A hypo-alert dog is a medical alert assistance dog specifically trained to identify changes in their owner’s blood sugar levels.

A potentially serious condition called hypoglycaemia occurs when blood glucose levels fall below 4mmol/L.

Hypoglycaemia episodes, commonly known as a ‘hypo’, can range in severity. While some episodes can be treated by consuming sugary foods and drinks, others can be life-threatening and may require hospitalisation.

Common symptoms of a hypo can include sweating, fatigue and dizziness. However, some individuals have hypo unawareness and cannot recognise when they are having a hypoglycaemic episode.

People with hypo unawareness may benefit from owning a hypo-alert dog that can detect the onset of hypoglycaemia, allowing the necessary treatment to happen sooner.

How can a dog sense hypoglycaemia?

If you’ve ever owned a dog, you’ll know they have a powerful sense of smell – often picking up scents from miles away. Did someone drop their lunch on the other side of the park? Your dog will be sure to let you know.

A dog’s sense of smell is 100,000 times greater than humans.[1] While we only have six million olfactory receptors in our noses, dogs can have up to 300 million. Alongside this, the part of a dog’s brain responsible for processing scents is proportionally 40 times greater than our own. [2]

Our furry companions’ olfactory factor means they can be trained to recognise particular smells – from drugs and dangerous explosives, to the tiny little tablets you try to slip in their dinner unnoticed.

You have already spotted drug-detecting dogs at the airport or watched reports of mine detection dogs on the news. More recently, a research trial in the UK found that bio-detection dogs could identify COVID-19 with an impressive 94% accuracy.[3]

A canine’s superior smelling ability can detect the most minute chemical changes in our bodies. In this way, a dog might recognise a drop in your blood glucose levels or the onset of a hypoglycaemic episode before you notice something wrong.

Hypo-alert or blood sugar detecting dogs are trained to identify shifts in blood glucose levels, alerting their owners that something is wrong so that the appropriate medical response can occur.

Training can take over a year to complete and usually entails hypo-alert training alongside the conditioning the dog needs to perform effectively in the outside world. The dog is usually exposed to many hypo samples and, through positive reinforcement, is rewarded when it can successfully identify and distinguish a hypo sample from a normoglycaemia sample.

How effective are hypo-alert dogs?

Many research trials have sought to explore the suitability of dogs in detecting hypoglycaemia but the results are often conflicting.

In a 2015 study, six diabetic alert dogs were placed in a room with seven samples, one of which was hypoglycaemic. The dogs all demonstrated significant sensitivity (50.0% to 87.5%) to the hypo sample, while they were all capable of recognising the normoglycemic samples too.[4]

However, a year later, a study involving real human participants suggested that trained dogs were an unreliable way of anticipating hypoglycaemic episodes due to a high false-positive rate. The researchers suggested continuous glucose monitors identified low blood glucose levels by a ‘clinically significant margin.’[5]

While the effectiveness of diabetes assistance dogs is still up for debate, the impact a dog may have on the owner’s psychological wellbeing has also been investigated.

Research involving 17 diabetes assistance dog owners showed that 94% reported having an enhanced quality of life since owning the dog, and 88% reported having an increased sense of independence. Perhaps most importantly, 88% and 81% of the participants said they had complete faith in their pet’s ability to alert them to hypoglycaemic episodes.[6]

How can I get a hypo-alert dog?

If you live in the UK, Medical Detection Dogs trains fully accredited diabetes alert assistance dogs and is a member of Assistance Dogs Europe (ADEu) and Assistance Dogs UK (ADUK). The charity is also the only UK organisation with full Assistance Dogs International (ADI) membership.

The eligibility criteria cover aspects of your own health and the dog’s welfare.

Medical Detection Dogs rule out people with type 1 diabetes who are currently using a glucose monitor, have recently been diagnosed, smoke or live in a smoking household, and have more than two dogs currently living with them.

To qualify, you must reside in the UK and be aged between 5 and 75 years.

You should be able to provide the dog with a stable home environment and be committed to its continual training.

Having any dog is a long-term commitment, and you must be prepared to care for the dog for the entirety of its lifespan.

A full list of eligibility criteria can be found here.

Can I train my own dog?

Medical Detection Dogs can also train your dog to be an accredited diabetes alert dog. This depends on several factors, such as the eligibility laid out above and whether your dog has demonstrated the potential to identify hypoglycaemia.

Your pet may have already picked up on your hypoglycaemic episodes without any prior training. This is quite a common phenomenon and has led to further studies on untrained dogs with hypo awareness.

In one study from 2009, two hundred and twelve dog owners with type 1 diabetes answered a questionnaire on canine responses to hypoglycaemia.[7]

One hundred and thirty-eight or 65.1% of the respondents reported their dog having a behavioural reaction to a previous hypo episode, with 33.6% believing their dogs reacted to hypoglycaemia before they were aware. The dog’s likelihood of responding to hypoglycaemia was also not influenced by its gender, age, breed or length of dog ownership.

Are hypo alert dogs the same as guide dogs?

Hypo alert dogs have a different set of skills to guide dogs.

However, it is possible that a guide dog could also be a hypo alert dog if it passed the necessary training.

As hypo alert dogs play an important role in providing medical assistance and are trained to be even tempered, they should be allowed the same flexibility as guide dogs, such as being allowed in places that only accept guide dogs.

Hypo-alert dogs in the news


[1] https://www.petmd.com/dog/behavior/5-dog-nose-facts-you-probably-didnt-know

[2] https://www.purina.co.uk/articles/dogs/behaviour/understanding-dogs/dog-sense-of-smell

[3] https://www.lshtm.ac.uk/newsevents/news/2021/bio-detection-dogs-identify-covid-19-94-accuracy

[4] https://link.springer.com/article/10.1007/s13300-015-0135-x

[5] https://journals.sagepub.com/doi/full/10.1177/1932296816666537

[6] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0069921

[7] https://www.liebertpub.com/doi/abs/10.1089/acm.2008.0288

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