Dog Talk with Early Alert Canines


Ever wonder what it’s like to have your best friend tell you when you’re running high or low with just a nudge? Dogs are incredible animals, bred to bond with humans and born with a keen sense of smell; they’re capable of aiding us in more than companionship. The average dog’s sense of smell is tens of thousands times stronger than ours, which means they can alert to us the presence of anything from drugs to changes in the breath of someone who has type 1 diabetes. But are all dogs capable of being a walking, barking continuous glucose monitor (CGM)? How accurate are they really? And how are they trained to perform these incredible services for humans?

Beyond Type 1 wanted to know more about theses Diabetic Alert Dogs (DADs) and how they’re changing the way the type 1 diabetes (T1D) community is looking at diabetes management. Chatting with Service Dog Trainer Erica Horn from Early Alert Canines, a non-profit that trains service dogs to be Diabetic Alert Dogs (DADs) and then gives them to clients in the California and Oregon area, we learned what it takes to wear that red vest. In the five years the organization has been in operation, they’ve successfully placed 36 dogs. This is what dog lover and type 1 diabetic Erica Horn had to say about their work and their canine pals who make it all possible.

BT1: How do you select the dogs to be trained? Is there a breed that is preferred? Can any dog be trained?

EH: While any breed of dog can be taught to detect changes in blood glucose levels, some breeds are easier to train than others, such as labs and golden retrievers. I only have experience with these breeds. We tend to like dogs who have more tenacity, (that trait might not work for someone who is a Guide Dog or Mobility Assistance Dog). We train dogs to take initiative and get into our space in order to alert for low or high blood sugar. We want dogs that won’t give up. We don’t breed our own dogs. Our dogs are donated to us from Canine Companions for Independence and Guide Dogs for the Blind.

We accept career change dogs. For whatever reason they haven’t been able to carry out a required task for a different service. Maybe they went through training but were slightly distracted by other dogs in public, so they can’t be a Guide Dog for the blind but could be a DAD still. The other organizations screen for us and we go check out the dog. We really appreciate it and the dogs still get a chance to be a service dog. We stay in contact with the puppy parents as well and put them in contact with the client. They are usually really excited that their dog gets to be a service dog still and they usually come to their graduation.

BT1: So it’s kind of like a big family network?

EH: Absolutely. Sometimes puppy parents didn’t know that their dogs could do this special skill and they are so thrilled to see them helping others. It’s kind of magical really.

BT1: What goes into training a canine? How long does it typically take?

EH: The nice thing about getting dogs from other parenting service dog organizations is that they are trained a lot. These dogs typically spend 12-18 months with a puppy raiser where they are socialized to the human world, so we get the dogs that are very comfortable being in public and we just train them to alert for blood glucose levels (BGLs). Usually it takes four to six months. It takes one month, (two months max), to be able to recognize BGLs. And then volunteer foster parents who have type 1 train them in the home one to two months. Typically we have two classes a year and that’s where we match our clients.

BT1: What must a dog complete in order to pass? Is there a top five skill list for example?

EH: We are looking for a dog that’s treat motivated. That’s the most important. They alert based on the motivation of receiving food. Overall, they need to be well-behaved in public too. We train Full-access Service Dogs (that can go anywhere) and Skilled Companions, (those will be trained to be with families with type 1 children under 12). The Full-access Service Dog is for adults and the Skilled Companion is for a child who might not test, so the dog is trained to alert the parent instead. If we have dogs that are great but maybe not comfortable walking in say, downtown san Francisco, we train them as a Skilled Companion. We are one of the only organizations that will place service dogs under 12, and we think that’s special. Children can have more volatile numbers so it can be harder to keep their BGLs in range.

BT1: How do you pair the client with the dog?

EH: We do a lot of matching. We have an application process, and ask specific questions about their lifestyle and family. Then we think of what dogs we have trained that are available. It takes about a year to 16 months. We have dogs that are more active and others, more reserved. If you have a couch potato family, you don’t put an active dog with them, for example. We usually have an orientation before placement. It helps to see the client and dog interact in person, because it can make a difference. We sometimes move things around based on these interactions. There’s still a learning curve, but it’s rare that a placement doesn’t work because of matching. Most people who apply have thought about this for awhile. Watching the growth of the dogs and then the connection they form to the clients through training is exciting to see.

BT1: It must be immensely rewarding to pair people with dogs who better their lives.

EH: It can be a little bit of an emotional roller coaster. I get to know the dogs pretty well. And as a type 1 diabetic, they alert on me, so sometimes it’s hard to let them go when their ready. Usually there are a lot of learning curves when there are a lot of type 1 diabetics in the orientation room. The first couple days, the dogs stare at me, unaware they should be alerting for someone else. Eventually they start bonding with their person and move that focus. They figure it out; the dogs are resilient.

BT1: What are they smelling? How do they detect a high or low blood sugar and know the difference?

EH: That’s a really great question. We don’t know what the smell is exactly. We know it’s some type of cocktail our diabetic bodies give it off. They actually detect the movement of the BGL, not an actual number. They are typically 95 percent accurate. They’ll detect the movement faster than a CGM, often they alert before you get there because they’re smelling in real-time. Usually when I’m around 100 or lower, I start feeling off, but my dog will alert me at 130, 120. Also, it’s common for them to alert during meal times. Our alert is the dog pawing. They used to teach a sign for your number is raising and a different one for lowering. We found that some people with type 1 got lazy and didn’t test then since the dog was telling them. They would just eat glucose or give insulin based on the dog’s signaling, which isn’t safe! We thought it’d be better to give one sign that’s just for the detection of faster BGL movement.

And the dogs have to be persistent—they paw, then bark and keep at it if you’re not paying attention. If I don’t check fast enough, my DAD will go to my boyfriend and start alerting him. This is trained a little to alert whoever will listen because they expect food when they smell that smell and if they don’t get food, they try and get someone else’s attention. They are taught at a young age to be problem solvers and work with humans since they are already trained as service dogs. Early training is really important and makes my job a lot easier.

BT1: What does orientation look like between service dogs and the T1Ds who adopt them?

EH: Our Skilled Companions class is about one week and our Full-access class is two weeks. They go home with the dog and come back with it for classes. We also do a lot of field trips. We want them to feel comfortable going everywhere with that dog. We actually walk around the Ferry Building in San Francisco and have lunch there. It’s a lot more work because of the busy location. A lot of family members come as well and help out and get training too in the process. After they finish their training, we continue working with the client. We actually have them take charts and record their blood glucose (BG) numbers when the dog alerts, so we can make sure they are alerting.

Sometimes it takes a little tweaking. Maybe the dog doesn’t like to alert in the car, or maybe it’s the placement and they can’t reach the person in the back seat, so we find out why the dog may not be alerting. We won’t certify the dog until four out of five consecutive weeks the dog has alerted 80 percent of the time correctly. The dog must also have at least one sleeping alert (where it woke up the person) and one car alert. Then they can graduate.

Sometimes a dog will stop alerting as accurately and people they think it just needs brush up training, but the dog doesn’t forget its training. Being that they are living creatures, they can be affected by their environment or changes in your life. These changes such as the birth of a child, a recent move or even job loss, can make them uncomfortable and be a cause for alert cessation. They are trained to be sensitive so maybe they wait to alert you when you’re upset or stressed. If someone says the alerting has become less accurate, I always start by asking what has changed since they stopped alerting.

BT1: Do you name the dogs for training?

EH: They come with names from the previous service dog organizations and it’s easier to keep them since the dog recognizes that name. We may tweak their names if we have more than one with the same name though.

BT1: How are you funded? What does a person with type 1 have to pay in order to get a DAD from you?

EH: We are completely funded by grants and donations. We only have three part-time staff members who are paid. Everyone else is volunteer-based. At any time, we have 10-20 foster home volunteers. Since the dogs are donated to us, we don’t charge clients for the dogs, but we do charge them for their training. It’s $1,800 for Skilled Companion training and $3,000 for the Full-Access Service Dog training. Usually the service dogs are worth $25,000 each.


For more information on DADs

Read a personal account: “Elle and Coach—How a Diabetes Alert Dog Changed My Daughter’s Life” by Stefany Shaheen

Read Maggie Jones’ advice: “Consider This Before Getting a Diabetic Alert Dog”

WRITTEN BY Michelle Boise, POSTED 03/28/16, UPDATED 09/25/22

Michelle believes that a single story has the ability to reshape the world. She has a BA in English literature and Spanish and an MFA in writing from the University of San Francisco. As a writer, editor and content guru, she's worked on both literary magazines and e-commerce platforms. Before joining the Beyond Type 1 team, she developed health-conscious articles for Fitbit. When she's not writing, you can find her tap dancing in the house with her little white dog or painting with acrylics (they dry faster).