Good dog: Meet Honey – the diabetes dog trained to save her master’s life
Posted on 11 April 2019
Duncan and Honey could be any other boy and his dog, playing on the beach. But she also accompanies him to school, sleepovers, even the movies
“Oh wow, it’s a dog!” When Duncan Smuts first took his new puppy to school, the kids in his class were delighted – shouting, laughing and crowding around to pat the young golden retriever. And can you blame them? Affectionate, endearing, the very picture of man’s BFF, Honey must have made quite a scene walking through the hallways of an ordinary primary school. Three years later, however, she has become a familiar part of the classroom furniture.
Duncan was diagnosed with Type 1 diabetes when he was three-and-a-half years old. His mom, Jenny-Ann, a dietician at Shelly Meltzer & Associates, based at The Sports Science Institute of South Africa, says the family went from noticing early warning signs to receiving confirmation of his diagnosis within the space of a week.
“He had all the typical symptoms: he was thirsty, urinating a lot, tired, lethargic, moody,” she says. “I suspected diabetes and took him to the doctor. When we got there he needed to go straight onto a drip. He was on the verge of a diabetic coma.”
People with Type 1 diabetes experience sudden and intense swings in blood sugar levels. Someone suffering from this rare, genetic disease will swing from hyperglycaemic, where their blood sugar is too high, to hypoglycaemic, where it is dangerously low. These swings are hard to control – a Type 1 diabetic needs to monitor their blood glucose continuously, and carry an insulin pump with them at all times.
This condition has a life-limiting effect on a young child. “He couldn’t eat anything without an insulin injection first,” says Jenny-Ann. “So he’d have to come home from school every time he needed to eat anything. And he hated the needles – he’d run and hide under the table every time he needed an injection.”
But Duncan is also a brittle diabetic. This means the swings in his blood sugar levels are more severe, more frequent and more sudden than usual. Also known as labile diabetes, this condition is characterised by its unpredictability: Duncan’s sugar levels can change so quickly that he can end up in a coma before anyone around him has noticed there’s anything wrong.
“He’s affected by everything – stress, his emotions, hormonal changes, the temperature outside,” says Jenny-Ann. “So our biggest challenge is stability. He’s never had stable blood sugar levels. It has always been up and down. Just when you think you’ve got a handle on it, it will change. That’s what we’re looking for, for him: some sort of stable life.”
This is where Honey comes in.
Honey is the first-ever medical alert dog to be trained to detect blood sugar levels in South Africa. Her trainer, Lucy Breytenbach, is a canine behaviour specialist with a BSc (Hons) degree in Animal Science, Behaviour and Welfare from the University of Plymouth in England, who has been training dogs for over 10 years. Her school, Honey’s Garden Medical Alert Dogs SA, is based in Bloubergstrand, Cape Town, and currently houses 12 students of various breeds – greyhounds, German Shepherds, labradors, border collies and even miniature poodles.
Lucy discovered the potential of training dogs to help people with complex health conditions when she was approached by Jenny-Ann and her husband, Greg. “When we started looking into a medical alert dog to help Duncan manage his blood sugar swings, we found they were only being trained overseas, and it was just too expensive to train and transplant a dog over here,” says Jenny-Ann. “So we went to Lucy, who agreed to help us train our family dog. Honey, in a way, was her guinea pig.”
Honey had been found on Gumtree, says Duncan. Her previous owners left her in the back garden and would throw food for her out of the window. When she moved in with the Smuts family, at first, she was scared of everything. “If a mop fell over, or if I fluffed a pillow, she’d run and hide.”
For a retriever starved of exercise and attention, being partnered with a 12-year-old boy must have felt like she’d been let loose from a cage. And for Duncan, the puppy was a new BFF, with one important added benefit: Honey is a literal lifesaver.
DOG WITH A DIFFERENCE
The average dog’s nose is tens of thousands of times more sensitive than a person’s. While you have an estimated five million olfactory sensors in your nose, research shows that dogs possess anywhere between 200 and 300 million. It’s a well-known fact that dogs are able to detect changes in odour that indicate fear and stress, but new studies have shown that dogs are even able to detect markers of lung, bladder, ovary, prostate and skin cancers.
A dog is also able to register subtle changes in a person’s blood sugar. A 2016 study in the journal Diabetes Care found that insulin-dependent diabetics secrete higher-than-usual levels of hormone known as isoprene in their breath when their blood sugar drops. Scientists believe that while our noses are indifferent to these variations, dogs are able to notice and respond to these changes.
Training a dog to pick up changes in blood sugar, through smell alone, is a matter of exposure and perseverence, says Lucy. “We started with obedience training and scent work, so Honey could recognise the scent of Duncan’s low blood sugar,” she says. “We wanted her to associate that scent with a reward, and to give or enact a certain signal when she detects it, in order to claim her reward. We then steadily made it harder and harder for her to find or recognise that scent, by bringing in distractions and taking her into different environments.”
Jenny-Ann says the dogs are exposed to saliva samples on cotton cloths, and taught to attach a behaviour to it. At first Honey was trained to paw at Duncan when she recognised the warning signs of his blood sugar variations, but her nails would scratch his skin. Lucy decided to see what Honey would do naturally, and today, Honey knows to lie down in front of Duncan and bark whenever he needs inject himself with insulin, or eat or drink something.
Honey’s signals are distinctly out of character. “When she picks up a smell initially, she’ll have this dumb look on her face,” says Jenny-Ann. “That’s her first sign. Then she’ll whine, and do this funny stretch, and then she’ll lie down and make a low, growly sort of bark.”
Another trick: “We’ve tied a scarf around the food cupboard door, so Honey can jump up on her hind legs and open it,” says Jenny-Ann. “So whenever Duncan’s blood sugar drops too low, she can run and get him some juice.”
Lucy trained Honey to begin with, before training Honey and Duncan together, and finally teaching Duncan to train Honey, on his own during the day. Because Honey was the first dog to undergo this training in SA, it was a trial-and-error process, says Lucy. The retriever was two years old – and untrained – when she started her training, which is not ideal. “She went from two years as a neglected pet, into this loving home where she’s treated like a queen,” she says. “At that point she needed to start working, but she still had that ‘pet’ mindset. So that’s something we’ve implemented at the school: to bring the dogs in first, very young, and train them before we match them to their families.”
Today, canine students are brought into Honey’s Garden from as young as eight weeks old, and they are trained five days a week, in preparation for a family that needs them.
While Honey is now fully trained, the work is ongoing: she accompanies Duncan to school every day, and they go to formal training once a week. “This was quite an adjustment for him,” says Jenny-Ann. “She sleeps on his bed, and every time the family goes to the shops, Honey is a part of the troop. The only time Honey isn’t with Duncan is when he’s at sports practice. But when he’s out and she’s at home, she mopes around without him.”
Being glued to a Golden Retriever is a lot of fun, and a lot of pressure, says Duncan’s dad, Greg. “In the beginning he was very excited, of course,” he says. “But to adapt a bit. Ordinary things are different for him: he’s 14, but he’s only really had one sleepover at a friend’s house, because the risk that his blood sugar might drop is just too great. Even then, Honey had to go with him.”
Duncan doesn’t have the carefree life you’d usually associate with a teenage boy, says his mom. “A while ago he was with his friends, without Honey, and we got a call to come quickly,” she says. “By the time we got there he’d blacked out and got a concussion. They were shoving sweets in his mouth. The other kids got quite a fright. So we have to keep tabs on him all the time. Sleeping over at friends, coming and going as he pleases, making spontaneous, unplanned decisions – these aren’t really part of his daily experience.”
BEST FRIENDS FOREVER
Dogs at Honey’s Garden are public-access trained, says Lucy. This means she and her team will take dogs into shopping centres, different schools, office blocks, busy towns, the beach – everywhere their patient may want or need to go. “Our dogs need to be calm and able to do their jobs, no matter where they are. They can’t interfere with people around them. We need our service dogs to be invisible to the public.”
To find the best service and medical-alert dogs, Lucy looks for high-drive pups that want to work in all situations. “A dog that is trained to pick up his patient’s blood sugar levels will need to wake up regularly in the middle of the night,” she says. “The dog can’t get tired or lazy and want to sleep. It is a lot of work and they need to want to do it.” The bond is everything, she says. “Honey needs to want to please Duncan all the time.”
Jenny-Ann and Greg warn that taking on Honey was a huge commitment. “This is a serious condition,” says Greg. “It requires serious commitment. The closer they are, the better she works. Because he’s a young kid, Duncan isn’t always on top of his illness, and that can be dangerous. But Honey brings that focus – she’s all in, all the time.”
And Duncan is learning to trust that his dog is more reliable than continuous glucose monitoring technology. “The other day she alerted him when his sugar was at 5 mmol/L, which is in the normal range, and he was feeling fine,” says Jenny-Ann. “We thought, okay, let’s just wait a bit, maybe she made a mistake. So he got in the shower and as he got out, she alerted him again, and it had dropped to 1, which is dangerously low.”
The family is not yet at the point where they feel they can leave the two at home alone for long periods, comfortable in the knowledge that between the boy and his dog, they will be fine. In that sense, Honey is not a magic bullet that has cured Duncan’s condition. “She can only respond to his blood sugar variations if they’re together,” says Jenny-Ann. “If they’re alone, he might go inside and play video games, while she’s outside. I don’t know if we can take that risk just yet.”
“These dogs are a great addition to a family with a rare disease, but they don’t offer a miracle cure for that condition,” says Lucy. “Everything else continues: the testing, the injections, all of it. Honey is just there for when something fails: a sensor freezes, or becomes delayed, or recalibrates incorrectly. Life happens. Honey isn’t foolproof, but she’s a big help.”
This is just part of life as a Type 1 brittle diabetic, says Greg. “Duncan is 14. His mind is elsewhere. That’s normal,” he says. “But when I’m at home and I hear Honey whining or barking in that way, I jump up,” he says. “When a child goes into a hypoglycaemic episode, it’s not nice for anyone. So we are also on high alert for Honey’s signals. In that way, yes, she definitely makes a real difference – you can’t take anything for granted, but you can relax that little bit more, knowing she’s on it.”
It’s also important that service dogs are allowed to be dogs, says Lucy. “We can’t reasonably expect them to be working 24/7 – they’re not robots,” she says. “They need a little bit of play time, some free time, but they are trained to save lives, and that takes work. And at the same time, parents of these patients also need to motivate their children to train their dogs, play with them and stay glued to them. It’s hard work for everyone involved.”
In a way, Duncan, his parents and Lucy have learnt a lot from Honey: the potential of a dog to sense what people can’t, and the responsibility of helping the animal to do that effectively. And two years later, not one person in this story would change a thing. “We love Honey. Duncan loves Honey. And Honey loves all of us,” says Jenny-Ann. “We see the benefits, of having her with us and helping our boy, every single day.”
The staff at Duncan’s school are equally enamoured with the Golden Retriever. One day Jenny-Ann found a letter in Duncan’s school bag. “Dear Honey,” it reads. “We love having you as part of our primary school. We were worried you didn’t have a place to drink upstairs, so we got you this bowl. You can keep it in the kitchen cupboard under the sink. We hope you like it! Thank you for all your hard work.”
PHOTOGRAPHS MICKY WISWEDEL