The Scent of Diabetes and the Gift of an Alert Dog-Diabetes 24-7

The Scent of Diabetes and the Gift of an Alert Dog

by Elizabeth Snouffer

Cadence is 4-years-old and was diagnosed with type 1 diabetes when she was 2 1/2.  She loves Tinkerbell and Lady Gaga, going to the beach, and learning about anatomy and the earth.  In so many ways, she is like many other bright little girls who suffer from type 1 diabetes.

Diabetes is difficult to manage on its own, but doubly so for Cadence.  She also has a condition called hypoglycemia unawareness (sometimes called impaired awareness of hypoglycemia), which is defined as a phenomenon where individuals, especially young children, are not able to recognize normal or severe falling blood sugars.  Cadence’s trouble doesn’t stop there either.  Not only does she not recognize when she has hypoglycemia, but she also does not feel or show any of the normal symptoms for low or high blood sugars.  Her mother has first hand experience with this, “ she can be playing, seemingly happy and unaffected, whether her blood sugar is 45 or 450 (mgdl).”   It is a very scary situation for Cadence’s parents,  Marijane and Dave Gray.

In one landmark study, (Impaired Awareness of Hypoglycemia in a Population-Based Sample of Children and Adolescents With Type 1 Diabetes , Diabetes Care, October 2009 vol. 32 no. 10 1802-1806), researchers defined hypoglycemia unawareness as a “very real phenomenon, caused by repeated low blood sugars” and further elaborated by pointing out that the brain is to blame:

The general understanding is that in response to frequent lows, the brain increases the number of glucose sensors on cell membranes to become more efficient in extracting glucose. As a result, the brain doesn’t feel starved until there is almost no glucose left, and at that point the risk for loss of consciousness or seizure is very high.
Essentially, patients with this condition will have blood sugars in the hypoglycemic threshold (starting at 63-69 mgdl) or lower without any symptoms, such as sweating, adrenaline release, and impaired cognitive ability.  Impaired awareness of hypoglycemia for adults with diabetes has been studied extensively with patients who either utilize insulin therapy or sulfonylureas.  There is significant evidence that proves older patients can essentially retrain the brain to sense lows at higher levels, by meticulously avoiding hypoglycemia for 2-3 weeks, but is difficult to nearly impossible to achieve this reversal with children.  The risk for these children having a hypoglycemia-related coma or seizure is great.  It’s worth noting that the study also found that about one in three children with type 1 have impaired awareness of hypoglycemia, so it’s important for parents to have children screened for the condition.

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The Scent of Diabetes and the Gift of an Alert Dog-Diabetes 24-7