Crystal Nichols' new best friend can be a real pest.

When Nichols is feeling low, Dela pushes and nudges until her buddy brings herself back up.

Dela hardly ever lets Nichols out of her sight.

Most people would consider Dela's behavior annoying. Nichols considers it life saving.

"It's a comfort to know that I have this companion who's involved with my disease," Nichols said from her Livermore home.

Nichols, a 21-year-old nursing student, has had Type 1 diabetes for 13 years. Dela, a 1-year-old black Labrador retriever, is her medical alert dog.

"When I read about dogs that can sniff out low blood sugars, that caught my attention," Nichols said. "It seemed amazing. I wanted to be part of something new."

Indeed, Nichols is on the cutting edge of what could be a new trend for service dogs. She is the first person to get a medical alert dog from Dogs for Diabetics, a year-old East Bay group that has the ambitious goal of being as synonymous with diabetes as guide dogs are for blind people.

"Our dream is to be able to take this new concept andthis new technology nationwide," founder Mark Ruefenacht said from the group's new Concord office. "We're building a good foundation for a nonprofit. We're working with local clients to build our foundation."

Ruefenacht, 44, works in his family's technology business and is a long-time volunteer dog trainer with San Rafael-based Guide Dogs for the Blind.

It was five years ago, when Ruefenacht was traveling in New York with a puppy in training, when he got the idea for Dogs for Diabetics. The typically calm puppy awoke Ruefenacht in the middle of the night with his relentless pawing and nudging.

When a frustrated Ruefenacht finally got out of bed, he realized that his blood sugar was dangerously low. The puppy had alerted his handler to what could have been a deadly situation.

What started as the seed of an idea expanded as Ruefenacht methodically studied what had caused the dog to pick up on the handler's low blood sugar. After years of research, Ruefenacht trained another dog — a yellow Labrador retriever named Armstrong — to be his medical alert dog.

Dogs are trained to detect the ever-so-subtle scent of low blood sugar by sniffing sweat and breath samples taken from people experiencing low blood sugar.

Nichols heard about Ruefenacht's fledgling non-profit group when she attended a support group for families dealing with Type 1 diabetes. The long-time diabetic and life-long animal lover was determined to get a medical alert dog.

"I'm so thrilled to be the first one," she said.

"We realized that no matter how many (sweat and breath) samples we use in training, it's really about working with a person," Ruefenacht added. "That's when we decided to go ahead and place a dog so that we could get it into real-life training. Overall, Dela has done exceptionally well."

More than 18 million Americans have diabetes, but only about 10 percent have the most severe form of the disease - Type 1 or insulin-dependent. It's an autoimmune disease in which the body turns on itself, ruining its ability to make the insulin everyone needs to stay alive. Insulin is what converts the sugars, or carbohydrates, in foods into energy.

It is not known what causes Type 1 diabetes, nor is there a cure. People like Nichols, most commonly diagnosed when they're children, rely on insulin - delivered by shots or an insulin pump - to stay alive. They must poke their fingers multiple times each day to check their blood sugar levels.

The longer a person has diabetes, the less likely they are to be able to feel when their blood sugar drops dangerously low. If it dips too low, a person could have a seizure, become unconscious or even die.

"You can't tell by looking at someone that they have diabetes," Nichols said. "More diabetics should have these dogs. Dela's woken me up twice in the middle of the night, and I'd only had her at my house three times. She alerts me when I don't even realize I'm low."

Dela (pronounced Day-la) went through about eight months of training before she was placed with Nichols.

Dela was trained to detect the smell of low blood sugar, a scent so faint that only an animal with the intense olfactory senses of a dog can pick up on it. After basic training, Dela and Nichols were trained to work together.

"She's been trained to bump me with her nose," Nichols said. "She'll jump up and hit my lower abdomen or legs with her nose. I've also noticed that she'll really start licking me a lot. She gets serious about licking my face."

It has taken time to train Nichols not to ignore the dog's somewhat annoying behaviors. She's merely trying to alert her handler to check her blood sugar.

"She gets frustrated with me if I don't pay attention to her," Nichols said with a chuckle. "She'll practically do a flying leap at me if I don't pay attention to her."

Nichols currently has Dela five days a week. The trusty pooch returns to the Dogs for Diabetics facility the other two days to continue her training and to assess how she's doing on the job with Nichols. The goal is for Dela to live with Nichols full time by the end of the year.

"Crystal knows she has to work with us to solve some problems and learn from the experience," Ruefenacht said. "It is very much a partnership. She's doing a lot of work."