Booties on all four paws. Safety goggles. A protective covering over her coat. All geared up, Holly finds her mat in the alcove near Mollie Stark's workstation and gets comfortable.

Holly is a goldendoodle service dog trained to detect changes in Stark's blood sugar before her medical devices can.

"I knew people were going to look and talk whenever I brought Holly into the lab," Stark said. "But if I saw a cute dog in the lab, I'd be looking at it, too."

Stark was diagnosed with Type 1 diabetes when she was 9 years old. A pre-pharmacy student who will be starting the UMKC School of Pharmacy program this fall, she has spent more than a decade managing a condition that most people misunderstand.

"You hear the word diabetes, and you usually think of someone with Type 2 who is older and potentially overweight," Stark said. "Type 1 diabetes is an autoimmune disease. There's nothing I could have done to prevent it."

Type 1 diabetes is also unpredictable, and it certainly doesn't pause for class. During a lecture, Stark's blood sugar dropped, forcing her to stop taking notes and drink a juice box while her professor continued lecturing. This meant she had to miss out on a portion of class just to manage her blood sugar levels.

In lab settings, losing 10-15 minutes to manage blood sugar levels can be more unforgiving. If Stark’s blood sugar crashes mid-reaction, she must leave the experiment to manage her levels, which can result in it being unsuccessful and a loss of over an hour’s worth of reactions. During exams, a low blood sugar can cost her up to 15 minutes of focus she can't usually afford.

To help manage her blood sugar, Stark uses a Dexcom continuous glucose monitor and an Omnipod insulin pump. However, the Dexcom can run 10 to 15 minutes behind real-time readings and its readings at times can be off by up to 20%.

"If my blood sugar is 300, Dexcom might not read 300," Stark said. "I just wouldn't get the insulin I need as soon as possible.”

Service dogs trained to detect blood sugar changes had always been on Stark's radar. Late last year, Stark's mother learned about CARES Inc., a service dog organization based in Concordia, Kansas, through a colleague who had a therapy dog. For Stark's wedding gift last July, her mother paid the deposit to get her on the waitlist. By December, CARES had a match. Stark spent a week in Kansas training with Holly before bringing her home.

Holly has been with Stark for a few months and is still learning Stark's individual blood sugar patterns.

In the middle of an organic chemistry lab session earlier this year, Stark noticed Holly sitting up and staring at her instead of sleeping. Her Dexcom read 101, which was not an alarming level. But Holly kept staring at her. Stark waited a few minutes and then stepped outside the lab to check her blood sugar with a finger poke. It read 84. Holly had caught the low blood sugar level before the Dexcom did.

"She knew she was supposed to be in a certain area, but also knew that something was wrong with me," Stark said. "It was interesting to see her do that for the first time, and I was glad I had her with me during that moment."

Holly detects blood sugar changes through smell. When Stark checks her blood sugar with a finger poke, she lets Holly smell the blood and then her breath. High blood sugar makes breath smell sweet while low blood sugar triggers a different hormonal response entirely. When Holly catches the right scent and alerts Stark, she gets a treat. Holly is still learning to distinguish between a routine check and a real warning but eventually she will simply smell Stark and know when to alert.

Bringing a service dog to class is straightforward in most settings. Bringing one into an organic chemistry lab is a whole other story.

"The honest answer is that it wasn't just 'a dog in a room,'" said Andrea Drew Hutchison, Ph.D., teaching professor of chemistry, coordinator of the undergraduate program in chemistry and coordinator of the organic chemistry labs. "It was a dog in a high-risk, controlled environment, and that changes everything."

Organic chemistry labs involve volatile solvents, glassware and hazardous chemicals. These are risks that students understand, but something a dog can't be trained to comprehend. The presence of a dog in lab also introduced practical safety concerns, like maintaining clear walkways, preventing tripping hazards and ensuring emergency procedures like evacuations or eyewash access weren’t compromised.

Hutchison worked with UMKC's Environmental Health and Safety (also known as EHS), Student Accessibility Services and the university's general counsel to develop a plan. Each group brought a different kind of expertise to the table. Chemistry lab coordinators helped outline the practical realities of the lab environment, including the procedures, materials and day-to-day risks. EHS focused on hazard assessment and risk mitigation, thinking through exposure pathways and necessary safeguards. Student Accessibility Services ensured appropriate accommodation for the students. Additionally, University of Missouri System general counsel helped interpret legal requirements and liability considerations, making sure the plan developed was compliant and defensible. Together, they developed a framework that was both inclusive and safety conscious.

Hutchison said it was important that UMKC treat this situation not as a one-time workaround, but as the foundation for accessibility policies.

"Handling it as a one-off might have solved the immediate situation, but it would have left us without clear guidance for the next time a situation like this comes up again. Accessibility and safety aren't competing priorities. They can be addressed together with the right planning and collaboration," Hutchison said.

The next step, now that UMKC has a policy, is to adapt it across all campuses in the UM System. For Stark, knowing that her experience will help make things easier for future students is meaningful.

"I'm glad I can help the university be more aware and inclusive about service dogs," she said. "I had no idea before I got Holly what any of this looked like. There’s a lot that goes into this, and I am glad I can make the experience smoother for future students.”

Stark is excited to start pharmacy school with Holly by her side.

“I’ve heard pharmacy school moves fast,” Stark said. “A 15-minute blood sugar crisis during a lecture or lab is time I may not be able to get back. With Holly, I hope to catch those moments before they become crises so that I can focus on getting good grades. For the first time since I've been diagnosed, I can kind of put diabetes to the side of my mind. I can rely on Holly instead of relying on how I'm feeling."