabetic technology since I was diagnosed 55 years ago, nothing has changed my life as much as Rainie has.  I hope to explain about diabetic alert dogs (DADs), and tell you some stories about how she has impacted my life.  Please note: when I refer to Rainie’s training, or the training of a DAD, I am talking only about the training Rainie has received.  I help to train the dogs at Early Alert Canines (EAC), and am supported by EAC’s head trainer, Carol Edwards, in order to keep Rainie certified with ADI (Assistance Dogs International).

First, let me answer this question: What is a Diabetic Alert Dog (also known as a Hypoglycemic Alert Dog)?

A diabetic alert dog (DAD) has been trained to recognize the biochemical scent that a diabetic’s body produces as the blood glucose begins to drop.  Upon smelling the scent, the dog will then alert its partner, thus avoiding acutely dangerous hypoglycemia and long-term diabetes complications.  Some DADs are trained to smell and alert on the scent of rapidly rising blood sugar also.

Rainie and I have been a team for over two years now.  When we were placed together, she was a semi-rowdy, 20 month-old, golden retriever/yellow Lab puppy.  She was raised as a seeing-eye puppy, but was ‘career-changed’ and trained as a DAD because she is very afraid of motorcycles.  Now, she is my best friend, non-judgmental companion and perpetual blood sugar alert system. Because she is a service dog, she can come with me anyplace the general public is allowed.  And her presence and constant monitoring allows me to experience a greater peace of mind.  I’m more confident because she will alert me before I get into trouble.

I like to consider her alerts a warning, as if she’s telling me, “Pay attention to your blood sugar NOW!  You’re changing fast.”   Her alerts begin as gentle nudges that will get stronger if I ignore her – even to the point of getting my husband, daughter, or a friend if I’m not paying attention.  Rainie has been trained to be ‘on duty’ no matter where we are or what we’re dong.  She has alerted me in places like the movies, on hikes, while I’m in the shower, in restaurants, at the farmers’ market, on airplanes, working in the garden, at the doctor’s office, while I’m swimming at the gym, etc.  She will wake me up at night (which is important), and once got my husband from another room when I was sick with a high fever, and was too asleep to notice her nudges, which proceeded to her lying on top of me.  She alerts me when I’m driving, and has blocked me from getting into the driver’s seat when she’s felt my blood sugar is too low – and she was right each time!

There are many wonderful things about having a DAD.  First of all, her alerting indicates my BS is dropping at this instance.  In fact sometimes the dogs alert before the meters can measure a change.  They can even smell that your blood sugar is going to drop soon! (And this is much more accurate that the 20 minute delay of a continuous glucose monitor.)  The first time Rainie alerted me early, I was at work.  I did my BS and it was 180 after breakfast – that number was expected, so I did my BS again 10 minutes later (as I’m supposed to do), and it was about 182.  But she kept alerting me! I repeated a test again 10 minutes later, and the reading was 179. Yet Rainie kept alerting.  Finally, I tested myself a fourth time, and my BS had dropped 100 points!  I was amazed, and ate some glucose.  Another pleasure about DADs is that their alerting is consistent and non-judgmental.  I don’t tend to get annoyed at Rainie like I would if my husband told me, “Hilary, don’t you think you should check your blood sugar?” I know she’s alerting out of duty and love.  And by alerting when my BS (blood sugar) begins to drop quickly, I can often avoid going too high afterword (often called ‘re-bounding).  My liver no longer has the need to push glucose out into my blood stream because my blood sugar levels haven’t gone so low that the liver is signaled to correct the hypoglycemia.  Having a dog is also a wonderful way to meet people, get exercise, and I find I’m not so self-conscious about having diabetes.  People will ask me, “What does she do?” or “What does she ‘early alert on?” and I’ll tell them that she is a diabetic alert dog and smells my low blood sugar.  I can then talk about diabetes and DADs without having the focus on me.  But I think the best ‘gift’ I get from having Rainie, my diabetic alert dog, is a fuller sense of peace-of-mind.  I no longer have to fear that my blood sugar will drop and that I’ll be unaware of it.  I can exercise, drive, and do almost anything while not worrying that I’m falling into danger.  Because of having diabetes so long, I can no longer feel when I’m going low, and having Rainie’s attention and monitoring makes me feel safer in the world, and during sleep.  My family doesn’t worry as much about me either.  My husband isn’t afraid to go on long trips because he knows that Rainie will help to keep me aware and safe.  And, even with all her life-saving responsibilities, Rainie knows just when to put her head in my lap when life with diabetes has gotten me down.

One of the reasons I’m excited about working with Early Alert Canines (EAC) is we train and place DADs with families with young diabetic children.  We call those dogs “Skilled Companions”.  I wish every family with a diabetic child could have a DAD.  Looking back on my own childhood, I wish I had had a blood sugar alert dog.  The dog would have been able to express what I, as an infant and child, could not.  The dog could have affirmed to my parents that my blood sugar was dropping, and that I was not cranky from teething pains, growth spurts, adolescence, etc.  And even though kids might get angry with their parents, a gentle nuzzle from a dog is usually returned in kind.

As a nurse, and a person born with diabetes, I can only imagine what a dog could do for a parent’s peace of mind.  The dog would be another set of eyes and ears (and nose) to monitor the young child’s (or children’s) BS levels and alert the child’s parent when appropriate.  The DAD can help shoulder some of the parent’s responsibilities, while, hopefully, allying some of their fears.  One mother who just graduated from EAC with her son and their dog tearfully exclaimed, “Thank you!  I don’t feel so alone!”  Here is another story that shows why I’m passionate about DADs being placed in families with diabetic children: One dog has been placed in a home with three diabetic children under age 6.  The dog sleeps in the hallway between the children’s bedrooms, and alerts the mom when one of the kid’s blood sugar begins dropping rapidly, bringing her to the appropriate child.

I apologize for getting on my soapbox!   I wish I could tell you all the ways Rainie has changed my life and my relationship to my own diabetes.  She is my friend and constant companion, as well as being my perpetual blood sugar alert system.  She has truly saved my life at night and during one particular walk on the beach.  There are so many stories to tell – and Rainie and I have only been together for a little over two years.

I’d like to make myself available to anyone who has questions about life with a diabetic alert dog!  Please feel free to read my blog RainiAndMe.wordpress.com or contact me at mailto:HilarythePotter@gmail.com.

And, for those individuals interested in reading a blog about having a DAD while in college, please read my friend Amelia’s blog http://www.doggoestocollege.com

And one last story: Not long after Halloween, I was walking Rainie when a little boy named Jason came running with his cape flying behind him as he swung his light-saber from side to side.  He was yelling, “Hey! Is that a Ewok?”  I laughed and introduced him to my golden retriever named Rainie.  He wanted to know why she had a red jacket on.  As I explained to Jason and his mom that Rainie is a diabetic alert dog and that she notifies me when my blood sugar is dropping rapidly, the mom began to cry — Jason had just been released from the hospital after being found unconscious due to low blood sugar.  As we were talking, Jason looked up at me, with his arms around Rainie’s neck, and said, “If I had a dog like Rainie, she would keep me safe – just like my light-saber.”

Twin Sisters
Leslie and Rainie
Both Diabetic Alert Dogs

“What does diabetes feel like?” This is a crucial question when you’re caring for, or dealing with diabetes, and its life-impact. If you have your own experiences, please comment, so that more of an understanding can be shed.”

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Sometimes Rainie’s nose amazes me! I was driving past the kids’ playground to get to the part of the park we hike in every morning when Rainie uncurled from the floorboards, and frantically began smelling the wind coming through the open window. She was obviously in some distress, so I pulled into the parking lot, leashed her, and let her out. She immediately led me to the play area, and began alerting on a little girl who was running up the slide with a pink pump clipped to the back of her pants. Little pink-sweatered arms soon encircled Rainie, as I talked to “Emma’s” mom. Yes, her blood sugar was low (65), after having refused to eat breakfast. As Emma’s mom and I talked, she mused, “I wonder what it feels like for her when she goes high and low?”

This is a question I’m often asked, “What does it feel like?” It’s taken me a long time to figure out how to explain the answer . I’ll try to describe how it feels to me. (Please remember that I’m describing this as an adult diabetic. When I was young, I had the same feelings, but no words to describe them with.) And as I describe the differences between ‘low’ and ‘high’ blood sugar, please realize that a diabetic often fluctuates between the two states many times a day due to the nature of diabetes.

Low blood sugar, or hypoglycemia, might be fun if it weren’t so scary and disorienting. Hypoglycemia is potentially life threatening because the brain’s only fuel-source is sugar, and with too little sugar, the brain cannot function properly. Therefore, most of the sensations of low blood sugar are brain-based. If my blood sugar (BS) is dropping slowly, the symptoms may be unnoticeable at first and slowly become stronger;  and if my BS is falling rapidly, I catch the symptoms as soon as I can. The first symptoms tend to be a general ‘fuzziness or blurriness’ in my thinking and perception. It is very easy to not even realize anything is wrong, and slowly become agitated and frustrated because ‘things just aren’t right’. I may also get very cranky or whiny.  One of  the most aggravating symptom of low blood sugar is frustration.  I like to describe it by saying, “On a scale of ‘one-to-ten’ my frustration tolerance is ‘a negative-three’.”  It gets in my way of dealing with every aspect of life, including my ability to make decisions that involve taking care of myself.  Everything becomes annoying – kids, traffic, choices, loved-ones (and others), work, my low blood sugar alert dog, etc.  I often figure out my blood sugar is falling because I’m so easily frustrated.  Living in this frustrated state is especially infuriating on those days when my body is extremely sensitive to my insulin, so I’m dealing with low-blood sugars for many hours at a time.  These periods of insulin sensitivity often happen for no reason I’m award of, and cannot be planned for or avoided.  When they do happen, it’s difficult to be patient while taking care of myself, and dealing with others.  I can only imagine what it is like for other people having to be around me! As my BS continues to drop, my thoughts and reflexes get slower and slower, and my coordination becomes poor.  It becomes more difficult to understand conversations and new ideas. I may also make relatively impulsive decisions. These are the times I’m glad I have my low blood sugar alert dog, Rainie. Her alerts keep me from doing things (like driving) when I’m still feeling ok, but could easily put myself, or others, in danger. (I am not drunk – although I may look that way.) As the blood sugar continues dropping, I become physically unstable, emotionally fragile, and easily overwhelmed. I’m dizzy, clumsy, disoriented, teary, sensitive to light, easily confused, and unable to make up my mind (which is really bad because it means I can’t even decide what I want to eat in order to correct the situation). Even though my lips and fingertips may be numb and my vision may be blurry from the low blood sugar, I get angry when people begin to question me and offer help – often becoming defiant. And I need help! And at the same time, I’m somehow unable to take care of myself. And I’m scared! If things were to continue, there is a good possibility I would become unconscious, go into ‘shock’, and, in the worst-case scenario, die.

The symptoms of high blood sugar, or hyperglycemia, are much more physical than low BS’s are. The first thing I notice is a deep headache. Then I get thirsty and agitated – very ‘squirmy’ and unable to concentrate and be still. I crave water to try to dilute my sugary/syrupy blood. I’ve noticed my tongue feels like it’s a dry cotton-ball sometimes. Then, my body begins to ache. Every part of me feels toxic, as if I’ve got the achiness of the flu. I don’t want to move because it feels ‘too hard’ – like walking through mud. And my brain feels that way too. Sometimes I just want to curl up in a dark, cool room and not move. If my BS gets high enough that I begin to ‘spill ketones’, I can get very nauseated and vomit. High ketones are poison to the brain. I’m also very sensitive to the fact that a few hours after high BS begins, my vision gets blurry because the sugar in the blood makes the lenses of the eyes swell.

High blood sugars can be very stubborn and not respond to extra insulin the way low blood sugars respond quickly to sugar. Often, with high BS, the body is resistant to the insulin because of adrenaline released as a protective mechanism by the liver. This can happen as a response to low blood sugar, exercise, excitement and all sorts of emotions like fright/fear, crying and laughter. And at other times, I am extremely sensitive to my insulin and am ‘low’ for hours on end and have a hard time bringing my BS up. Frustratingly, sometimes blood sugar control seems impossible, as if it’s influenced by the weather or color of socks I’m wearing – there seems to be no rhyme-nor-reason to it. Unfortunately, even though it may only take a few hours for the blood sugar to ‘get back under control’ with either insulin (for ‘highs’), or sugar (for ‘lows’), it takes many hours for the cells in the body (and the emotions) to get back into balance.

It’s easy to get wrapped up with the severity of diabetes. But it’s a part of life, just like joy, laughter and friends.

Life with diabetes is a true seesaw. High and low blood sugars happen. It’s part of living with the disease.  If you have diabetes, or know someone with diabetes, please be patient, and be present. We all have ‘one of those days’ occasionally; unfortunately, for someone living with diabetes, ‘those days’ happen almost every day.

Please help me explain what it feels like for you – whether you’ve got diabetes, or are part of the community that knows and supports someone with diabetes. ~h

As I was wrapping each piece to get ready for the show, I realized how unique each one was.  Some were thin, others heavy and clunky.  There were different shapes and heights and weights, even when I had tried to make a matched set.   Some people commented, and I told them that when I pick up a piece, I can tell what my blood sugar was doing while I was throwing/creating it.  When my glucose levels are changing rapidly (either up or down), my coordination and balance are affected.  When my blood sugar is high, I can’t control my strength very well; and when it is going low, I have poor depth perception, no frustration tolerance, and it’s best if I quit for the day.

When people make remarks like, “You know, you could have made this thinner/taller/bigger…(etc),” I sigh, and try to remember that, considering all I’m dealing with, I’m doing the best I can – always.  And often times, people will choose to buy the piece we’re talking about, because their knowing the ‘history’ behind it makes “even more special”.

Oh, and how I missed Rainie!  Even though, legally, I could have brought her with me, I decided to leave her home since we were taking a seven-day cruise.  I’m glad I did.  Since Rainie is an energetic dog who loves to go on runs and chase after balls (and squirrels), she would have been miserable having no place to run free.  For exercise, she would have had to be on leash as I walked/jogged around the wooden “Navigation Deck” that encircled the ship (3 laps = 1 mile).  And since she gets anxious in crowds, she would not have done well-being surrounded by the throngs of other passengers (2,100 total) as we searched for dining tables and waited in line to get to the buffet.  Another concern of mine was that she would have been the only dog on a ship so large.  There would always be people wanting to reach for her, and no place for her to have ‘personal space’ outside our state-room.  I believe she was much happier going to ‘summer-camp’ at her foster-mom’s were there were other dogs, a pool, and lots of loving attention. Along with missing her constant companionship (I’ve grown accustomed to having her by my side, and didn’t know what to do with my free, unleashed, left hand) I especially missed Rainie for her blood sugar alerting!  I discovered I’ve lost almost all my ability to sense where my blood sugar is.  There were times when I’d do my blood sugar “just because it seemed like it was the right thing to do”, only to see numbers in the 30s and 40’s peering up at me from my meter.  How did that happen?  I felt fine!  I never have numbers like that with Rainie around – her alerting wouldn’t let me.  I had some pretty scary episodes on the trip.  I missed her so much!

Rainie aside, our trip was incredible!  The reason my husband and I chose this cruise was to participate in a photography workshop.  Rick ended up taking over 4,000 photos.  Thank goodness we don’t use film anymore.   We discovered that the grandeur of Alaska can only begin to be caught on film

As we traveled from Seattle toward Juneau, the weather was inclement and stormy (I had trouble getting my sea-legs, which was surprising since I used to be a sailor), but after that, the seas were relatively calm, and the sky mostly sunny.  We went whale watching in Juneau.  At one point, there were eight hump-back whales doing their whale-thing near us.  None of them breached, but there was plenty of tail slapping going on.  We were told that the whales were attracted to the captain of our boat (he was one of the original whale-watchers in the area).  We also saw our first bald eagles, stellar seals, and a glimpse of the Mendenhall Glacier.

Mount Fairweather

The day we slid into Glacier Bay was absolutely gorgeous.  The tranquil ice blue waters were stunning and reflected the beautiful mountains that surrounded is on all sides. It is a rare exception to see the great while pinnacles of frozen ice glistening in the sunshine.One of the naturalist onboard said that day was the first time in three years she‘d been able to see Mount Fairweather (named because you could only see it during fair weather).  We saw huge pieces of ice cleave away from the main glacier body, creating thunderous roaring crashes as they entered the water, followed by their ‘footprints’ of waves and ripples.  We were lucky because one of the ship’s pursers invited a small group of us to take photos from a high balcony that was designated for crew only.  It was a truly phenomenal day.

While visiting the town of Sitka, we hiked through the Tongas rainforest (where I would not have brought Rainie due to the wild bear population), and viewed a great collection of native totem poles.From there, we hiked to the Alaska Raptor Center where raptors (eagles, owls, falcons, etc.) are brought for rehabilitation when found hurt.  Here, the docents honored us by brining two owls and a bald eagle out of their enclosures so they could be photographed.  (This is generally unheard of, and would not have happened if Rainie were there).  The snowy owl was quite happy posing in its regal way, while the bald eagle wanted nothing to do with the paparazzi. Then came the highlight of the trip for me!  We were brought to “the Fortress of the Bear”, a sanctuary that takes orphaned or problem brown bears and prepares them for a “more positive future”.  The bears were huge!  (And, to me, loveable and so cuddly-looking.)  It was fun to watch them frolic, tease and play with each other, and pose for the camera.  After seeing the eagles at the raptor center, it was wondrous watching them dive into the bear arenas and snatch up the salmon that was being thrown for them, and the bears.  I wished we could have spent more time there – I’ve always had a ‘thing’ for bears.

We also went to Ketchikan, a quaint canning and tourist-oriented town, and visited Victoria, B.C. at night.  Both places have their charms and charisma. However, for me, the highlight of the trip is still the Fortress of the Bear; and that is a close second behind being home with Rainie.

If you’d like to see more photos, please go to my husband’s Flickr pager at:http://www.flickr.com/photos/rickfreeman00/sets/72157630832350612/ 

Rainie and Mike

This post isn’t about diabetes, or diabetes alert dogs.  This is a story about Rainie going to the beach on a foggy, 4th of July morning and lifting the spirits of a very sad yellow Lab named Mike.  His parents told us he was in deep mourning because his two ‘canine brothers’ had to be put to sleep – one was 12, and the other 13, and both of them failed within 4 days of each mother.  (Mike’s human mother was in tears relating the story.)

It was phenomenal to watch Rainie, although much younger and faster than Mike, run into the water after the stick, then proceed to push it toward Mike, and let him carry it back to shore.  His parents said he’d been unable to do anything but mope for the past 10 days.  Playing with Rainie was the first time he’d perked-up and shown any enthusiasm about life.

Rainie’s not invited

I’ve been mulling this issue over for a few days now, trying to make common sense of it all.  The problem isn’t that my diabetic alert dog, Rainie, is not invited to the wedding of a close family member.  (And, yes, I know that weddings are all about the bride and groom; and I’ve been warned that brides can be ‘funny’ about lots of different issues – especially about having a dog at their wedding.)  What is bothering me is that the bride (a nurse, like myself) has taken it upon herself to tell me exactly how to take care of my diabetes so that I don’t need Rainie at her ceremony.

The offending paragraph of our on-line conversation goes like this (the bride is typing and all names have been changed to protect those involved): “I realize it’s a service dog and not a pet. We are both nurses and both know symptoms of high/low blood sugars. I have many guests who are afraid of dogs and on top of that are diabetics and would freak out if she came near them and a few who have severe allergies. I don’t want to upset you, but this is ‘the groom’s’ and my day and we can’t accommodate her for many reasons including lack of space in our reception hall and others not listed. All of your medical needs will be accommodated as we will have doctors, nurses, and a fire station across the street in case of emergency. I’m sure if you check your blood sugar before the ceremony, it will be fine for 30 minutes as there will be drinks and appetizers immediately following that you will have access to and dinner following that.”

 Somehow, I don’t believe that the bride, who does not have diabetes, truly knows the symptoms of high/low blood sugar; while I, being a nurse and a diabetic living with hypoglycemic unawareness, intimately know the signs and symptoms of changing blood sugars, and often cannot feel when danger is near.

The issues of space, allergies and fears are something I don’t want to spend a lot of time on.  Having a certified service dog makes me very aware of other people’s needs.  This is why I’m not bringing Rainie.  The fact that the bride is somewhat fearful of larger dogs and prefers ‘pocket-pooches’ does not change the fact that I, as a handler of a certified medical alert dog, will do what I can to respect other individual’s physical and psychological safety.  And, as anyone who has been surprised when a service dog uncurls and appears from under a chair or table knows, the dogs are trained to be quiet, still, and very small upon command.

It is the last two sentences that discuss how my “medical needs will be accommodated” that truly upset me.  Having never needed emergency help for my diabetes in the 53 years before I had Rainie, nor the two years afterword, I feel that her statement is very condescending presumptuous and impudent.   No one at the wedding will ever know I have diabetes, since Rainie won’t be with me.  I understand the bride has been planning ‘the big day’ in her mind since she was a young child, wanting everything to be perfect and totally on her.  I would prefer had she just told me that Rainie is not invited, and left control of my life with regards to my diabetes and her ‘perfect day’ to me.

And, if I should need to do my blood sugar during the ceremony, I will do so.  No one will ever know.

Rainie in the field

Oh, hallelujah, it worked!  Rainie’s timing couldn’t have been worse. During our Friday morning walk, she decided to enthusiastically roll in the spot where a skunk had freshly sprayed.  I was not happy!  Not only did I have to be at an appointment in less than an hour, I also had to go to a black-tie event the next day (which I was nervous about anyway).  Plus, my blood sugar was already low, on top of having to climb up our very steep driveway in order to  get home – with a very odoriferous dog.  This is what I get for living in the country.   I hurriedly huffed and puffed my way up the hill, put her in the shower-stall, and took care of my blood sugar.  Then I made up “the mixture”  (the recipe follows).  Fortunately, it worked!  I made it to the appointment with a non-smelly, slightly damp dog; and no one in their tuxedos or fine evening-wear had any notion of why she was so soft and silky.  I just smiled, and breathed a sigh of relief.

• Skunk Out
• 1 qt. 3% Hydrogen Peroxide  (Must be brand new!)
• 1/3 cup Baking Soda
• 1 T Liquid Dish Soap (Dawn)
• Mix all ingredients and sponge directly into animal’s coat.  Do not rinse your animal first.  This must be the first thing applied to the coat.
• Let sit for at least 5 minutes
• Rinse well.
• Avoid getting in eyes!

Hilary the potter

Sigh… I’m feeling rather behind the times when it comes to the computer and the internet.  Last night my husband showed me how to “Google” someone, so this morning I decided to see what happens when I “Google” myself.  First, I typed in my name into the search bar, and up popped another woman who shares my name (with the exact spelling).  However, I did not discover me – I am not a journalist, nor am I a novelist.  And the photo certainly does not look like me.  Then I decided to submit my name and town into the search engine.   This is what is posted about me (from a few weeks ago):

http://www.firstfridaysantacruz.com/2012/04/capitola-reef-script-craft-hilary-freeman/

I hadn’t realized that my pottery and my mission to support EAC had already been discovered by the world-wide-web!

Rainie – one of the stabilizing factors in my life!

Today is day 3 of the Diabetes Blog Week, and the question of the day is, “What is one thing you would tell someone who doesn’t have diabetes about living with diabetes?”  I’m going to repost this blog I wrote a couple of weeks ago in response to a question that each of us with diabetes has been asked.  (Being a nurse, I’m asked it professionally as well as socially.)  The question is, “What does it feel like?”

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Sometimes Rainie’s nose amazes me! I was driving past the kids’ playground to get to the part of the park we hike in every morning when Rainie uncurled from the floorboards, and frantically began smelling the wind coming through the open window. She was obviously in some distress, so I pulled into the parking lot, leashed her, and let her out. She immediately led me to the play area, and began alerting on a little girl who was running up the slide with a pink pump clipped to the back of her pants. Little pink-sweatered arms soon encircled Rainie, as I talked to “Emma’s” mom. Yes, her blood sugar was low (65), after having refused to eat breakfast. As Emma’s mom and I talked, she mused, “I wonder what it feels like for her when she goes high and low?”

This is a question I’m often asked, “What does it feel like?” It’s taken me a long time to figure out how to explain the answer . I’ll try to describe how it feels to me. (Please remember that I’m describing this as an adult diabetic. When I was young, I had the same feelings, but no words to describe them with.) And as I describe the differences between ‘low’ and ‘high’ blood sugar, please realize that a diabetic often fluctuates between the two states many times a day due to the nature of diabetes.

Low blood sugar, or hypoglycemia, might be fun if it weren’t so scary and disorienting. Hypoglycemia is potentially life threatening because the brain’s only fuel-source is sugar, and with too little sugar, the brain cannot function properly. Therefore, most of the sensations of low blood sugar are brain-based.

If my blood sugar (BS) is dropping slowly, the symptoms may be unnoticeable at first and slowly become stronger;  and if my BS is falling rapidly, I catch the symptoms as soon as I can. The first symptoms tend to be a general ‘fuzziness or blurriness’ in my thinking and perception. It is very easy to not even realize anything is wrong, and slowly become agitated and frustrated because ‘things just aren’t right’. I may also get very cranky or whiny.  One of  the most aggravating symptom of low blood sugar is frustration.  I like to describe it by saying, “On a scale of ‘one-to-ten’ my frustration tolerance is ‘a negative-three’.”  It gets in my way of dealing with every aspect of life, including my ability to make decisions that involve taking care of myself.  Everything becomes annoying – kids, traffic, choices, loved-ones (and others), work, my low blood sugar alert dog, etc.  I often figure out my blood sugar is falling because I’m so easily frustrated.  Living in this frustrated state is especially infuriating on those days when my body is extremely sensitive to my insulin, so I’m dealing with low-blood sugars for many hours at a time.  These periods of insulin sensitivity often happen for no reason I’m award of, and cannot be planned for or avoided.  When they do happen, it’s difficult to be patient while taking care of myself, and dealing with others.  I can only imagine what it is like for other people having to be around me!

As my BS continues to drop, my thoughts and reflexes get slower and slower, and it becomes more difficult to understand conversations and new ideas. I may also make relatively impulsive decisions. These are the times I’m glad I have my low blood sugar alert dog, Rainie. Her alerts keep me from doing things (like driving) when I’m still feeling ok, but could easily put myself, or others, in danger. (I am not drunk – although I may look that way.)

As the blood sugar continues dropping, I become physically unstable, emotionally fragile, and easily overwhelmed. I become dizzy, clumsy, disoriented, teary, easily confused, and unable to make up my mind (which is really bad because it means I can’t even decide what I want to eat in order to correct the situation). Even though my lips and fingertips may be numb and my vision may be blurry from the low BS, I get angry when people begin to question me and offer help. And I need help! And at the same time, I’m somehow unable to take care of myself. And I’m scared!

If things were to continue, there is a good possibility I would become unconscious, go into ‘shock’, and, in the worst-case scenario, die.

The symptoms of high blood sugar, or hyperglycemia, are much more physical than low BS’s are. The first thing I notice is a deep headache. Then I get thirsty and agitated – very ‘squirmy’ and unable to concentrate and be still. I crave water to try to dilute my sugary/syrupy blood. I’ve noticed my tongue feels like it’s a dry cotton-ball sometimes. Then, my body begins to ache. Every part of me feels toxic, as if I’ve got the achiness of the flu. I don’t want to move because it feels ‘too hard’ – like walking through mud. And my brain feels that way too. Sometimes I just want to curl up in a dark, cool room and not move. If my BS gets high enough that I begin to ‘spill ketones’, I can get very nauseated and vomit. High ketones are poison to the brain. I’m also very sensitive to the fact that a few hours after high BS begins, my vision gets blurry because the sugar in the blood makes the lenses of the eyes swell.

High blood sugars can be very stubborn and not respond to extra insulin the way low blood sugars respond quickly to sugar. Often, with high BS, the body is resistant to the insulin because of adrenaline released as a protective mechanism by the liver. This can happen as a response to low blood sugar, exercise, excitement and all sorts of emotions like fright/fear, crying and laughter. And at other times, I am extremely sensitive to my insulin and am ‘low’ for hours on end and have a hard time bringing my BS up. Frustratingly, sometimes blood sugar control seems impossible, as if it’s influenced by the weather or color of socks I’m wearing – there seems to be no rhyme-nor-reason to it.

Unfortunately, even though it may only take a few hours for the blood sugar to ‘get back under control’ with either insulin (for ‘highs’), or sugar (for ‘lows’), it takes many hours for the cells in the body (and the emotions) to get back into balance.

It’s easy to get wrapped up with the severity of diabetes. But it’s a part of life, just like joy, laughter and friends.

Life with diabetes is a true seesaw. High and low blood sugars happen. It’s part of living with the disease.  If you have diabetes, or know someone with diabetes, please be patient, and be present. We all have ‘one of those days’ occasionally; unfortunately, for someone living with diabetes, ‘those days’ happen almost every day.

Rainie - one of the stabilizing factors in my life!

This is a question I’m often asked, “What does it feel like?” It’s taken me a long time to figure out the answer to that. I’ll try to describe how it feels to me. (Please remember that I’m describing this as an adult diabetic. When I was young, I had the same feelings, but no words to describe them with.) And as I describe the differences between ‘low’ and ‘high’ blood sugar, please realize that a diabetic often fluctuates between the two states many times a day due to the nature of diabetes.

Low blood sugar, or hypoglycemia, might be fun if it weren’t so scary and disorienting. Hypoglycemia is potentially life threatening because the brain’s only fuel-source is sugar, and with too little sugar, the brain cannot function properly. Therefore, most of the sensations of low blood sugar are brain-based.

If my blood sugar (BS) is dropping slowly, the symptoms may be unnoticeable at first and slowly become stronger; if my BS is falling rapidly, I catch the symptoms as soon as I can. The first symptoms tend to be a general ‘fuzziness or blurriness’ in my thinking and perception. It is very easy to not even realize anything is wrong, and slowly become agitated and frustrated because ‘things just aren’t right’. I may also get very cranky or whiny.

As my BS continues to drop, my thoughts and reflexes get slower and slower, and it becomes more difficult to understand conversations and new ideas. I may also make relatively impulsive decisions. These are the times I’m glad I have my low blood sugar alert dog, Rainie. Her alerts keep me from doing things (like driving) when I’m still feeling ok, but could easily put myself, or others, in danger. (I am not drunk – although I may look that way.)

As the blood sugar continues dropping, I become physically unstable, emotionally fragile, and easily overwhelmed. I become dizzy, clumsy, disoriented, teary, easily confused, and unable to make up my mind (which is really bad because it means I can’t even decide what I want to eat in order to correct the situation). Even though my lips and fingertips may be numb and my vision may be blurry from the low BS, I get angry when people begin to question me and offer help. And I need help! And at the same time, I’m somehow unable to take care of myself. And I’m scared!

If things were to continue, there is a good possibility I would become unconscious, go into ‘shock’, and, in the worst-case scenario, die.

The symptoms of high blood sugar, or hyperglycemia, are much more physical than low BS’s are. The first thing I notice is a deep headache. Then I get thirsty and agitated – very ‘squirmy’ and unable to concentrate and be still. I crave water to try to dilute my sugary/syrupy blood. I’ve noticed my tongue feels like it’s a dry cotton-ball sometimes. Then, my body begins to ache. Every part of me feels toxic, as if I’ve got the achiness of the flu. I don’t want to move because it feels ‘too hard’ – like walking through mud. And my brain feels that way too. Sometimes I just want to curl up in a dark, cool room and not move. If my BS gets high enough that I begin to ‘spill ketones’, I can get very nauseated and vomit. High ketones are poison to the brain. I’m also very sensitive to the fact that a few hours after high BS begins, my vision gets blurry because the sugar in the blood makes the lenses of the eyes swell.

High blood sugars can be very stubborn and not respond to extra insulin the way low blood sugars respond quickly to sugar. Often, with high BS, the body is resistant to the insulin because of adrenaline released as a protective mechanism by the liver. This can happen as a response to low blood sugar, exercise, excitement and all sorts of emotions like fright/fear, crying and laughter. And at other times, I am extremely sensitive to my insulin and am ‘low’ for hours on end and have a hard time bringing my BS up. Frustratingly, sometimes blood sugar control seems impossible, as if it’s influenced by the weather or color of socks I’m wearing – there seems to be no rhyme-nor-reason to it.

Unfortunately, even though it may only take a few hours for the blood sugar to ‘get back under control’ with either insulin (for ‘highs’), or sugar (for ‘lows’), it takes many hours for the cells in the body (and the emotions) to get back into balance.

It's easy to get wrapped up with the severity of diabetes. But it's a part of life, just like joy, laughter and friends.

Life with diabetes is a true seesaw. High and low blood sugars happen. It’s part of living with diabetes. If you have diabetes, or know someone with diabetes, please be patient, and be present. We all have ‘one of those days’ occasionally; unfortunately, for someone living with diabetes, ‘those days’ happen almost every day.

Please see my next entry, “An Addendum”. I go on to explain a few characteristics of low blood sugar that I forgot to mention here.

It isn’t about the dog.

Rainie and Molly at the Beach

One firefighter asked, “Has she ever saved your life?” I think she may have, at least once. The most incredible alert she ever gave me happened when she and I were walking on the beach with Rainie’s friend, Molly, and my friend, Sally. We had been walking for about 40 minutes when Rainie came and started dancing around me. Usually she alerts by nudging my hand first, then does her dance later. I was feeling fine, but did my blood sugar anyway. The reading was 135 – perfectly normal, so we kept walking. But Rainie wouldn’t stop her dancing and jumping. We had only gone about 5 minutes further when Sally said that I’d better test again since Rainie was trying to tell me something. Still, I was feeling fine, but Rainie was going crazy! We stopped, and I tested. The meter read 84. Usually his number would be all right if I weren’t walking; and I was dropping way too fast – 41 points in about 5 minutes! Way too fast! I reached into my pocket for some glucose or some sort of candy, but all of my pockets were empty. I asked Sally if she had anything to eat, but she didn’t. I told her we needed to turn around and get back to the car. I was still feeling ok, but I knew this was not a good situation. On the way to the car, I asked every person we met if they had some candy, but no one did. When we got to the car (where we couldn’t find my glucose bottle either), my blood sugar tested at 31. This is dangerously low! Now I was feeling shaky and was wet with perspiration. Sally quickly drove to the nearest store while I kept talking the whole time. When we got there, my meter read “low”, (too low to read). I don’t even remember what she bought me to drink; but I do remember that Rainie stayed in my lap, licking my face, and possibly keeping me from going unconscious.

One of the rights of having a service dog is that I may legally bring her anywhere that is open to the public. About the only places that a service dog cannot go are operating rooms, into the kitchens of public restaurants, ICUs, and CCUs. Rainie, and dogs like her, have no legal rights to enter a private home or church without permission, either.

However, there are times when I’ve found that even though I can bring Rainie with me, it may be best if I didn’t. In other words, I need to use my best judgment. I think I did this today. I guess I could have left her at home, but we would have been gone too long for me to be comfortable with that. Also, I’ve never left her home alone since I’ve had her. Once I have left her with my daughter to dog-sit when I went to a movie about a zoo. I’d heard there would be lots of roaring lions, and this would probably upset her. And since Rainie isn’t the best at movies to begin with, I decided to go by myself. Another issue is that in the theater there is really no easy way to distract her (although the stuff spilled on the floor does a pretty good job by itself). I couldn’t bring a chew bone because it would roll down to the next tier. So I left her with my daughter.

There was one particular situation I found that a ‘distracter’ didn’t work, and bringing Rainie did not work for me: this was when I took water aerobics classes. Rainie is welcome in the gym. She stays with me in the locker room, and sits outside the stall while I shower. The gym even installed a special hook for me to leash Rainie to right next to the pool and behind where I stood while in the pool. The problem is that when I exercise strenuously, my blood sugar falls rapidly, so Rainie is alerting all the time. She’d sit next to the pool, and paw toward me, or whimper for my attention. All of these are good, except that I was prepared for the changes, and knew it was part of my exercise routine. I decided to try to distract her. It was suggested that I fill a ‘kong’ (a hard, roundish, hollow, rubber toy) with peanut-butter, freeze it, and give it to her while I was exercising. I tried it and it worked really well – once. The second time I tried the trick, it did not go so well. I had settled Rainie and given her the kong. We were in the middle of class when another class member cried out, “Agh! What’s that in the pool?!” I looked to see a large, black, peanut-butter filled blob (the kong) bobbing on the bottom of the pool; and Rainie, leashed behind me, pulling as tight as she could against her tether, with her toes gripping the side of the pool, trying to jump in and retrieve it. Needless to say, I never did that again. In fact, I don’t practice water-aerobics anymore.

The moral of the story is: Despite what the law states, it is always best to use your best judgment.

At one point, as I was describing how Rainie alerts me when my blood sugar is falling or rising rapidly, what it looks like, and why it is important for me that she does it, someone asked if every alert is important and life-saving? I responded saying, “No. Every alert does not mean that I’m in true danger. The alerts mean that I need to pay attention to myself – that I need to pay attention to my blood sugar.” This is the same response I’ve given to that question in the past.

But, since those classes, I’ve been thinking about a lot about that answer and the section where I said, “I need to pay attention to myself.” I’ve realized that, until now, Rainie’s alerting me has brought about a stimulus-response reaction in me. She’d alert and I would do my blood sugar, reward Rainie, check my pump or need for food, and calculate what sort of correction I needed to do. I’m realizing that this is not what ‘taking care of myself’ means. There is so much more to taking care of any body, and especially one with diabetes. What is my mood? How much stress am I in? Could I use some exercise, to laugh or cry, or take some time out? When did I last eat, and what was it? Do I feel like I’m getting sick? Or, am I bored and want to go play? All of these things affect my body and influence my blood sugar control. And Rainie is attuned to these, and more. Sometimes I’ll realize she’s led me to a place to sit down, or blocked my path so I don’t walk into someone or something. She senses people who are approaching and will lead me around them, or encourage me to interact. I’ve been surprised when she tries to take me to the other side of the street, only to realize that some ‘gang-members’ were approaching on the side we had been on. And my favorite is when she beacons me outside by catching my eye and flicking her head to follow her outside. There she’ll sit next to me on the step so we can watch the birds. I love watching the birds. She senses so much more than just my blood sugar. I need to pay more attention to Rainie, and myself.

While we were at the school, Rainie was a model service dog, curling up at my feet, and walking up and down the aisles, letting the students pet her as she went. At one point, she stopped, stared and sat-up in front of one particular young woman. Rainie was exhibiting her typical ‘alerting behavior’, and the girl seemed extremely knowledgeable about the technicalities of diabetes. Having not asked the classes whether anyone had diabetes, I can’t help but wonder whether she has diabetes. I will probably never know.

Finally, I thought she’d settled down, when I felt a gentle paw on my lap. She was alerting me. I remembered she’d alerted me at home after lunch, and my blood sugar was a little high (180). I wasn’t worried then because I had just eaten. But I was surprised when she alerted again so soon. So, in the dark with the help of a flashlight, I tested my blood sugar. It was much higher (260). I gave myself some corrective insulin, and decided to wait – but Rainie wouldn’t let me wait, nor would she settle down. She kept pawing at me, and soon she was in my lap. I tested again and discovered my BS was in the mid-300s. Way too high for me! I was feeling sort-of panicky, so with the help of my trusty flashlight, I pulled out my pump’s cannula. Wow! I found that when I’d replaced my pump site in the late morning, the cannula had crimped against my skin and I hadn’t gotten any insulin for the past few hours. Rainie had alerted me to my blood sugar rising and her alerts intensified as my blood sugar became way too high.

I still don’t know how the movie ends…

Rainie was not specifically taught to alert me when my blood sugar is high – she taught this to herself. When she does alert on my rising blood sugar, she alerts well before ketoacidosis sets in, so she’s not alerting on the fruity smell that ketones produce. I’m not sure that science knows exactly what the dogs are smelling/sensing when they alert to highs. Rainie’s alert for ‘highs’ is different than her alerts for ‘lows’ because she is very nervous when I’m high.

Here is Early Alert Canines‘ definition of what a diabetic alert dog is and what they are trained to do: “Diabetic alert dogs” are trained to be able to recognize the biochemical scent that a diabetic’s body gives off as his or her blood glucose begins to change. These dogs learn that the biochemical scent is a command to the dogs for them to carry out an “alert” action–which means that their diabetic partners can receive an early warning to help them avoid acutely dangerous hypoglycemia (low blood sugar), and curb damaging hyperglycemia (high blood sugar).

Because hypoglycemia can cause acute and severe problems (including coma and death), and because hyperglycemia can contribute to long-term diabetes complications, it is imperative for a diabetic to receive early warnings, which allow them to verify their blood glucose levels and treat themselves according to current consumer technology as advised by their physician.

All day I’ve been musing, wondering, how often do we have the chance to possibly save someone’s life?

Not long after Halloween, I was walking my dog when a little boy named Jason came running with his cape flying behind him as he swung his light-saber from side to side. He was yelling, “Hey! Is that a Ewok?” I laughed and introduced him to my golden retriever named Rainie. He wanted to know why she had a red jacket on. As I explained to Jason and his mom that Rainie is a diabetic alert dog and that she notifies me when my blood sugar is dropping rapidly, his mom began to cry — Jason had just been released from the hospital after being found unconscious due to low blood sugar. As we were talking, Jason looked up at me, with his arms around Rainie’s neck, and said, “If I had a dog like Rainie, she would keep me safe – just like my light-saber.”

(I will refer to this story in my next post.)

Saying "Hi" to a Friend

Today we went to the local ‘biggest-box’ store called Costco. On our way into the store we were greeted by, “Here comes Rainbow! Rainbow! Look, there’s Rainbow!” The person sharing those joyous exclamations was a ‘regular’ from the farmers’ market. And while browsing the book section, a little voice behind us broadcast, “Look Mommy! There’s Rainie from the library!”

One thing I’ve learned quickly since having Rainie is there’s no such thing as anonymity!

Daisies at the Farmers' Market

We got to the farmers’ market earlier than usual, so the regular crowd wasn’t there. However, a ‘Daisy Troop’ was out really early to sell their cookies, and ask lots of questions about Rainie. Here are just a few:

“What is an Early Alert Canine?” I told them that she is a service dog that helps me with a medical condition called diabetes.

“I have a friend who’s 5 with diabetes. Can she get a dog like this one?” I told her that Early Alert Canines trains and gives the dogs to children and adults who are diabetic and have to take insulin.

“She’s got a pump. Is that the same thing?” Answer – Yes. That’s one way she can get her insulin.

“How much do they cost?” (Leave it to a child to ask this question so tactfully.) I explained how EAC doesn’t charge anything for the dogs.

“You mean they’re FREE! Can I get one?” She was so earnest. I explained that dogs like Rainie are specially trained for people with diabetes and that I hoped she would stay healthy and gets a pet dog someday.

At this point, one of the moms stepped in and stopped the conversation – they had customers.

As usual, I was dozing on the table with Rainie nestled on the floor below me. Suddenly, I was aroused by Rainie leading Holly, my acupuncturist, back into my room. Apparently I had fallen completely asleep and Rainie had gone to find Holly down the hallway in another patient’s room to ‘alert’ her that I needed help. My blood sugar was falling very quickly – it went from 85 when I was woken up, to 60 a few moments later.

What is amazing is that Rainie had only been in that office twice before, and had met Holly exactly that many times. How did Rainie know to go and get her? I’ll never know how or why she does some of the things she does. Life with a diabetic alert dog is full of surprises!

Rainie's First Day Home

This reminds me of my training and all the "firsts" that Rainie and I have had. Initially there was a week of classroom training where we were introduced to topics such as dog behavior, the basics of handling a dog in public, and dog first aid, as well as learning what an alert may look like, and how to reward the dog when they do alert. And finally, toward the end of the week we were finally matched with the dog we’d each go home with (in my case, this was Rainie). The second week we spent actually going out in public under the trainers’ watchful eyes, where we got to get used to actually dealing with a dog in public places such as restaurants, parks, shopping, pubic transit, etc. It was all very exciting!

However, the most amazing things began to happen over time as Rainie and I got to know each other, and as we began, experiencing our ‘first alerts’. The first one she gave me (while we were not in the classroom) was when she poked her head through the shower curtain as I was showering at the hotel. What a joy and surprise! And from there, the list of ‘firsts’ go on: in a restaurant, on a walk, while shopping, at a movie, in every room of the house, while working in the garden, on an airplane, while giving a lecture on what a diabetic alert dog is, etc.,etc. The list continues to grow…

I truly wish the best for the new teams that begin their training today! Their lives will never be the same.

Our normal routine on Saturday mornings involves going to the local farmers’ market where Rainie is usually enthusiastically greeted my many of the vendors and some of the ‘regulars’.  Since Rainie is a service dog, she is allowed here, as opposed to pet dogs which are forbidden.  As I mentioned earlier, Rainie is a huge attention getter.  And with that, comes a lot of questions about what she does and how she does it.  Here are a few that were asked today:

(Before I begin, I want to emphasize that everything I write in this blog I write from personal experience with Rainie and from my life as a diabetic, while also referring to Early Alert Canines‘ beliefs and offerings as a diabetic alert dog training program.  Thank you.)

What is a Diabetic Alert Dog?  (Also asked as: What is an Early Alert Canine?)

An Early Alert Canine is a medical alert service dog that has been intensively trained to smell changes in blood sugar levels and alert its partner at the onset of a drop in order to avoid a potentially dangerous hypoglycemic episode or low blood sugar event.  Other names for dogs that alert on blood sugar are: “diabetic alert dogs”, “low blood sugar alert dogs” and “hypoglycemic alert dogs”.

How Do They Do It?

The dogs are trained to identify the smell that is created when a person’s blood sugar drops rapidly.  This odor is strongest on the breath, and is also produced by the skin.  The quick changes in blood sugar usually happen when there is too much insulin in a diabetic’s body.  The dogs are trained to ‘alert’ the diabetic, or caretaker or parent, when the dogs detect this odor.  At Early Alert Canines (EAC) they are taught to alert by picking up a strap of webbing that hangs off their collar (this is called a ‘bringsel’) and touching the person.  One of the goals is for the dog to wake up the person if they are asleep and the blood sugar is dropping rapidly.

Who Can Get A Diabetic Alert Dog?

EAC places dogs with insulin dependent diabetics who have been taking insulin for at least one year.  We train two classification of diabetic alert dogs: service dogs with public access rights are given to adults and children 12 years of age or older. For younger children, and those wishing for only in-house alerting, we train skilled companions.  In a household with a young diabetic child, the dog is trained to smell the changes in blood sugar of the child, and alert the parent/caretaker.  These dogs are invaluable for nighttime and playtime monitoring.

How Long Does It Take To Train One?

Since EAC usually gets the dogs when they are at least a year old and after they have been behavior trained, it generally takes about six months to scent train the dog and have them ready for placement with their human partner.

…And then there’s always the question: Can I touch or pet her?  If the time is right and there aren’t too many people around, I’ll usually say, “Thank you for asking. Yes, you may.”  But if the time isn’t good or it’s too busy, or if I’m too busy,  I’ll say, “Not right now.  She’s working.”  Rainie has a way of playing ‘hide and go seek’ with little kids.  She seems to love it, and the kids laugh when she kisses them.