Unleash your own d-senses

A Diabetes Alert Dog provides an invaluable service to a person with diabetes and their loved ones. The keen senses animals possess are refined into an early warning system which can alert a person or others around them to blood sugar levels drifting into the extremes of high or low. These animals primarily use their sense of smell, but their vision might also contribute to their uncanny abilities too. But human beings also possess a formidable array of senses which, properly harnessed, can be powerful tools to avoid certain diabetes care related catastrophes. I will explain. Insulin preparations have a distinctive smell, some might say odor. This smell comes from the preservatives (metacresol and/or phenol) and is not the insulin itself. Metacresol and phenol are what are known as "aromatic" hydrocarbons. The aroma of these agents is quite distinct.

If you use an insulin pump, once the system is operational you should never smell the aroma of insulin in or around the pump, tubing, or the infusion site. If you do smell this unique odor, be alert to the possibility of a breach in the insulin delivery pathway. This could exist anywhere along a path from the pump itself (insulin reservoir), the tubing connectors, the tubing itself, or the infusion site. If a breach is suspected based on smell, take extreme caution to verify the pump is working properly. This includes checking blood sugar immediately. If the blood sugar is greater than 250 mg/dL (~14 mmol/L or greater) then also check urine or blood for ketones. If high blood sugar and ketones are present, strongly consider correcting the high BG with an insulin injection (not through the pump) and change out the entire system with fresh insulin, reservoir, tubing and infusion site. If using a tubeless system, change the pod. Make a point to correct high BG levels by injection rather than relying on the pump. Otherwise, valuable time is wasted. This leads to a rapid deterioration into frank ketosis and possibly diabetic ketoacidosis (DKA). Your sense of smell can also be useful in these cases. When excessive ketones accumulate in the blood, the body attempts to eliminate these through the kidneys and the lungs. Ketones are byproducts of the breakdown of body fat. The kidneys flush ketones out in the urine, but ketones are also converted into a form which is able to pass through blood vessels and quickly into the air sacs of the lungs. This chemical property is called volatility. Acetone is the volatile ketone form which is capable of entering the lungs and being exhaled. Acetone can be smelled by others around the person. Its smell is lightly "sweet". The person exhaling ketones may also be breathing more deeply and forcefully. This is a reflex that helps the body rid itself of ketones and the person may not notice their deeper breathing pattern. The medical term is called Kussmaul breathing.

If you suspect ketones in a loved one, get close enough to smell the exhaled air from mouth or nose. To better prepare yourself, open a small bottle of nail polish remover (acetone) and dab a drop on a cotton swab or piece of tissue paper and 'learn' this smell. Next, what about your vision? It's also a potent tool for identifying extremes in blood sugar. Your person of interest is most likely someone very close to you: a child, parent or spouse. You know how they look and behave under in range blood sugar situations. Your ability to see and hear changes in their tone of voice, how they form words, carry themselves or just the look in their eyes just might be a cue that their blood sugar is out of range (usually low, but high blood sugars may cause states of fatigue and drowsiness. Even skin color can be a cue: pale and sweaty denotes a possible severe low BG. Flushed and red faced is a common "look" of early DKA. The ketotic state dilates blood vessels leading to a flushed facial appearance in the cheeks.

You possess powerful senses which can be honed. While your nose may not be as sensitive as a diabetes alert animal, even these animals come from certain breeds and undergo intense training to obtain their skills. Plus, you possess the power of reason. Never underestimate your own powers. Aim to develop and refine them. The senses of smell and sight are powerful, yet often under appreciated abilities we should spend more time developing. Share a story of when you used your senses to help someone in need with diabetes.