To start we are going to define all the terms for your reference to make sure the rest of the process is smooth for you.
Terms
Metabolic Health
How your body utilizes energy from all your inputs (food, water, sleep, exercise etc)
Glucose
Understanding Glucose
What is a “normal” glucose level?
First, let’s outline all the ways you can test your glucose levels (also referred to as blood sugar levels):
- Blood work through your doctor (diabetes screening test)
- At home finger prick test
These methods measure fasting plasma glucose (FPG) or sometimes called fasting blood glucose (FBG), which is the most common practice. These tests are conducted by checking blood glucose levels after at least 8 hours of not consuming any calories prior to the test (called a “fasting/fasted” state)
Blood Glucose Measuring Metrics
Blood glucose levels are measured in either milligrams (mg) of glucose per deciliter (dl) of blood or mmol/L depending on the country you are in. (to get a mmol/L reading all you have to do is divide mg/dl by 18)
The American Diabetes Association (ADA) uses this test to classify people into three categories:
Normal
Prediabetes
Diabetes
According to ADA a normal fasting glucose must be under 100mg/dl (5.5mmol/L).
However, it’s important to note that post-meal glucose levels are equally important to measure because if they are too high, they can signify worsening glucose control inside the body which leads to cardiovascular disease, obesity, diabetes and impaired cognitive performance.
According to the International Diabetes Federation (IDF) a normal post meal glucose level should be no higher than 140mg/dl (7.78mmol/L).
Alternative Blood Glucose Tests
All of the previous glucose tests mentioned above are point-in-time glucose tests. At Theia one of our core principles we believe in is “always on data is more accurate than point in time data”.
Which brings us to a third way of testing blood glucose levels - through a technology called continuous glucose monitoring (CGM), which monitors your blood glucose levels all 24 hours of the day. This allows for deeper insights into your health like: analyzing moving averages of your glucose and daily up-and-down swings in blood glucose level.
CGM devices use interstitial glucose level testing (glucose from the fluid in between cells instead of from the blood). Interstitial glucose measuring correlates highly with blood/plasma glucose measures, however they are not the same and interstitial glucose measurements are not used for diagnosis.
There is currently no standard criteria for a 24 hour glucose moving average, however scientists are actively collecting more data on people using CGMs in the healthy population.
For the purpose of analyzing and benchmarking “normal” nondiabetic glucose levels, we have analyzed CGM studies to create benchmarks, which are the following:
Normal Glucose Ranges
- Avg Fasting Glucose: 85-92mg/dl (4.72-5.11 mmol/L)
- Avg Daily Glucose ranges 90%+ between 70-140mg/dl 3.88-5.78 mmol/L)
- 4% or less of the time glucose to go above 140mg/dl (5.78 mmol/L) or below 70mg/dl (3.88 mmol/L)
Optimal Glucose Ranges
- Avg Fasting Glucose: 72-85mg/dl (4-4.72 ddol/L)
- Avg Daily Glucose ranges 90%+ between 79-100mg/dl (4.39-5.56 mmol/L)
- Optimal post-meal glucose goal - 115mg/dL (6.38mmol/L) with less than 30mg/dl spikes from pre-meal levels
Prediabetes Glucose Ranges
Avg Fasting Glucose: 100-125mg/dl (5.6-6.9 mmol/L)
Diabetes Glucose Ranges
Avg Fasting Glucose: 125+mg/dl (5.6-6.9 mmol/L)
Glucose Spikes
Blood glucose naturally rises and falls, however when Theia's platform refers to a "Glucose Spike" we are referring to any glucose spike of more than 30mg/dl or a spike above 140mg/dl.
Glucose Dips
Theia's platform refers to a "Glucose Dip" when glucose dips more than 30mg/dl or a dips below 70mg/dl.
Hyperglycemia
A condition in which the level of glucose in the blood is higher than normal. This is interchangeably called "high blood sugar".
Hypoglycemia
A condition in which the level of glucose in the blood is lower than normal range (generally below 72mg/dl).
Postprandial
Occurring after a meal.
Time To Baseline
You will hear this reference talked about in training videos - it refers to how long it takes a glucose spike to come back to the baseline where it started from.
Biosensor
Any sensor that can be used to read biological data from the body.
Continuous Glucose Monitor (CGM)
A CGM reads glucose data via a person's fat cells in 5 minute intervals.
Time In Range
Whatever is set as a healthy range for the user is defined as their "healthy range". Thus, time in range means what % of time are they in their healthy zone.
Note: Out of the box the time in range differs for the daily graph vs. the activity graphs. The reason for the difference is that daily the glucose range is tighter whereas when logging activities it's normal to have some reaction in glucose, thus providing a larger range for glucose to come up and down.
Daily Graph
The range set here is 72-120 as optimal based on clinical trials in healthy individuals using CGM tech, as per our explanation earlier in the document.
Activity Graph
The range set here is 72-140 as optimal to allow for natural glucose spikes with logged activities.
Daily Metabolic Score
This is Theia's daily score it gives all users.
Think of this score as a "check engine light' for the body. The way it works is it's a score from 0-100, with 100 being the best. This was done on purpose to utilize user-learned behavior since grade one where all of us learned that 100 is the highest mark we can get on a test.
There is also a ring around the daily metabolic score which changes color from red to yellow to green. The higher the metabolic score the closer and the darker the green becomes. The lower the score, the more red it becomes.
The parameters set for someone to score positive on a daily score are as follows (within a 24 hour time range):
- Glucose stability (not a lot of ups and downs)
- Time in range (Glucose stays within 72-110mg/dl)
- Avg glucose remains between 85-110mg/dl
Example of a low scoring daily metabolic score
- Lots of glucose variability (constant ups and downs)
- Almost no time in range
- Avg glucose well over 110mg/dl
Example of a moderately high scoring daily metabolic score
- Decent amount of glucose variability (although not as much as the example above)
- Good amount of time in range
- Avg glucose stayed within 85-110mg/dl
Example of a high scoring daily metabolic score
- Low glucose variability (no real ups and downs)
- Very high time in range
- Avg glucose stayed within 85-110mg/dl
Activity Score
When using Theia, clients log activities throughout the day, all of which are given their own score. These activities can be anything from food, exercise or other.
The parameters set for someone to score positive on an activity are as follows (NOTE: This is for Theia's default activity scoring profile - you can change these parameters by creating/changing score profiles):
- Glucose spikes less than 30mg/dl from baseline
- Glucose doesn't spike over 140mg/dl
- Glucose does not dip below 72mg/dl
- Time in range stays within 72-140mg/dl
- Glucose stabilizes to starting baseline within 90 minutes
-
The analysis for a complete activity score is over 3 hours
- This gives Theia enough time to measure the body's response to the input as typically glucose levels stabilize within this time period
The scoring system is similar to how daily scores work, just using different variables. We are going to walk you through the variables and how to interpret activity score data.
Example of an activity that scored poorly
You will notice that these protein pancakes scored 35/100 and that the band is red. That is for the following reasons:
-
Glucose spiked over 140mg/dl
- Not only did it spike over 140mg/dl however it went up to 192mg/dl (thus impacting the score more than a spike that say went to 145mg/dl)
- Glucose spiked way over 30 mg/dl from one activity (impacting score more than had it spiked 32mg/dl from baseline)
-
The activity took over 90 minutes to stabilize back to baseline
- Time in range was low given that a lot of the 3 hours was spent outside of the green zone
For all of the reasons above, this activity scored low.
Example of an activity that scored moderately well
This sashimi meal scored 71/100 with the band showing in yellow/orange. Here were the reasons for the score:
-
Glucose spiked over 140mg/dl
- In this case spike to 178mg/dl vs. the 192mg/dl in the previous example (thus impacting the score less)
- Glucose spiked over 30 mg/dl from baseline
-
The activity took less than 90 minutes to stabilize back to baseline
- Time in range was high
Example of an activity that scored extremely well
This scramble with cheese scored a very high 95/100 and has a green band. Here is a breakdown of the score:
- No spike in glucose
- 100% time in range
- No hours to stabilize since there was no spike
Healthy spikes
Some activities create glucose spikes which are healthy in nature. Here is a list:
- High heat (Sauna's or long hikes in high temperatures)
- High cold (Cold plunges or other cold exposure therapy)
- High intensity exercise (HIIT)
The parameters in the default Theia activity score are as follows:
- Glucose spike of up to 50mg/dl from baseline
- 75 minutes post activity to stabilize
If someone goes outside of the above parameters, Theia starts to deduct points as the healthy activity starts to show too much strain on the body.
*Theia can only account for healthy spikes if the user logs them, otherwise the data won't be as clean.
**The healthy spikes are also accounted for in the daily metabolic score.
Score Profiles
Theia allows you to customize the scoring algorithm for both the daily metabolic score as well as the activity scores.
Every daily and activity score have a "profile" attached to them - always starting with Theia's out of the box profiles. Here is a reference on where you will see the profile selected in the app:
The reason score profiles were created is so you can cater to different clientele (type 2 diabetics vs a healthy client). The point of scores and score profiles is to meet the client where they are and motivate them to achieve better health.
Theia's out of the box algorithm is very good for lots of cases, however this is something to explore if you feel the algorithm isn't meeting the client where they are. To explore how to setup customized profiles please click here.
Reports & Analytics
Health Metrics Overview
In this section we are going to review exactly how to and where to look at data within Theia. Use the following methodologies to help automate and scale your health business.
Weekly Report
The primary use case of the weekly report is to act as a scorecard to show how a user is doing this week compared to last. Even though Theia engages daily the weekly report shows the user how they are trending week over week.
Here is the breakdown of how the weekly report shows data:
- % change in glucose spikes
- % change in glucose dips
- % change in avg daily score
- % change in activity score
(See sample report below)
Metabolic Report
Think of this report as a health overview over any timeline (one day, week, month, year etc.) The metabolic report is similar to the weekly report in terms of data shown with the added flexibility to see longer or shorter timelines depending on your use case.
(See sample metabolic report below)
In the context of the metabolic report, here is what all the metrics mean:
- Glucose Spikes: Anytime glucose goes over the upper green bound of the graph
- Glucose dips: Anytime glucose goes under the lower green bound of the graph
- Time in range: Time spent in the green zone of the graph
- Avg glucose: Weighted average of glucose for the time period selected
- Avg daily score: Weighted average of all daily scores for the time period selected
- Avg food score: Weighted average of all activity scores for the time period selected
Metabolic Graph
The metabolic report graph is interactive, where you can zoom in and out of specific areas to get more or less granular with your analysis.
For Desktop: Use your mouse to choose an area of exploration.
For Mobile: Pinch to zoom in and out.
Data Interpretation
When looking at data and metrics, there will be many different correlations or paths to take to administer care.
Running A Client Analysis
Attached is an example of how you would interpret all Theia data when actioning care plans and going into client meetings.
Below are all the metabolic health factors to consider as part of your analysis/interpretation:
Diet
There is many factors to diet, here are the key ones to consider when looking at data:
Food intolerance
Can cause an inflammatory response where additional testing is required. Intolerance can show as glucose spikes or dips even when the meal doesn't seem like it should act in that manner.
Over-eating
A more common one factor where people eat too much food. Eating too much of anything can cause irregular glucose fluctuations due to the excess energy the body is responding to.
Under-eating
Less common, however often not talked about. Glucose could show high even on low calorie and none-carb diets. The main reason here would be that the body is producing it's own energy due to sufficient energy coming in.
Portion sizes
People will eat thinking it's in accordance with their care plan unknowing that the amount of food is high/low. This can be seen in glucose data even when someone eats a 0 carb meal but sees abnormal blood sugar fluctation.
Nutrient Breakdown
Is the user adhering to their dietary guidelines or just thinks they are. Sometimes people think they are eating a lot of a certain macronutrient let's call it protein for this example. Yet they are less satieted and snack a lot. It could be an indicator that they are not satieted and their nutrient intake needs a rebalance.
Exercise
High Intensity Interval Training
It's natural for glucose spikes to occur during high intensity training. It's a period where the body is producing more energy to keep up. As long as a user logs an exercise as HIIT the Theia algorithm does not deduct point as it understand this is a healthy response.
The only time Theia will deduct point when someone logs a HIIT workout is if the data shows the users body is not recovering quickly enough and thus it may have been too intense of a workout.
Cardio
Depending on the type of cardio, typically the longer a person does cardio the more it stabilized blood sugar (caveat being HIIT as mentioned above). If glucose is remaining high with long bouts of cardio, it can be a sign that it's consistently high and you may wish to review other factors.
Resistance Training
This type of exercise often doesn't impact glucose in the short term, unless it's done with lots of intensity and becomes a cardio session as well. However, building muscle has shown to increase glucose stability over a longer period of time. It's good to see if this type of exercise is impacting irregular glucose spikes/dips as it could be a sign that something else is impacting the client.
Lifestyle Factors
High Heat/High Cold
A glucose spike is a natural response whenever a user does a cold plunge or enters a sauna. If the user logged this activity, the Theia algorithm knows it's a healthy spike and does not deduct points.
The only time Theia will deduct points is if the data shows the users body is not recovering quickly enough and thus it may have been too intense of a workout.
Stress
Whenever someone is feeling under pressure their physiology changes. There can be multiple instances in a day where glucose spikes without any food or exercise logging. In these situations if the use logs that they are stressed, it's a great way for you to explore what was happening in their life at that moment in time.
Feelings/Emotions
Similar to stress, users will go through a wide variety of feelings/emotions/day. All of these are good points of discussion to understand better how the user lives their life daily. There may be certain feelings that correlate more strongly with glucose spikes.
Other People
People are often tied to emotions, however, there may be certain days of the week you notice that a client does poorly or well on. If all other factors seem normal, then digging into relationships that serve/don't serve the client is a good path to explore.
Unfortunate Life Events
The passing of a loved one or a terminal diagnosis for example can impact all the other factors such as feelings/emotions. It's a consideration to take into effect if correlations are not making sense with glucose irregularity.
Hormone Factors
Pre/During/Post Menapause
A time when lots of things are changing in the body and users will need more assistance. It's good to This is highly personal so if you have checked all the other factors and glucose is still acting irregular, think about other diagnostics you could run in order to get more data.
Post Surgery
Anytime a user goes through surgery, it's a traumatic event and glucose irregularity is to be expected due to inflammation in the body. If the trendlines are moving in the right direction, no intervention may be needed. Otherwise, more diagnostics can be helpful to narrow down any complications.
Environmental Factors
Mold
Lots of homes all around the world have some type of mold build it. It can be severe or mild, however every user will have a different reaction to it. Glucose can react as the immune systems reacts and a giveaway of this happening is when glucose rises in certain parts of a home but not others.
Allergies
Cats, dogs, dust mites etc are known allergies which can be impacting blood sugar. This is dependent on the user and how severe of an allergy they have.
Co2
Poorly ventilated areas/homes/offices can have high Co2 buildup. This can cause inflammation in the body and thus spike glucose.
Water Supply
Due to poor filtration and old pipes it's common that the majority of people are taking in chemicals, heavy metals and sometimes bacteria from their water supply. Any combination of these can impact metabolic health via inflammation, allergic reaction or hormone disruption.
Tech Issues
Low Glucose
CGMs are great technology however they are not perfect. Anytime a sensor has lots of pressure put on it, the sensor thinks glucose is dipping causing a false negative. Check in with your client to make sure to see if they slept on their arm (the most common reason this happens) or put unknown pressure on their sensors.
Faulty Sensors
On the rare occasion a sensor can be faulty (reading extremely high or low). In these scenarios you may wish to test against a finger prick to make sure it's a sensor error vs. the client having hyper/hypo glycemia. In the case where the finger prick verifies the sensor is faulty, we have a streamlined process for requesting replacement on behalf of your client. Please just send them these instructions.
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