On the scrap of fabric is a saliva sample from a diabetic with high blood sugar. As soon as the puppy finds the scent, a trainer gives it a treat.

Teaching dogs to recognize the scent of high or low blood sugar is the first step of scent-based diabetic-assistance dog training, said Deb Cunningham, co-founder of Eyes Ears Nose and Paws.

The nonprofit trains mobility, disability and diabetic-assistance dogs and matches them with clients. It was founded by Cunningham and a partner, Maria Ikenberry, in 2008.

While many organizations train service dogs, Carrboro-based EENP is one of only six in the country that trains diabetic-assistance dogs, according to the website for Assistance Dogs International.

The smell of high blood sugar stands out to dogs. After learning to notice and respond to it, the dog learns to nudge the diabetic and sometimes to retrieve the blood sugar-monitoring supplies.

The dog's excitement escalates until the diabetic notices. If the person doesn't respond, the dog tries to get help from another person. If no one else is around, the dog is trained to use a canine-rescue phone, essentially a button the dog can push. The phone dials either a friend of the diabetic or 911.

Another aspect of training is socializing the dogs. For example, the dog is trained to sit under the table in restaurants and ignore food and passing people. This process is called public-access training and is done by volunteers known as "puppy parents."

"Volunteers do the bulk of the training, about 90 percent," said Ikenberry, executive director of EENP.

Puppy parents adopt and train a dog until it's about 2 years old. They bring the dogs with them everywhere possible, teaching them to behave appropriately in different social situations, she said. They also bring the dogs in regularly for advanced training.

EENP is training nine dogs that will likely graduate in December, and at least two could become diabetic-assistance dogs, Cunningham said.

An assistance dog costs $20,000, Ikenberry and Cunningham estimated. That includes the cost of purchasing and caring for the dog and training, plus medical work to ensure that the dogs are healthy, Cunningham said.

Potential clients can apply for scholarships from EENP while applying for the dog itself, and scholarships can cover up to 75 percent of the fee. Grants and donations fund EENP's budget, and scholarship money comes out of that budget.

Paws on the bed

Ansil plants his front paws up on the edge of the bed and licks Randy McGarity's face until he wakes.

McGarity's blood sugar is falling dangerously low. Ansil, a diabetic-assistance dog, is alerting McGarity as clearly as he can. When McGarity wakes, he'll check his blood sugar and take steps to fix it. If he doesn't wake up, Ansil is trained to get help.

Ansil, a 3-year-old golden retriever, and McGarity, a diabetic living in Campobello, S.C., work together to keep McGarity healthy.

"I've had Ansil 14 months," McGarity said. "Everywhere I go, he goes with me. I have him attached to me like a prosthetic leg."

McGarity is a Type 1 diabetic and has been insulin-dependent for 40 years. In Type 1 diabetes, the body doesn't produce hormones, including insulin, to regulate blood sugar, according to the American Diabetes Association.

Type 1 diabetics must monitor their blood sugar so that it doesn't become too high or too low. If it does, complications such as blindness, nerve damage or death can occur.

Three years ago, McGarity began having problems maintaining his blood sugar and was struggling against diabetic comas, he said. But since Ansil came, McGarity has had little problem maintaining his blood sugar.

"I do have highs and lows, but he recognizes them before I get into a terrible situation," McGarity said. "He protects me."

"Even at home, my confidence is... way higher with him in my life," McGarity said. "He lets me know when I start to get in trouble so I don't get into deep trouble."

Ansil is the first diabetic-assistance dog trained by Eyes Ears Nose and Paws. McGarity is the first and only client of EENP's diabetic-assistance dog program.

Why a dog?

Even diabetics who check their blood sugar eight times a day have highs and lows, Cunningham said. When a diabetic's blood sugar gets low, his or her judgment often suffers, she said. A diabetic-assistance dog is a physical reminder to pay attention.

Dogs can also detect blood sugar changes more quickly than blood glucose meters, Cunningham said. With quicker notification, diabetics can keep the levels in the appropriate range, she said.

"Often diabetics will have a high high or a low low, and then their blood sugar will bounce across a huge range for the next few days," Cunningham said. Dogs can help prevent these swings.

Also, if a diabetic has an emergency, the dog can get help.

McGarity enjoys this partnership with Ansil.

"All a dog wants to do is please you," he said.

"So all Ansil wants to do is make me a happy guy and take care of me, much like I do him."

The only downside?

"He's really spoiled," McGarity said.

"I can't go anywhere without him without someone asking 'Where's Ansil?' They ask how he's doing, but they never ask how I'm doing."