Shari Rudavsky

shari.rudavsky@indystar.com

Brystin Fleetwood does not sense when her volatile blood sugar dips too low. Although the 12-year-old Bloomington girl cannot feel the changes in her body, a brown-and-white rescue dog who stays perpetually by her side can.

Brystin has Type 1 diabetes and falls in the 20 percent or so of diabetics whose sugar can dip with no warning symptoms. If her blood sugar drops too low, she could pass out or have seizures. When this happens, Gracie delivers a gentle nose bump to her hand, letting Brystin know it’s time to test her blood glucose level. After about 15 minutes, Brystin will recheck to see whether she needs more insulin to counteract high blood sugar or needs to eat something to bring a low sugar level back to normal range.

Gracie doesn’t take no for an answer. If Brystin ignores her, her lip quivers and she’ll bump again. If Brystin still doesn’t take action, Gracie will turn to Brystin’s mother, Jinni Fleetwood, and start nose-bumping her.

“She won’t give up,” Brystin said.

The same could be said for Brystin, who was diagnosed with diabetes when she was 7. She spent a few days in the hospital after her diagnosis, learning what foods to eat and how to monitor her insulin to ensure that her blood sugar goes neither too low nor too high, both potentially dangerous.

Doctors told the Fleetwoods about devices such as insulin pumps and continuous glucose monitors that made it easier for Brystin to deliver insulin to herself and to monitor her sugar levels. The technology helped, but Brystin and her mother still felt uncomfortable knowing that Brystin is “hypoglycemic unaware.”

Then, they heard about diabetes alert dogs, canines trained to smell when a person’s blood sugar is rapidly rising or falling. The idea appealed to Brystin. Jinni, too, saw the advantage of having a dog to help alert her daughter.

“This is a roller-coaster ride we’re on,” Jenni said. “That’s where all the extra tools come into play, like Gracie.”

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A rescue dog, Gracie was trained to detect changes in Brystin’s saliva that signal dramatic blood sugar shifts. Gracie goes everywhere with the girl — to school, to cheer competitions — and sleeps by Brystin’s side because it’s not uncommon for the girl’s sugar levels to plummet while she sleeps. The one place Gracie can’t go with Brystin? Diabetes camp.

Gracie alerts Brystin at least once a day and often much more.

Scientists remain divided on how good a job the dogs do. Studies tend to be small, such as one conducted in 2013 that found that more than a third of 36 people participating reported their dogs alerted them for all the hypoglycemic episodes they experienced in a month. Twenty-eight percent reported less than one missed episode per week, and 36 percent said their dogs missed more than one such event a week.

More recently, a study by an Oregon researcher of eight people and their dogs found that continuous glucose monitors did a far better job than dogs of telling patients with diabetes when they had hypoglycemia. In only 12 percent of the alerts that the dogs gave did the patient actually have hypoglycemia.

About five of the approximately 300 diabetes patients Dr. Todd Nebesio treats at Riley Health own service dogs. Nebesio has no problem when one of his patients, such as Brystin, decides he or she wants a dog. But the animals are expensive, and the evidence for how well they work is not strong.

“I think dogs are great. But they’re not for everyone,” said Nebesio, a pediatric endocrinologist at Riley Hospital for Children at IU Health.

Jinni and Brystin agree that Gracie is more accurate than studies of diabetes-alert dogs suggest. Often, they say, Gracie alerts Brystin before the sensors do.

“She’s faster than all of our technology,” Brystin said.

The Fleetwood family can’t help but think that Gracie is special. Brystin raised money to purchase her, saving birthday and Christmas gifts and selling rubber loom bracelets. Then, a cousin, who was raising a 4-H pig, offered to donate the proceeds from his pig’s sale. Brystin named the pig Sparkles, dressed it in a pink tutu and got into the pen with the animal. Sparkles sold for about $17,500.

Brystin could now buy a dog, and she knew exactly what she wanted: a dog with spots and one blue eye, recognizing that the more specific she was, the longer she might wait for a dog. The first picture she saw was of Gracie — a brown and white dog with one blue eye.

Last year, Brystin met Gracie in Omaha, Neb. Gracie had "met" Brystin through swabs soaked with her saliva. On the very first day, Gracie alerted Bystin. For the past year, the two have been inseparable.

When Brystin is on the move, Gracie is tethered to her with a leash that wraps around the girl’s waist. When Brystin sits, Gracie lies down with her body just inches away. Gracie makes having diabetes much more bearable, Brystin says.

“She makes it feel almost safe, because I know I won’t get that feeling as often as I used to, and I always have a companion,” she said.

Call IndyStar reporter Shari Rudavsky at (317) 444-6354. Follow her on Twitter: @srudavsky.