title: The fractal nature of blood glucose fluctuations.
abstract: OBJECTIVE
  Fluctuations of blood glucose are generated by multiple external and internal factors continuously modifying glucose concentrations through complex feedback loops. This equilibrium may be perturbed during physiological or pathological conditions. The traditional theory suggests that physiological systems achieve homeostasis when disturbed and restore equilibrium through linear feedback loops. Complex systems on the other hand, may function nonlinearly with feedback loops that operate at different time scales, exhibiting chaotic or fractal behavior. We hypothesized that blood glucose fluctuations recorded for prolonged time periods show chaotic, fractal-like behavior that may be altered in diabetes.
  
  
  METHODS
  We applied nonlinear analytical methods such as detrended fluctuation analysis to glucose data derived from continuous glucose monitoring devices for prolonged time periods in healthy volunteers, diabetes type 1 and pregnant diabetes type 1 patients.
  
  
  RESULTS
  Glucose fluctuations extracted for prolonged time periods show fractal-like behavior and power law behavior of the system.
  
  
  CONCLUSIONS
  Hidden features underlying glucose fluctuations in health and in disease were revealed by using dynamic nonlinear analyses methods to discrete glucose readings extracted from continuous glucose monitoring devices. By using such methods we can enhance our understanding of the dynamics of blood glucose fluctuations in health and disease.
authors.affiliation: Department of Obstetrics & Gynecology, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Physiology, Haifa, Israel. Electronic address: wamir@netvision.net.il.
authors.forename: Amir
authors.initials: A
authors.lastname: Weissman
authors.affiliation: Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel; Department of Physiology, Haifa, Israel; The Sohnis Family Stem Cells Center, Haifa, Israel; The Rappaport Family Institute for Research in the Medical Sciences, Haifa, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Binah
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000453:epidemiology; D005260:Female; D017709:Fractals; D006262:Health; D006801:Humans; D017711:Nonlinear Dynamics; D011247:Pregnancy; D011254:Pregnancy in Diabetics / Q000097:blood* / Q000453:epidemiology
chemical_list: D001786:Blood Glucose
keywords: Diabetes; Fractal; Glucose; Glucose sensors; Pregnancy