Dr. Hardin on Training Diabetic Alert Dogs
Dr. Dana Hardin is a senior medical advisor in Biomedicines at Eli Lilly and Company, and a pioneer in the field of understanding the clinical benefits and training of diabetes alert dogs (DADs). She first became involved in this endeavor as part of a collaboration with the Indiana Canine Assistance Network (ICAN), and the head trainer at the time, Dr. Jennifer Cattet. She has since expanded these collaborations and currently works with multiple trainers to better understand the complex world of DADs.
“Sensing dogs for medical alert was something that had not been done at all by Indiana Canine Assistance Network, and Dr. Cattet believed there was a strong need for this type of training. When I attended a talk given by Dr. Cattet and ICAN head Sally Irwin, I instantly wanted to be involved,” Dr. Hardin said during a recent conversation with Beyond Type 1. “So we worked together to talk about, ‘What would a dog do for somebody? How does that work? What do people need?’”
While she worked with Dr. Cattet and ICAN to train and place the first successful DAD, who ended up helping a young man with Type 1 finish his graduate program, Dr. Hardin noticed big gaps in medical literature about training dogs to support this very specific population. Case studies could be found here and there, but there were no data-driven reports to rely on.
“I wanted to get what I would call real-world evidence of what a dog could do for a person with diabetes: collecting information before a dog is placed with a person with diabetes and collecting data again after the dog is placed with that person. This is a much more scientific way of obtaining information and reporting information. My concern was that you have to have some standard to measure against to know that when the blood sugar really is low, the dog is going to notice.”
Dr. Cattet now runs her own program for training DADs, called Medical Mutts, and when she’s not supporting her colleague, Dr. Hardin is working on finalizing her research.
A strong enthusiasm for the research she does and the guidance she provides trainers working with DADs is apparent to anyone who meets Dr. Hardin. During our conversation, she shared with us a few key concepts behind training and utilizing DADs to their highest potential:
Families looking to invest in a DAD can choose one of two routes: the for-profit route or the not-for-profit route. “ICAN is a not-for-profit route,” says Dr. Hardin. “One of the the things I love about ICAN is they’ll use the prisoners in the prison system to do some of that training. So that’s a very creative not-for-profit way to do the job.”
Dr. Hardin excitedly describes other options along this route — for both parties involved. “At Medical Mutts, Dr. Cattet will go to the animal shelters and humane societies. The people at the humane society identify potential dogs, and Dr. Cattet will spend six weeks doing all of the scent training and behavior training. Now, let’s say the dog doesn’t end up becoming a DAD, but the dog can serve what medical needs there are: mobility work, that kind of thing. They still get adopted with a snap of the finger.
“I love that program because it saves two lives: the person with diabetes and and the dog.”
The other route, Dr. Hardin explains, is when the trainer charges the expense of the dog and the dog training. “They’ll take a dog, they’ll breed a dog, and they’ll train the dog, and that full expense is paid for by the patient.”
The Value of a Trainer
No matter how a patient chooses to get a dog, Dr. Hardin stresses the importance of the trainer’s role.
“A good trainer is worth their weight in gold,” she says, “The trainers have a very complicated job.”
Dr. Hardin strives to help trainers achieve consistency with DADs. “We have published some methodology on training that leads to better dogs. Some key questions include: are the dogs in an in-vitro setting, not attached to a person? Are they able to alert to the scent of low blood sugar repeatedly, not just once? And in different people?”
Dr. Hardin has also visited training camps and offered her physician’s insight into how DADs are trained. She advises trainers on the levels at which dogs should signal for low blood sugar and high blood sugar.
In addition to understanding the physiology behind diabetes and selecting dogs with a specific temperament that is suitable for service work, trainers must also develop a reward system based on positive reinforcement.
“It’s not always just food, it can be a ball, it can be a squeaky toy — whatever it is that dog wants to work for. But that dog has to have positive reinforcement to continue the behavior,” Dr. Hardin says. “It’s a beautiful thing to see a good trainer working with a dog and making them helpful to a patient.”
Among the many things for families to consider when researching DADs is the lifetime of training that’s involved. While working with DADs-in-training, Dr. Hardin experienced some of the ongoing maintenance required to keep DADs at the top of their form.
“I need to have certain expectations for a working dog that I don’t have for my pet dog. It’s really easy to slip. If I let those things slip for a while, there’s no reinforcement in the training, and bingo: they don’t do the job anymore,” Dr. Hardin cautions. “Let’s say I’m a person with diabetes and maybe I’m having a bad day and I’m getting a lot of low blood sugars, and the dog keeps bugging me, because that’s what they’re trained to do. I just kind of blow him off and I’m not going to do anything about it. It doesn’t take long to extinguish a trained behavior in a dog.
“As a physician, I don’t write a prescription, send the patient home, and never see them again. I follow up to find out: did what I give them work? What are the things not working? A physician won’t turn you loose and never see you again. The trainer shouldn’t turn you loose and never see you or talk to you again.”
The ICAN program values communication, as illustrated by follow-up sessions arranged with patients that have been assigned to dogs. Dr. Hardin recalled one instance in which a dog from the ICAN program was assigned to a very young patient.
“The young man needed the dog for multiple reasons, for a hearing impairment and other things. But he was really young and there was a real sensitivity on how best to have that dog with this guy because he was too young to reinforce the training. There were lots of discussions back and forth to decide what to do and how to do it for this particular patient.”
The Future of DADs
“The Holy Grail is knowing what the dogs sense,” says Dr. Hardin. “I am blessed to be working in collaboration with Indiana University Purdue University in Indianapolis on a grant from the National Science Foundation to understand what dogs sense. Let’s say it’s a chemical made by the body and we don’t know what it is — one could isolate it and use that for training. I’m always amazed at how wonderfully reliable the dogs are. If you were to train drug alert dogs, you would introduce them to the very purest cocaine, and then that would get diluted or put under a cement column and the dog would still be able to smell it. DADs are almost trained backwards: we train the dogs on everything and then they narrow it down. So wouldn’t it be cool if we had THE stuff to train the dogs?”
Dr. Hardin continues to work toward her ultimate goal of standardizing certification for DADs. “If a patient says, ‘I want to get a diabetes alert dog,’ my fellow physicians could say, ‘Here are the places that you can go to get one, and these dogs come out with a certification that you know what you’re getting.’
“My patients with diabetes just want to lead a normal life. What that looks like for everybody can be different. Let’s say you live alone and you need an alert system that can help you beyond just being alerted: you need something to carry your Glucagon kit to you. Or push a button on the phone to ring 911. If you’re a child that’s a bit uncomfortable at school because your diabetes makes you different from all your friends at school, now suddenly that difference is a cool thing. You’ve got this cool dog. With a dog, kids tell [others about their diabetes]. It builds confidence. It makes me so happy that they can have something that makes their life better. That’s what I went into medicine to do.”
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