GH-METHODS

Math-Physical Medicine

NO. 045

Categorizing PPG Waveforms into Three Generalized Distinctive Patterns Based on Wave Theory and Energy Theory (GH-Method: Math-Physical Medicine)

Corresponding Author: Gerald C. Hsu, eclaireMD Foundation, USA.

Introduction
This paper discusses three generalized waveform patterns of postprandial plasma glucose (PPG) data which were collected via a continuous glucose monitoring system (Sensor).

Method
The author has collected 17,046 glucose data by applying a sensor on his upper arm to collect his glucose values continuously, in parallel with his routine finger-piercing and testing strip (Finger) measurements (four times per day).  During this period of 241 days (5/5/2018-12/31/2018), he has collected his Sensor data about 71 times per day, approximately every 15 minutes during the day and every hour in the evening.  In total, he has generated 964 glucose waveforms, including 241 FPG and 723 PPG.  Other waveforms generated outside of the normal period range of PPG (180 minutes) are not included in this analysis.

Pattern one, known as Himalaya, has a continuous plateau which is caused by having excessive energy infusion from eating back-to-back meals or additional snacks/fruits and not enough energy diffusion due to inactivity after meal intake.

Pattern two, known as Grand Canyon, has a high peak (crest) but decaying rapidly to a low valley (trough) and staying there which is contributed by having sufficient post-meal exercise to diffuse energy.

Pattern three, known as Twin Peak or even Triple Peak, has a similar first peak as the Grand Canyon in the beginning but then a second or third peak shows up afterwards which is caused by having excessive left-over energy infusion from over-eating carbs/sugar in combined with insufficient energy diffusion due to interrupted post-meal exercise.

Results

  • PPG patterns distribution % & peak/average PPG (mg/dL):
    Himalaya 13% & 157/142;
    Grand Canyon 52% & 151/137;
    Twin Peak 35% & 159/150;
  • Sensor’s & Finger’s Average PPG: 135 mg/dL & 116 mg/dL (116%)
  • Peak & Averaged % (Sensor vs. Finger):
    Himalaya: 136% & 123%
    Grand Canyon: 129% & 118%
    Twin Peak: 146% & 129%

Conclusion
(1) For T2D patients, the preferred order of PPG patterns in terms of differential energy level are:

  • Grand Canyon (best),
  • Himalaya (in-between),
  • Twin Peak (worst).

(2) Avoid having back-to-back meals or over-eating carbs/fruits to reduce energy infusion.  Try to eat fruits during trough period between meals.

(3) Have sufficient quantity and non-interrupted post-meal exercise to diffuse energy.  Exercise longer period of time when eating more carbs/sugar during your meal.

(4) carbs/sugar intake amount determines peak value (amplitude) of glucose waveform while exercise amount and elapsed time determine the waveform patterns (i.e. decaying pattern shown in later 2/3 portion of waveform).

Figure: Generalized PPG Waveforms and Distribution % of Himalaya, Grand Canyon, & Twin Peak