As soon as Deb Cook snaps on Ruby's red vest stitched with the words "Service Dog In Training," the 20-month-old Dalmatian with a liver spotted coat knows she's on the job.
Ruby accompanies Cook, 59, on shopping trips and goes to the movies with her. The sounds blarring from the theater's speakers sometimes startle Ruby, who enjoys lapping up lost pieces of buttery popcorn lying on the floor. Ruby will step on an airplane for the first time next month when Cook travels to Seattle.
Ruby's mission 24 hours a day, 7 days a week is to tell Cook when her blood sugar plummets. Type I diabetics like Cook suffer frequent episodes of hypoglycemia, a reaction to low blood sugar that when left untreated can lead to a seizure, unconsciousness and even death.
Ruby licks Cook's face, but she'll also gnaw on her ear or wake her husband when she can't rouse her from a sound sleep.
"I think she's saved my life many times," Cook said as the energetic pooch sat beside her on the front porch of her redbrick home on the city's north side. "She's very, very smart. She's a good puzzle-solver, which is what you want in a diabetic alert dog."
Cook was diagnosed with Type I diabetes at age 25, although she said she had symptoms of the disease as early as age 11.
About six years ago Cook developed insensitivity to hypoglycemia, meaning she can no longer tell when her blood sugar is low. Dizziness, weakness, sweating, shaking, hunger and confusion are signs of abnormally low blood sugar. Cook's blood sugar dropped so low that she passed out a couple of times.
One of her most frightening episodes occurred while she was sleeping. Cook fell off of her bed onto the floor and ended up underneath the bed, crawling through bags of shoes. When she came to, her forearms were black and blue.
"I thought that I was in a jungle crawling through the jungle," she said. "I pulled my insulin pump off and it was alarming. I wasn't continuing to get insulin, so my blood sugar went back up. I could hear the alarm go off, so eventually I came back."
Another time Cook accidentally overdosed on insulin at work. A cleaning lady found her an hour and a half after she fainted.
"I continued to have a number of incidents where they didn't get that serious, but I kept having lows that I didn't anticipate," said Cook, an attorney who owns her own mediation firm.
A friend suggested that she get a diabetic alert dog. Cook contacted a slew of organizations that train and provide service dogs. She learned that there are rules that regulate the dog's ownership, where it can live and whether it has to be spayed or neutered.
She put her name on a waiting list with a group in Minnesota, who interviewed her at her home.
"They really weren't in any hurry to place dogs outside of the Minneapolis area," she said. "If it's going to take me another two years to get a dog that someone else has trained, I might not be around to get it."
Having both shown and trained dogs, Cook decided to purchase one herself. Her husband, who had prior experience with Dalmatians, encouraged her to pursue that breed.
"He had five Dalmatians before and thought they were the most brilliant animals alive. He claims that they are the one dog that has independent thought," she said as Ruby hurriedly paced around the living room, carrying a rubber ball in her mouth. The ball gave off a high-pitched squeak as Ruby sank her teeth into it.
A few minutes later Ruby jumped onto a beige leather couch and laid down, her head resting between her front paws.
Cook researched the breed and learned that the Dalmatian, whose ancestry dates back to Ancient Egypt, is known for its endurance and intelligence and has been used in a variety of roles over the years.
"They can smell people in fires, so you know they have good noses," she said.
ON THE JOB
Cook purchased Ruby when she was 8 weeks old from a breeder in St. Louis, Mo. On the ride back to Sioux City, Cook began the training process. When her blood sugar dropped, Cook breathed into the puppy's face, told her this was a "low," and got her excited.
"When they train them at the diabetic alert institutes or training facilities they use a combination of things. Some of them use saliva and some of them use sweat," Cook said. "They say that these diabetic alert dogs can smell the smell that triggers their alert. One drop of that smell in a swimming pool they would smell."
Later that night, in her crate beside Cook's bed, Ruby became upset. Cook's blood sugar was low. When it rose again half an hour later, the puppy calmed down.
"She alerted the first time, the first night she was home," Cook said. "She's been pretty consistent since then."
While out in public with Cook, Ruby has even detected low blood sugar levels in other diabetics.
A few weeks ago at Sam's Club, Cook said a woman inquired about Ruby. While they were talking, Ruby stared at the woman, who is also a diabetic, raised up on her hind legs and then licked her face. Cook asked the woman if her blood sugar was low.
"She checked, and she was going real low," Cook recalled.
At a hospital a few weeks ago, Ruby became frantic when a couple entered the room where Cook was. Cook explained to them that Ruby is a diabetic alert dog.
"I couldn't even hold on to her. She had to go to them," Cook said. "The woman goes, 'I'm a diabetic and I think I'm really high.' She went and checked and she was really, really high."
In the coming years, Cook, who is president of the Sioux City Cosmopolitan Club, said the non-profit organization devoted to the cure, prevention, education and treatment of diabetes plans to assist other diabetics, especially children, in obtaining their own diabetic alert dogs.
"A lot of people with a child who gets a diagnosis of Type I diabetes, they never sleep again. They're up two, three times a night testing their child," she said. "If a child can get a diabetic assist dog, even if all that dog does is sleep with them, that parent can get some more sleep."