Brianna and Rosie
Like any person with type 1 diabetes, Brianna Carr experiences quick changes in her blood sugar levels.
The otherwise healthy, active 12 year old has her parents, Brad and Heather, and her medical team to help monitor her illness. She also has Rosie, a yellow Labrador retriever trained to recognize and alert others whenever Brianna's blood sugar becomes too high or too low.
Rosie joined the Loudonville, Ohio, family 2 years ago and is an integral part of Brianna's life, accompanying her to school, church and on outings with friends. She is seldom more than an inch or 2 away from Brianna and is especially clued into subtle changes in her scent.
"Rosie gives us an extra set of eyes - in this case, an extra nose - to watch over Brianna and let us know everything is okay," said Brad. "She is a working dog - on the go with Brianna all day and at her bedside through the night."
Brianna was diagnosed with type 1 diabetes in January 2007 at age 5. It was a surprise for all as there was no family history.
After spending 3 days at Akron Children's Hospital, where Brianna and her parents received their initial diabetes education, life returned to a new normal.
In search of a service dog
Brad had heard about service dogs for diabetes and began doing Internet research. He quickly learned taking on a service dog is a very expensive proposition. He was also warned to watch out for less-then-reputable organizations in the business of training and selling medical service dogs.
"We heard very good things about the organization Canine Hope for Diabetics
, based in southern California," Brad said. "After talking to founder and trainer, Crystal Cockroft, and Johanna Reynolds, who has type 1 diabetes, about their program, we began the application process."
Rosie cost about $7,500 but the family's out-of-pocket expenses, including several trips to California for training, are closer to $25,000.
"Thankfully, we live in a very wonderful community where churches, scouting troops, schools, the Lions Club and many individual friends and neighbors contributed to our fundraising effort," Brad said.
Scent imprint training began when Rosie was just days old with the goal of having her distinguish chemical changes that happen when Brianna's blood sugar goes high (a sweet scent) or low (a metallic scent).
"We use saliva samples as we have found saliva carries the scent for use in training," said Cockroft. "However, no one has been able to scientifically figure out exactly what the dogs smell."
Even before they met Rosie, the Carrs would send Crystal and Johanna cotton rolls swabbed with Brianna's saliva, frozen and shipped overnight with dry ice.
Trainers gave Rosie positive reinforcement when Rosie would use a specific fetch toy to get attention in response to a scent cue. A low blood sugar level is more dangerous and Rosie knows this requires more urgency.
"Trainers call this controlled disobedience," said Brad. "Rosie may need to even jump on me. She basically is saying, 'Hey, I need your attention.'"
After Brianna and her parents completed their training with Rosie in California, they brought their 15-month-old service dog home.
Brianna is the oldest of 3 children. Her younger brothers are Gavin and Braden.
While Rosie doesn't replace other monitoring tools - Brianna still wears an insulin pump and a continuous glucose monitor and has 16 to 18 finger pricks a day - Brad believes she has helped Brianna avert ER visits, hospitalizations and what may have become life-threatening episodes of diabetic ketoacidosis
She has even helped catch strep throat and other illnesses in their early stages.
In one of the family's most remarkable stories, Rosie did not, for a change, accompany Brianna down the street to a friend's house. But she still sensed something was amiss and alerted Heather.
After rushing to check on Brianna, it was clear Rosie's instinct was spot on and Brianna's blood sugar was dangerously low.
"This is an exceptional family very dedicated to 24-hours-a-day training and Rosie is an exceptional dog," said Dr. Cydney Fenton, director of Akron Children's Center for Diabetes and Endocrinology
. "Brianna and Rosie came to our annual diabetes camp this summer and Rosie alerted Brianna to a high in her blood sugar shortly upon arrival. The fact that there were at least 30 other children with type 1 diabetes in the immediate vicinity did not confuse or distract her."
Dr. Fenton estimates about 6 out of 1,300 of Akron Children's patients with type 1 diabetes have service dogs.
"They are not for everyone," Dr. Fenton said. "They are expensive and you really have to be committed to ongoing training. I think Brianna is an especially good candidate for a service dog because some kids, more than others, have more difficulty noticing changes in their blood sugar levels."
Symptoms typically associated with drops in blood sugar include shaking, feeling irritable, turning pale, feeling confused or hungry, or an increased heart rate.
There's increasing evidence that whatever type 1 diabetics can do to avoid drastic swings in their blood sugar can positively impact their health long term.
According to Dr. Fenton, research shows that careful management of blood glucose, especially through the A1C test which measures average blood glucose over 3 months, can help protect the body's organs and systems, particularly the eyes, kidneys, finger and toes which are at most risk for diabetics.
"Brianna and Rosie have many good years ahead of them," Dr. Fenton said. "I am going to enjoy watching the relationship change and grow as Brianna enters her teen years and high school."