What You Need to Know about Diabetes Alert Dogs – Diabetes Daily

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Before there was the continuous glucose monitor, there was the diabetic alert dog, or, to use their adorable acronym, the DAD. These highly-skilled furry medical assistants are trained to do something remarkable: they can sense your blood sugar and warn you when it is too low or too high. Diabetic alert dogs have saved lives.

More than a few members of the Diabetes Daily community have their own DADs, and many swear that their dogs can sense low blood sugar far faster than any medical device. A few years ago, we spoke to six friends with diabetes alert dogs and learned how they offer companionship as well as protection. Click here for the stories and the cuteness.

While the increased quality and availability of the CGM has probably reduced demand for DADs, some people with diabetes may still want nothing more than their own diabetes helper doggo.

For those at an especially high risk of hypoglycemic attacks—for example, if you have hypoglycemia unawareness, experience frequent lows during sleep, live alone, or cannot wear a CGM—an alert dog may even represent the very best safety option.

If you’re thinking about getting a DAD, this article is for you. We’ll discuss what you need to know.

Diabetes Alert Dogs (DADs) Aren’t Pets

DADs aren’t just cute companions to have as a family pet. They’re working 24/7, and are trained for months (or even years!) to do so. They may be sweet and they may like to cuddle, but an alert dog’s job is to keep you safe, and you need to support them by respecting their responsibility.

If you mostly just want a regular pet, get one. If you need an alert dog to help prevent you from going into severe hypoglycemia, then a DAD may be appropriate.

The Science is Unclear on DAD Accuracy

While many DAD owners swear by the accuracy of their pups, the science is not so clear.

A 2017 study that looked at 14 dogs and graded them against the results of a CGM found that a majority of the dogs “did not demonstrate accurate detection.” A different 2017 study, also performed under real-life conditions, found that dogs only identified a minority of hypoglycemic events; when they were accurate, they were 22 minutes slower than a CGM. They also provided a huge number of false alerts.

The most recent study we identified, from 2019, found that DADs perform “better than previous studies suggest.” Nevertheless, their performance is extremely variable: some dogs identified their owners’ hypoglycemia almost every time, and four individual dogs didn’t issue a single false alarm, but others detected out-of-range blood sugar values less than half the time.

This study peered deeply into the statistics, and learned some surprising things:

  • Dogs that had been working longer were “significantly more sensitive to high blood glucose levels, but significantly less sensitive at low glucose levels.” While DADs are typically not trained to recognize high blood sugar, they are often rewarded for doing so, which may gradually affect their behavior.
  • Dogs that began their lives as family pets performed the best at detecting hypoglycemia.
  • DADs may be less sensitive with children than adults—possibly because they typically cannot attend school with the kiddos and therefore spend less time with their partners. On the other hand, they seem to give fewer false alarms when partnered with a child, possibly because it requires more confidence to alert an adult.
  • Dogs seem to perform better when their owner experiences more severe blood sugar changes.
  • Ongoing training helps dogs keep up their abilities.

Perhaps it should all be taken with a grain of salt anyway: the team of researchers that performed and described the above study included several employees of the charity that provided the dogs for the experiment, the UK’s Medical Detection Dogs.

In fact, scientists are not completely sure what it is that dogs are sensing when they indicate a blood sugar alert. Is it a compound in the patient’s breath? A scent emitted from the skin? Is it not a scent at all, but a subtle behavioral clue, or some combination of them all? We don’t yet know.

Perhaps diabetic alert dogs are best thought of as an additional layer of security to be used in conjunction with glucose monitors or meters.

DADs Can Be Very Expensive

Although you might get lucky, you should not expect your private insurance to pay for a diabetes alert dog, especially with the rising availability of the CGM, which has scientifically-validated accuracy and a much smaller up-front cost. (Medicaid and Medicare do not cover the costs for service animals.)

That makes DADs an out-of-pocket expense, and the costs are steep. A trained alert dog from a reputable source can cost up to $20,000, or perhaps even more.

Some charities can help. Dogs4Diabetics is one organization that offers training, resources, and even trained dogs free of charge to individuals in need of help.

Additionally, like any other member of your family, diabetes alert dogs require routine care: food, grooming, licensing, and routine veterinarian care can all be expensive and are not covered by the owner’s health insurance. Think twice before committing yourself financially to such an expensive investment.

DADs Require Time and Commitment

Just getting a DAD in the first place can take years. Diabetic alert dogs are not available off the shelf—they receive special training to recognize your smells. One trainer we reviewed reports a minimum of six months’ wait after you place an order, and that’s assuming that there’s no waiting list.

Before jumping onto the alert dog train, remember that they require a lot of time and commitment. The diabetes alert dog must adapt to your diabetes regimen, and you must be patient during the (often steep) learning curve.

Additionally, owning a DAD takes a lot of commitment on behalf of the owner. A DAD must properly bond with his or her owner to prioritize their health during all hours of the day. Good trainers will instruct new owners on how to reward their dog’s behavior and reinforce accuracy; following these instructions takes time and effort, but it’s critical to keep a dog’s performance from declining.

Let’s not forget that DADs need the love and attention that any furry family member deserves, along with walks and regular treats. All of these things take a lot of time and commitment.

Some People Train Their Own Dogs

That’s right—not every diabetic alert dog comes from a reputable trainer. Some people train their own dogs. If you search Amazon, you’ll find more than a few books devoted to the practice. Way back in 2013, we reviewed one such book.

Does it work? We can’t say. Good trainers are extremely picky about potential service dogs, and they know how to identify the multiple behaviors and tendencies in puppies that suggest that a dog can succeed in this demanding role. And even dogs trained in these exacting circumstances are not always up to snuff. It seems unlikely that an amateur would have as much success, although it is perhaps worth remembering that a dog that is reared in the same home as its diabetic owner seems more sensitive to hypoglycemia, suggesting that lifelong familiarity can improve accuracy.

We do have community members that have trained their own dogs, and feel confident in their furry friends’ ability to detect blood sugar lows. Just keep in mind that few doctors would recommend that a diabetic alert dog should be considered a completely reliable safety measure, anyway.

Don’t Overlook the Emotional Support Factor

Many studies have found that pets can have a powerful positive effect on mental health, and there’s good reason to believe that these effects can be especially powerful in people with diabetes.

Whether or not DADs are highly accurate, their owners seem to love them, and there’s little reason to doubt that they bring additional emotional value to the table, no small matter in a condition that causes so much anxiety and stress.

Although diabetic alert dogs are not trained to be emotional support animals, they may well have the same effect. And unlike a cat, guinea pig, or even just a regular dog, a DAD uniquely helps to share the cognitive and emotional burden of diabetes. They are a partner in your daily glucose management rituals and travails.


These days, almost all service dog agencies have an online presence (there are both for-profit and nonprofit agencies, and that will largely determine price). Doing a bit of online research can help you get a sense of their teaching methods and process for pairing alert dogs with applicants. You can also contact Assistance Dogs International for information about agencies in your state.

Additionally, your endocrinologist and care team may also have recommendations for potential dog training organizations near you.

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Read more about animals, diabetes burnout, diabetes management, diabetic alert dog (DAD), hypoglycemia unawareness, insulin, Intensive management, low blood sugar (hypoglycemia).

Author: Mabel Freeman