That time I went into kidney failure....

Recently I became fed up. I've gained this weight from having kids, being lazy and my RA medications...and it just sucks. So I wanted to try something both fun and challenging. I'm sure many of you have heard of CrossFit, as had I. A legit CrossFit gym had recently opened near mi casa...so I decided to try it out! The first week was free, so I had nothing to lose. Or so I thought.... {dum dum DUMMMMMMM}

My first workout was on a Monday. The prescribed workout was 100 pull ups, 100 push ups, 100 squats and 100 sit ups. Well, there was no way in HELL that MY body was going to be able to do THAT on my first day, so we modified the workout {WOD: Angie...for those of you in the know}. I ended up doing 35 of each, and although I was drenched in sweat and stringing curse words together like a sailor, I got through it all. Pre-workout BG: 94 mg/dL, post: 86 mg/dL, and I removed my pump during the actual workout, and drank water before, during and after. I dropped low later that night, which I promptly over treated with juice and then almond butter & honey...jussssst to make sure I didn't die. As soon as I came home from the gym I was immediately sore in all of the muscles I had just abused. Triceps, abs, quads...all were killing me. I upped my hydration, hit the Magnesium & L-glutamine...and a little Advil so I didn't feel like I was dying. Trainers told me to def come back the following day, that working out again would help with the soreness. Sure, ok...seemed legit..plus I loved the community feel of the gym and workouts, and how positive everyone was. Crossfit was also super appealing to me because of the connection with the Paleo diet, which Dr. C and I have dabbled with and prescribed in our clinic for the past year or so.

2nd day work out consisted of weights...jerks, lifts..and I did some modifications with a 35lb kettle bell. Again, not easy, but I never felt like I was over doing it. BG stayed ~90 again, and I also hydrated. Next day I felt pretty sore, but pushed through and did a run. Which I completed. Again with good sugars and {what I thought was} adequate hydration.

Thursday I took totally off. I was sore. I had also noticed that I was UP 10 lbs since Monday. That was a bit unnerving. I had puffiness around my eyes, in my fingers, my tummy and my ankles. Hmmmmmm. So I reached out to FaceBook....which warned me of a certain condition that I was familiar with because of my nursing background. But, again, STILL didn't feel bad...was still ok in my eyes. My sports medicine Dr suggested getting some blood work done when I came in the following day to see patients in my practice. So I did. About an hour later I get a call from the hospital's stat lab informing me that my muscle breakdown level, a "CK" or "CPK" level, was more than their machine could measure...and that they would be sending my blood to another hospital. Hmmmph. My liver enzymes were also more than quadruple what they normally are, and my creatinine {blood kidney test} was double what it normally runs. SHIT. At this point I'm getting upset. My triceps and quads had also begun to abnormally swell, and my skin in those areas became super tight. FML. Dr. C called over to the hospital, and at that point their machine was also having difficulty running my CK level, but they were guessing it was around 20,000. Ruh Roh. Normal is 60-400.

So by now, Dr. C and I have consulted with my sports med Dr {Hey, Dr. D!!! Love ya!} and an internal medicine doc in our practice. Both were recommending a trip to the hospital for IV fluids. Dr. Google was scaring the crap out of me. When you hear things like "renal failure" and you've had diabetes for 20+ years, you tend to get nervous. So I drove myself to the hospital, Dr. C followed....I turned up the music, LOUD...and cried, because I was scared, y'all.

I get into the ER and my blood pressure is abnormally high. Hmmmph. And my weight is up 15 lbs from Monday {it's now only Friday}...ERMAHGAWD. I get shown to a room, and a physician looks over my blood work. I started hearing things like "acute renal failure" and "rhabdomyolysis". At this point I'm sobbing, and feeling like I'm going to faint. I was given no choice in the matter, I was being admitted to the hospital for intensive IV fluid management and monitoring. WHOA. Seriously, I've been in the hospital for baby-having stuff and for DKA when I was 16. I used to work in a hospital. I KNOW what goes on there, I KNOW how sick the patients can be. I was fuh-rrreaking.

Fast forward. 4 days of intensive IV fluids. Peeing gallons of water and protein out almost hourly. My CK level at admission was around 25,000, and that indicated that my muscles were swelling and dying, and as they are breaking down, releasing proteins. These proteins then are being caught up by the filters in my kidneys, which overloaded them. The ER doc said to think of my kidneys like a swimming pool after a super crazy summer party: my pool filter is now clogged with hair and the pool is getting murky. Uhhhhhhhhhh.
Thankfully I have zero kidney involvement when it comes to my type 1 diabetes. My kidneys took it all in stride and immediately began to improve and heal. I was told I wasn't allowed to leave until my CK levels came down to below 1,000...remember, normal is 60-400. On Monday, my level came back at 4,300...and I whined and complained enough that I was allowed to come home and rest for a few days before returning to work. I was also told no exercise for 1-2 weeks. Y'all. This shit was craaaaaay craaaaay, and I NEVER EVEN FELT THAT BAD.

Dealing with my diabetes in the hospital was easy. After the Dr on call "placed" me on a "sliding scale" with "regular insulin", I informed all Drs that NO ONE was to even THINK about the management of my sugars, insulin or diet. Do you think that stopped them from ordering a "diabetic diet"? Or prescribing bed time snacks of sugar free pudding and cheese to "prevent hypoglycemia"? Bless it. That's all I have to say. My highest sugar there was 136 mg/dL. Funny how basal/bolus Novolog with carb counting works. Like a Champ. Pffffffft.

So now I'm home. Feeling a bit weak, having muscle cramps, and still spending hours of my day peeing. I gained a total of 18 lbs in 7 days from the fluids and swelling. Mofo 18 pounds. My face is round and puffy and I look 5 months preggo. I'm ready for this to be over!

I have spoken with the gym owners and trainers at great length. They have been awesome, and have a prescribed plan just for me, catered to my delicate, flower like self. I am in no way blaming them for what happened, as it was just a random ass shit storm that occurred in my body. I'm also not afraid to work out again. I'm sad that I have to take so much time off, but alas, my body has to heal!

I was also under the assumption that marathon runners, persons taking cholesterol lowering medications and those that experience crush injuries were the ones that were diagnosed with rhabdo. It never occurred to me that I was at risk. Going from my un-gym like status, under hydrated and working out at 5:30 in the hot as Texas heat...I set myself up for the perfect storm of bodily dysfunction.

So now, here I am...a few days after discharge. And I still feel like ass. My muscles are cramping, I'm tired and have only peed off 4-5 lbs of that fluid. My arms and legs are still
a little swollen, so I am hoping all of this will improve in days to come.

How do you prevent rhabdomyolysis? First of all, again, my diabetes status had zero to do with it. It was more like, hey...you haven't lifted weights in 3 years? How about you take it easy instead of going all Chuck Norris style.
-immediate muscle soreness after a workout
-increasing muscle weakness
-fatigue
-red, rust or tea colored pee {I never had this} {you're welcome}
-muscle swelling
-new workout routine you're not accustomed to....and you just ADR {ain't doin right}
-generalized edema
I was lucky I had peeps to ask what the fudge to do. I could have easily ignored my symptoms and blown them off...then done some major ass damage to my kidneys. That ain't cool. So, being an educator, I'm sharing my story with my public. In hopes that you share it with yours. {as in DO IT, or I will beat you}.

Thanks for all of the love, support, thoughts, prayers, food, texts and emails...I'm a blessed lady!

Time!!!

The 'Betes, 101 {Guest Post}

Hey, party people...please welcome my guest poster, none-other than the super famous {well, at least in the DOC} D-Dad with DADs: Frank Wisenski, who blogs over at Blackdogsrule.com
. Please welcome him with sugary, bitchy love!!!

Hi everybody! Welcome to diabetes 101, day 1. Today's topic? Things that can affect blood sugar in a 10 year old girl, that makes managing diabetes so tough, and prevents us from knowing "normal", or having our diabetes (or our children's diabetes) "in control"

1. Food
2. no food
3. drinks
4. exercise
5. no exercise
6. math tests
7. pop quizzes
8. your best friend just got a new "insert cool thing here"
9. cleaning your room
10. horseback riding
11. hormones
12. growing
13. heat
14. cold
15. puppies
16. mom and dad miscalculating carb counts
17. miscalculated carb counts printed on food packaging
18. waking up in the morning
19. not wanting to go to bed at night
20. butterflies
21. going to Costco
22. excitement
23. Disneyland
24. anything school related
25. little brothers
26. when dad says "have you finished your homework?"
27. not washing hands
28. eating more than 1 "free" snack
29. Thursdays
30. playing outside
31. playing inside
32. not playing outside
33. rainy days
34. sunny days
35. Mondays
36. hot showers
37. pizza
38. bananas
39. blue shirts
40. birthday presents
41. Halloween candy
42. going to Nana's house
43. walking down the hall
44. reading a book
45. orange socks
46. car rides
47. crying
48. eating the same lunch today as yesterday
49. laughing
50. kittens
51. breathing
52. stopping to smell the roses
53. Computer games
54. Sunsets

You see, here's the funny thing about diabetes. EVERYTHING can affect blood sugar. Or it won't. Maybe it will. It did last Tuesday. Today? Nope.

They say the definition of insanity is doing the same thing over and over and expecting different results.

The thing about type 1 diabetes that drives us insane? It's doing the same thing over and over and GETTING those different results


Comment below and keep the list going! What affects YOUR sugar????

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Gotta have faith

Faith....in humanity...and in the general public has been challenged here as of late. The tragedies that have transpired over the last week have been heart breaking and gut wrenching, completely senseless and make me ache for those so closely affected.

The trust I have in the public has also been challenged in a "people of Walmart" kind of way, too. My new gig as a clinical trainer for a diabetes alert dog service organization has put me somewhat in the spotlight in my small community. Having a gorgeous dog or puppy, in a vest, as my constant companion has invited some interesting interactions while visiting different establishments.
"Is that your seeing eye dog???" As I'm holding my latte, a new bathing suit and bottle of vitamins at Target.
"Is your DOG diabetic!?" Yep, he also wears a tiny insulin pump.
"If I pet your dog, will it bite me??" Indeed, that's why I brought him here.
"Why can't your dog tell me if I have diabetes?" I'm pretty sure that giant Big Red you're drinking with your gut hanging out tells me you have diabetes.
"Paying that much for a service dog is why our country is in a financial crisis" -_-

Don't get me wrong, any opportunity I have to educate people about diabetes alert dogs is a good thing. But please just consider asking generalized questions.....instead of jumping to conclusions and saying asinine things that in no way make sense, or that possibly offend others.
It very much goes along with the stupid shit that people say about type 1:
"Did your mom feed you too much candy as a kid?"
"You/your kid will grow out of that, right??"
"My grandmother had diabetes, and had her leg cut off, and then she died a horrible death..." {thanks for your story of hope and encouragement, asshat}
"My 17 year old cat has diabetes....you should look at the diet plan I have her on"
"You know...if you ate more kale and came to see my chiropractor, you could totally get off of insulin all together" {yeahhhhh, my chiropractor is definitely on the forefront of type 1 diabetes cure treatments...right, Karly???}
The list goes on and on, and I know each and every one of you has anecdotes of your own. It is ALWAYS my first instinct to be an asshole to these people, but then I take a deep breath, bite down on that Xanax I was hiding in my cheek, and know that God wants me to use my powers for GOOD. Educate. Tell them you're less than 5% of the diabetic population. Tell them that nothing will get you off of insulin, short of a transplant. And tell them that while you're super sorry about their grandmother/cat/aunt/rotted off toe, that you're doing great and hope for a better, healthier future.

Please approach me if I have a dog. I'd love to share the good word of DADs and their super powers. Ask thoughtful questions, rub their chin and admire their awesoemness. Just don't say idiotic things, or I will straight up call you out on my blog!
Ahhhhhh, the power of social media.

Please feel free to share YOUR unfortunate diabetical interactions, below...we all need a good laugh.

Life sentence

Being diagnosed with a chronic disease can be devastating. Whether you're a toddler, tween, teen or almost adult, it can rock your world. Knowing the statistics. Listening to the news, the billions of dollars spent on others with your same disease state. Constantly being screened for potential complications and issues. Having your feet stripped down and examined by the Dr...I think it's just plain humiliating. I mean, sometimes I just can't make it to get a dang pedicure, mmmmk, doc!?

But what happens when you're faced with yet ANOTHER diagnosis. Another blood test that rocks your entire existence. Being told you must take yet another life saving medication just to function daily. Sometimes it's almost too much to bare. But wait...oh wait...life isn't finished with you. Your immune system is in a full on revolt, and launches a destructive war against yet one more bodily system. Why is this happening? Why did I get chosen to bare the burden of this auto-immune hell???

Truth is, once you're diagnosed with one autoimmune disease, you're very much predisposed to others. It's like a genetic lottery. Will your number be picked? And again? What about one more time? Disease grouping is common when we look at autoimmune diagnoses. Crappy part is, all of these disease states are relatively rare, and barely measure as a blip on the public health radar. There are multiple specialists associated with each diagnosis, which means more cash spent on copays, medications and treatments. T1 diabetes has brought most of us here, but how many of you also share your life with an additional AI disease? Rheumatoid Arthritis, Lupus, Hashimoto's Thyroiditis, Graves' Disease, Addison's, Vitiligo, Celiac Disease, Crohn's, Ulcerative Colitis....and these are just the more common.

I personally struggle with my hand basket of random autoimmune issues. Type 1 since the age of 9, Hashimoto's not long after the birth of my first son, Celiac Disease not too far behind that one, and the suckiest by FAR: a rare hybrid of Rheumatoid Arthritis and Ankylosing Spondylitis. I struggle with anti-inflammatories and immunosuppressants trying to treat the pain while also attempting to slow down the damage being done to my body. It ain't fun.

Some days are easier than others. But something as simple as a cold my kids brings home can send me to the hospital..where they want to shoot me full of steroids..which affects my 'betes. So, I feel like this delicate juggling act can disrupt with the tiniest of interferences. There are days I can barely get out of bed, or nights that I sleep for 12 hours straight. It has affected my ability to be the kind of mother to my sons that I wish I could be. That guilt then manifests into a crippling fear that I have passed along my crappy genes to these guys. Yeah he got my amazing dimples and winning personality, but will he also have to face these struggles and burdens as I have? It takes my breath away at times. The only thing that helps is to sneak my fingers to interlace with theirs while they sleep. And listen to their breathing, and know that I am not in control of these things, and all I can do is take this life one day at a time. The advances made in medicine over the last 20 years have been amazing, and I so look forward to what the future holds for me, my husband, my kick ass kids and my patients.

Know the signs and symptoms of other autoimmune disorders. Early detection and treatment is key, just like with T1. We, at the endo's office, routinely screen you for many of the common issues...you may not even realize it. And if you find yourself a sudden collector of suckage, much like myself, seek out the love and support of others! My life and health have been enriched by the thought and care of my husband, friends and family. They can't understand what I'm going through, but they sure know how to make me laugh and which foods make me poop my pants and which aggravate my joint pain. I am beyond a lucky girl.

This week I celebrate my 30th year on this planet, and I am enriched and humbled by all of you, so thank you for your kind words, support and accolades. Being here, now, is pretty damn awesome.

DiabLaziness

I was laying in bed several nights ago, and it struck me: "I am diabetically lazy". A shocking realization, it is not. An epiphany when examining those of us with chronic disease lazies after decades of just "dealing", YES.

It all started when my new Dexcom G4 Platinum {Yes, I IS fancy} required a finger stick for calibration. This would have required several actions on my part, including getting up to grab a new vial of test strips. It was then I decided my bed was just too comfy...my book just too enchanting...the soundness of my sensor, just not THAT important...So I did it. I calibrated my CGM with a MADE UP NUMBER of my choosing. GAAAASSSSSSPPPPP. I calibrated my sensor with a number close to what it was already reading, hoping it wasn't that far off from what my actual sugar was reading.
Now, why is this a BAD idea?? What if my sensor was WAY off? I could have just caused my sensor to continue to read "off", and thus miss any important shift changes in my sugar, rather that be low or high. This could have resulted in a missed "LOW" or "HIGH" alert, rendering my sensor useless. At the time, I seriously couldn't have cared less. But in retrospect: DiabeDUMB.

We have all been guilty of DiabeLaziness. Changing our lancets only when the clock falls back or springs forward, using a new pen needle or syringe only when it begins to bend into our skin from over-use, or simply skipping out on a fingerstick or insulin dose all together, what about injecting in the same area over and over? Using a pump site past 72 hours??. Do I condone this behavior?? Certainly not. Do I partake in these behaviors? DUH, I'm human. Remember the old addage "Do as I say, not as I do?", yes, precisely.

Will these things harm you? Possibly, and that is a risk we all take with our bodies. Re-using lancets sets us up for pain and infection, same with re-using needles for injection. I've had patients who have had a needle actually break off in their skin. What about re-using the same injection spots/pump site areas repeatedly: insulin is a growth hormone and will antagonize the growth of tissue, the technical term being lipohypertrophy. Lumps and bumps from over insulinizing a site can also prevent you from fully absorbing your insulin dose, the tissue becoming sponge like, sucking up the insulin and preventing your body from using to lower the sugar. And we ALL know skipping out on insulin doses is bad dog behavior: and will absolutely result in a higher A1c, which results in a grumpy Endo, which results in sad face immediately following said Endo appointment. I am reminded of the genius comedy website DogShaming.com. We need a DiabeticShaming dot com. Ok, so maybe not. As my patients would probably get pretty upset when I force them to wear their bad habits around their neck while I crack up and post their mugs on the site. Hmmm Ok, so probably a bad idea wrapped in pure awesomeness.

I know we are all guilty of SOME of these offenses. Some of the milder ones like putting a bloody finger in your mouth or not using an alcohol wipe before an injection. Overtime I think we learn what we are able to "get away" with, and which of these rules truly matter. There is scientific evidence that wearing your pump site past 72 hours decreases your ability to fully absorb your insulin...so...DON'T DO THAT! But if over time, not changing your lancet works for you AND you've weighed the risks involved, then be my guest. Balance your smarts with your dumbs, and all will be well with the world.

What are some of YOUR worst offenses???

Double Agent

We have discussed "pumpcations" here , before. And because this is my blog, we are going to talk about them again..dang it.
I have been a pumper since 2004, before I met my hubs, the infamous "Dr. C". I loved my first insulin pump, an Animas IR1250, like pre-color screen and hugeness, Animas. It was silver and sleek and meant I didn't have to take shots anymore: suhhhhh-weeet.
I then transitioned over to a Medtronic Paradigm, and had met my true love in the pump world. The ease of use and having a back button were probably more exciting than they should have been.
Then marked my stent with Schmomni Plod, where I was told I MUST wear their product if I were to remain employed...you know, a totally legal request {insert sarcasm font}. Going tubeless WAS nice, having a tumor under my clothing, not so nice. Plus, at any given moment, a bad pod would awkwardly begin loudly beeping, and is only silenced by a hammer...or defusing it like a bomb, which easily breaks your nails. Rude.
About 2-3 years ago I began my annual pumpcations. A vacation from pumping, where I switch over to multiple daily injections {MDI} for a few weeks or months out of the year. It's so liberating. To not deal with pockets or clips or shoving it in my bra. Not having to worry about my site while getting bussaaaaayyy {yes, yes I just said it like that}...or worry about what my husband thinks of how it looks on my body. Not worrying about what others think about it, feeling stares when they catch site of my tubing or see me bolusing. Don't get me wrong, I'm the biggest pump proponent out there, especially for a Medtronic pump, but sometimes...I just need a break. And that's ok.
I take great care in explaining pumpcations to my patients. That they ARE ok, that they won't get in "trouble" for wanting to switch from time to time. We always have a back up plan for shots. We sit down and calculate the correct basal injection doses, adjust the carb ratio and correction factor, and review the fundamentals of MDI.
I found something surprising, though. People are even MORE apt to make comments about my diabetes management choices when I'm using insulin pens. "Aren't you supposed to be on a pump? Did it break? Why are you STILL on shots, I could NEVERRRR do that...." And so on. Geeze, people. Let me be pancreatically challenged on my own. Calling attention to my injection in a large group of people is awkward and uncomfortable. I will talk diabetes all day, any day {lets get real, that IS my day} but don't be a douche and point me out to the vast majority of folks that don't even notice me!!
I guess diabetes, especially type 1, is something new and unknown to most. Questions, comments, insensitive statements..the general public has no filter. I've seriously heard it all. If someone you knew was diagnosed with cancer, would you ever consider walking up to them and saying "oh! You have cancer?? So did my uncle..he lost his leg..and then died.", uhhhh no. So I wish more common sense was used in that regard.
It's ok to be different. Even if its a different different every week. If you need a break from pumping: take it. Discuss with your team, and take a pumpcation...but use common sense, and have a game plan. Make sure you have long acting insulin to replace your basal rate, syringes or pen needles, adjusted doses {you use about 20% more insulin on injections} and a plan.
And to you non-diabetics: we are people, with feelings, with a chronic disease...use caution when relating your anecdotes to us. We are very sorry your grandmother lost her life or limb, but that is not us. Do we look immobile and unhealthy? Yeah, well we probably won't ever be that way. Ye of little faith. I've had this disease for 2 decades, and I'm pretty darn healthy, diabetically speaking.
Ok..rant over, pumpcation: month 3, set to begin! I am looking forward to slapping on a T-Slim, since I have no current endorsement deals with Medtronic..hint, hint...but also, so I can report back to my public {see: you, lovely reader}.

PS. I have zero plans to censor THIS post...many took issue with my DAD post, and it is now so beyond edited, it is unicorns and bullshit and not me at all. So, I hope it at least informed a few of a growing treatment option. Because that is the LAST time I change who I am so as not to offend.

Who's your DADdy?

I recently accepted a {non-salary..volunteer} position as a clinical consultant with a dog breeder that also trains services animals, namely: Diabetes Alert Dogs. I help screen potential clients, and help them grasp who is, and is NOT, a good candidate for a dog. Oh your A1c was last done 2 years ago and was 13%? Ehhhhhhhhhh

For those of you not in the know, a diabetes alert dog is a service animal that has received 1,000+ hours of training to become a service/assistance dog that you're able to take everywhere, and is also trained to detect high and low blood glucoses in a handler. I've seen it happen, and it made me cry. Here is this sweet faced labrador that is telling someone that they need to check their sugar. it gives you goosebumps. What exactly are they smelling? We aren't quite certain. its not neccesarily the actual "sugar", its a shift in hormones that their super noses are able to pick up on (I wonder if they know I skipped my shower last night....). Its best done with a type 1 diabetic, as its somewhat a stunted occurance in type 2s...again, we aren't sure why. We are calling it "Factor X'...sounds like super CIA stuff, right? So any chemists out there that would like to do a study as to exactly WHAT these dogs are getting a whiff of, PLEASE, contact me ASAP.

For those of you with loved ones that suffer from severe hypoglycemia awareness, ya'll are the ones that can benefit the most from these pups. Being able to catch a downward swing long before its seizure time would be a blessing for anyone that has experieinced them in real life. They ain't fun. Seeing my husband seize, realizing I don't have glucagon in the house, and knowing I am at least 30 min away from an ambulance arriving at my house: NOT FUN, and the stuff that nightmares are made from. Imagine if that was your child? Well...I can't..I wouldn't want to. These dogs are beyond what we are even capable of knowing ourselves...and although they may have puppy breath, they will love you no matter what...even if you do look stupid trying to fit into your Spanx and fall over onto the floor. Not that I have ever done that. Ever.

These guys are service animals, they wear a vest, and can go anywhere with their handler. They begin socialization and training at age 4-6 weeks, and some have even been able to alert at the age of 9 weeks. Although, they are not ready to "go live" in a home until closer to 18 months of age. Training involves using saliva samples from a type 1 diabetic, placed in a vented tin that can be hidden anywhere on a person. The dog is then rewarded to recognize and paw (see: alert) when it smells this scent. And they use spit. To train a dog. I felt pretty dumb the first time I was 41 and standing in my kitchen shoving gauze in my mouth to collect a sample. Even stupider when I realized that my mouth was bright pink from the strawberry Jello I had just consumed.

Diabetes isn't sexy. I mean, I'm sexy..and have diabetes..that's different. Diabetes is work. Its a fulltime job on top of a full time life. So anything that is able to help someone live a life that's a little easier....why not??? Well, maybe the price tag. For the cost of a used vehicle, you can purchase a gently used DAD, fresh out of training...to the tune of $25,000.00. But unlike a car, it poops, pees and burps in your face. Dogs need constant care and love, and a DAD is no different. They are there to serve you, not sit in a crate all day long. Some DAD trainers are able to get grants or organize fund raisers to assist in the purchase of these animals. Some (not so nice) trainers sell you a 12 week old puppy that has been "scent imprinted" and youre given a booklet to train the animal. There are not so nice trainers that will assure you your dog has endured hours upon hours of training, only for you to get home with a spazoid dog with ADD that shizzles on your shoe. As in any market, scammers are here. So you best do your research, yo.
And as this growing industry gets rid of some its stretch marks, we will have set standards that dogs must meet to be called a DAD. You wouldn't want a seeing eye dog that only guided 30% of the time when it was distracted. Same with a DAD. We need genetically sound, healthy animals, and non-asshole, smart trainers, that are working towards the greater good of diabetes betterment.