Characteristics of the physiological function of human insulin: small amount, continuous insulin secretion Insulin pumps the biggest feature: the basal rate (micro-volume, continuous), so that the administration of insulin into a more physiological, rationalization of the physiological state of the human body in the basal secretion of insulin, which not only secretes a micro-volume of insulin every 3-5 minutes, and There are peaks and valleys throughout the day. Two peaks and two valleys. That is: the peak is reached from 5:00 to 6:00 in the morning, and the peak is reached from 4:00 to 5:00 in the afternoon; 10:00 a.m. to 2:00 p.m. and 10:00 p.m. to 2:00 a.m. are the times when the physiological need of insulin is the least and the secretion of basal insulin is the lowest. The insulin pump can simulate the physiological basal insulin secretion with peaks and troughs. Make blood glucose stable, normal, more perfect 1. Because insulin pump only outputs micro insulin at night, no longer use intermediate-acting insulin or long-acting insulin, there is no peak glucose-lowering effect at night of these two kinds of long-acting preparations, which reduces the hypoglycemia at night, and then automatically increase insulin input in the second half of the night to reduce the hyperglycemia in the early morning, so as to normalize the fasting glucose and daytime glucose, and to reduce the dosage of insulin for the whole day.2. No need to inject several times a day.3. Reduce the dosage of preprandial insulin, avoiding the overlapping effect of large doses of short-acting and intermediate-acting insulin injections in the body and reducing the occurrence of hypoglycemia.4. Postprandial hyperglycemia is often unavoidable in patients with type 1 diabetes mellitus even if they are injected with insulin treatment, and postprandial blood glucose can be effectively reduced after the use of the pump to almost reach the normal level.5. Avoiding the fluctuation of blood glucose and lowering the level of glycosylated hemoglobin, thus Prevents the occurrence and progress of multiple complications of diabetes.6. Increases the freedom of diabetic patients to eat, making life varied and flexible, and improves the quality of life.7. Enhances the health and nutritional status of the body and improves the courage and confidence of patients in overcoming the disease and in life, and significantly reduces the heavy mental and psychological pressure caused by the disease.8. For some people who live and work in an irregular manner, often work overtime, work night shifts, and travel, For some diabetic patients who live and work irregularly, often work overtime, night shifts, travel, business flights, especially those who work in the transportation sector, the use of insulin pumps can control blood glucose well without the need for regular meals or additional meals, and no hypoglycemia will occur.9. In the well-trained and educated diabetic patients who use the insulin pumps can obtain completely normal metabolic conditions and almost normal or completely normal blood glucose levels.
Stainless steel needles:AdvantagesNo pain on entry, good compatibility with insulin, low price, multiple use; DisadvantagesOccasional pain at non-entry sites, and individuals may be allergic to nickel in the steel of the stainless needles.
Polytetrafluoroethylene hose needles: Advantages catheter soft subcutaneous buried patients psychologically easier to accept; Disadvantages 1, the needle into the incorrect method may be painful (thin people should be 30 degrees into the needle, fat people should be 45 degrees into the needle); 2, easy to twist and turn caused by the blockage of the pipeline, resulting in blood glucose fluctuating high and low; 3, into the skin at the needle needle eye is larger, there may be a scar; 4, the price is higher, can not be reused after the skin is pulled out.
The principle of choice: prioritize the use of stainless steel needles, if the steel needle allergy and then use a soft needle.
The needle is usually inserted into the subcutaneous fat tissue of the abdomen. The process of placing the needle of the infusion line under the skin is called "insertion. The infusion line is usually changed once a week, but in hot weather, it may take 2 or 3 days to change the site.
The insulin pump delivers a continuous infusion of insulin 24 hours a day, according to a program set for each wearer. A small amount of insulin that is continuously infused is called the "basal rate". This amount of insulin is used to control blood glucose in the desired range between meals and at night. When a meal is eaten, the user sets the pump to deliver a "high dose" of insulin that matches the amount of the meal.
Insulin pumps are not automated, and the amount of insulin administered still needs to be determined by the patient's condition. But the insulin pump is the most accurate, simple and free insulin infusion system available. Through blood glucose monitoring, experienced pump users can utilize this weapon to achieve perfect glycemic control and lead a normal life without being limited by the strict diet and meal requirements of traditional insulin therapy.
Insulin pump therapy has many unique advantages over conventional injection therapy: better blood glucose control than multiple injections a day -- statistically, the HbA1c (glycosylated hemoglobin) of insulin pump users is lower than that of patients who take injections, and more importantly, their blood glucose fluctuates less and tends to be normal. level. Fewer hypoglycemic worries -- The basal rate of short-acting insulin infusion replaces long-acting insulin in the treatment of diabetes, and there is no longer a need for regular meals, which can be delayed or canceled without worrying about the occurrence of hypoglycemia. Wearers of the pump blood glucose decline is more gentle, can be detected early symptoms of hypoglycemia, can minimize the help of others.
Freedom of life -- you can sleep in, eat when you want, and not eat when you don't want. No one can live a consistent life for a long time, and with an insulin pump, you can choose when to eat, exercise, and sleep,
even when you work shifts or even travel across time zones, your blood sugar is easier to control.
Precise Insulin Infusion -- If you want to inject 1.7 units of insulin accurately, the insulin pump can
do it completely because the pump can infuse up to 0.05 units of insulin accurately. Children and lean adults with diabetes who are sensitive to
small doses of insulin are best treated with an insulin pump.
Convenience - Take your mind off the hassle and pain of having to take injections all the time. With an insulin pump, you can take your insulin at any time
and any place, just turn your body sideways, press a few buttons, and the insulin is automatically fed into your body, which is easy and not
undignified.
No needles - Multiple insulin injections in a day bring discomfort to patients and may cause subcutaneous fat
tissue atrophy, forming unsightly cellulite-like dimples and localized hardening of the skin, leading to unstable insulin absorption. With
insulin pump, you only need to change the infusion line every 2-4 days, just bury a small hose under the skin
without causing skin damage.
Simple adjustment - a change in routine. During childhood growth and development, seasonal sports, pregnancy, menopause, or acute illnesses, the body's insulin needs change all the time
With an insulin pump, you can easily adjust the amount of insulin input to best meet the body's needs
.
Weight control -- Whether you are trying to gain or lose weight, an insulin pump allows you to regulate your diet as you would a normal person
, while working out to get healthier and more toned.
Better blood sugar control during exercise -- Long-acting insulin can cause an untimely drop in blood sugar during exercise,
and with an insulin pump, you'll never experience this low blood sugar again. Adjusting the preprandial high dose makes blood glucose easier to control during postprandial exercise
If you are going to exercise for a long period of time such as gardening activities, long distance running, etc., you can temporarily adjust the insulin basal rate downward
to make your blood glucose more stable and easier to control.
Novelty - No one can resist novelty and excitement. During diabetes treatment, insulin pump will bring you
passion and enjoyment, giving you a refreshing feeling (which is simply not possible with conventional injection therapy).
[edit]Three benefits of treating diabetes with an insulin pump
First, treating diabetes with an insulin pump can effectively control and delay complications. Insulin pump simulates physiological secretion, insulin absorption is stable, so the blood glucose control is smooth and up to standard, control and delay complications for 15.3 years. Life expectancy is extended by 5.1 years. International evidence-based medical research has confirmed: insulin pump therapy can reduce the risk of the following complications: retinopathy by 76%; neuropathy by 60%; nephropathy by 54%; and various cardiovascular events by 42%.
ii. Treatment of diabetes with an insulin pump increases the patient's freedom to live.
Third, while treating diabetes with an insulin pump, patients can still eat and sleep normally. [1]
[edit]How insulin pumps work
The body's liver stores glucose glycogen and releases small amounts of glucose into the bloodstream throughout the day, so we always have plenty of fuel for energy. To aid in the transport of glucose into body cells (while maintaining a stable blood glucose level), the pancreas releases tiny amounts of insulin into the bloodstream every few minutes. When the food we consume contains carbohydrates (sugar or starch), the blood glucose level rises rapidly, and the pancreas releases a large amount of insulin into the bloodstream, to prevent the level of blood glucose from getting too high. The insulin pump mimics the human pancreas by automatically releasing tiny amounts of short-acting insulin (1/10 or 1/100 of a unit) every few minutes, called the basal rate, to keep blood glucose steady between meals and during sleep at night. During meals, the pump is programmed (by pressing the button on the pump) to rapidly output a larger dose of insulin, called a high dose, which can deal with the amount of carbohydrates contained in food and thus effectively reduce the postprandial hyperglycemic state.
Insulin pump can infuse large or small amount of insulin according to the body's need, and multiple insulin injections in a day can not mimic the pancreatic secretion mechanism because the absorption of long-acting insulin (NPH, Lente,Ultralente) into the bloodstream is unstable, and it can not be infused continuously and stably according to the body's need. Long-acting insulin has a peak absorption, so meals and snacks must be taken regularly, whereas with an insulin pump, the basal rate of insulin stabilizes blood glucose between meals, so you are free to schedule your meals, exercise, and sleep - in other words, you live a truly normal, healthy, and free life !
[edit]Insulin pumps are suitable for those people
(1) Mainly suitable for type 1 diabetics, especially those whose condition is "difficult to control", "changeable" and "brittle". The first is for patients with type 1 diabetes who are "difficult to control", "fickle", and "brittle".
(2) Diabetic ketoacidosis, hyperosmolar coma and other patients. Can increase the basal amount according to the blood glucose level, shorten the "acceleration" time (2 to 4 hours once), can be an alternative to small-dose insulin intravenous method.
(3) microvascular complications. Foreign reports can make the amount of micro-protein reduced to disappear. It can be used in the treatment of diabetic nephropathy and retinopathy.
(4) Improve diabetic neuropathy.
(5) Relief of new-onset diabetes.
(6) For diabetic women who are pregnant or diabetic women who wish to become pregnant after marriage.
(7) For severe diabetes mellitus type 2, which is difficult to control with previous methods or when combined with severe infections.
(8) When a diabetic must undergo a major surgical procedure. (9) Patients who have irregular life due to work, and it is very difficult to control blood glucose stably with insulin injection therapy.
Insulin pump and children and adolescents
Children and adolescents with type I diabetes must be treated with insulin. Almost all children and adolescents with type I diabetes have obvious dawn phenomenon, and subcutaneous injection of insulin treatment often causes hypoglycemia in the middle of the night and hyperglycemia at dawn and dramatic fluctuation of blood glucose, and insulin pump is most suitable for this group.
I. Indications for insulin pump therapy in children and adolescents with type I diabetes
1. Children and adolescents who are on or will be on insulin therapy
2. Children and adolescents who have persistent hyperglycemia despite insulin therapy
3. Children and adolescents whose hyperglycemia is difficult to control even with the best of their efforts (including monitoring blood glucose several times a day, adjusting insulin dosage, and controlling their diets, etc.). Children and adolescents who have difficulty controlling high blood glucose despite their best efforts (including multiple daily monitoring of blood glucose, adjusting insulin doses, and controlling diet)
4. Young women who are trying to get pregnant or who are already pregnant
5. Youths who live and work very irregularly (such as police officers, actors, and firefighters)
6. Adolescents and young adults with diabetes who regularly participate in sports such as long-distance running, hiking, long-distance biking, skiing, swimming, or playing soccer
7. young people with diabetes who are growing and developing
8. people who want better and tighter glycemic control
9. families who have the necessary financial security
The key to success in treating children and adolescents with insulin pumps lies in the parents choosing the right treatment plan for their children.
Second, to determine the children and adolescents insulin pump therapy, in principle, similar to adults, but there are the following differences:
1. children in the rapid growth period, in order to fight against the rapid and massive secretion of growth hormone after sleep, often need to increase basal rate from dinner to the first half of the night that is to increase the basal rate of adults at night basal rate is often from the beginning of the morning 3-4 o'clock to start to increase, 5-6 output rate is the biggest, after 7 o'clock gradually decrease, the adult night basal rate is often from the beginning of the morning 3-4 points, the output rate of the 5-6 points, the maximum. Adult nighttime basal rates often start to increase from 3 to 4 in the morning, 5 to 6 output rate is the largest, and gradually decrease after 7 o'clock, while children according to the different sleep time often need to increase the basal rate from 1 to 2 hours before going to sleep, and reach the highest peak in the middle of the night at 3 to 4 o'clock, which can effectively inhibit growth hormone secretion caused by the increase in the night and the dawn of the hyperglycemia.
2. Children and adolescents, due to rapid growth, need to eat 1 to 2 times a day in addition to three meals to ensure sufficient calories and nutrition, so the additional amount of insulin and basal rate ratio is different from that of adults.
3. Adolescence is the most irregular period of "eating", "moving" and "sleeping", which is often accompanied by huge fluctuations in blood glucose.
4. Adolescents in puberty due to the large secretion of sex hormones to increase insulin needs, changes in blood sugar fluctuations, especially after the first menstruation of the girls and young women, menstrual cycle will often have fluctuations in blood sugar. This causes a large change in insulin requirements.
For this reason, it is very important for the specific group of diabetic children and adolescents and their parents to have a correct understanding of insulin pump therapy before they start it, because diabetes in children is more difficult to control than in adults, and it takes a lot more effort and patience to get a good outcome for a child to grow normally.
Type 2 diabetics should choose the right time to wear a pump
Supplementing with insulin in the early stages of type 2 diabetes can lead to effective control of hyperglycemia and a certain degree of restoration of B-cell function, which in turn can alleviate the diabetes condition over a period of time. The insulin pump is currently the most accurate, simple and free insulin infusion system and one of the main means of intensive insulin therapy. Compared to multiple daily insulin injections, insulin pumps provide better glycemic control and their incidence of hypoglycemic events is significantly reduced. Patients can choose their meal times more flexibly, which is especially superior for some patients who have poor glycemic control due to irregular work schedules and inability to take medication and eat meals regularly.
Short-term pump wearing in patients with first-onset type 2 diabetes
Supplemental insulin in the early stages of type 2 diabetes can provide effective control of hyperglycemia and a certain degree of recovery of B-cell function, which in turn can alleviate the condition of diabetes over a period of time. In recent years, studies of newly diagnosed type 2 diabetes patients have found that within a few years of intensive treatment with insulin pumps, some patients can maintain a good glycemic state with diet and exercise alone, and most patients' first-time-phase insulin secretion is restored to varying degrees.
Wearing a pump after failure of oral hypoglycemic agents
Failure of oral hypoglycemic agents is one of the challenges in the treatment of patients with type 2 diabetes. Increased insulin resistance and progressive decline in islet B-cell function may be the main reasons for secondary failure of oral hypoglycemic agents. Secondary failure of oral hypoglycemic agents aggravates insulin resistance, creating a vicious cycle of high blood glucose. Insulin pumps can simulate the normal physiological insulin secretion pattern and provide ideal control of blood glucose in a short period of time. It can also significantly increase the sensitivity of patients to oral hypoglycemic drugs, rapidly and stably control blood glucose throughout the day, significantly improve the insulin secretion ability of B cells, and reduce insulin resistance.
Patients with chronic complications wear pumps
Diabetic macrovascular and microvascular complications are a serious threat to the health of diabetic patients, and are the main cause of disability and death. Therefore, diabetics know that diabetes is not scary, but complications! Long-term high blood glucose or blood glucose high and low is the main cause of various complications of diabetes. Strict control of blood glucose, so that the blood glucose standard, can significantly reduce the occurrence of complications. Once complications occur, strict glycemic control is the main factor in slowing down the progress of complications. Studies have shown that intensive insulin pump therapy can reduce the incidence of microvascular complications in patients with type 2 diabetes mellitus by 60%, delay the onset of complications for 15.3 years, and extend life expectancy by 5.1 years. Imagine if you compare the inconvenience of living with tight glycemic control to 15 years of healthy living, which is more important?
Wearing a pump for a better quality of life
Many patients are going to two extremes - treating themselves too little as patients and treating themselves too much as patients. Too little attention to the disease results in a lack of attention to glycemic control up to standard, leading to a variety of complications, seriously affecting the patient's quality of life and life expectancy. And too strict control of diet and living has brought many patients great inconvenience in life and work. Many patients have to take their meals, medications or injections on time, and many of them have to take injections on airplanes or in hotel restrooms due to business trips, which may also attract curious or misunderstanding eyes. If you give up injecting insulin for these reasons, you will cause harm to your body, and the insulin pump is a good solution to these problems. Insulin pumps are small in size and require only a few clicks of a button to inject insulin, which protects the privacy of patients who don't want others to know about their condition. You can eat with everyone at the table and don't have to wait a half hour after the injection to eat. The insulin pump allows patients to eat normally, sleep normally, work and study normally, bringing great convenience to their lives.
[edit]Conditions for using an insulin pump
(1) Being able to self-monitor blood glucose frequently (at least 4 times a day).
(2) To have good self-care ability and the initiative to control blood glucose.
(3) Have a certain degree of cultural knowledge and understanding, be able to listen to the trainer's explanation, learn the basic operation of the insulin pump under the guidance of the doctor, such as replacing the battery and drug reservoir, etc., and be able to deal with some minor problems on their own. And can follow the doctor's requirements, on time to the doctor, and at the same time with the medical staff to keep in touch at any time.
(4) To have some financial ability, because the insulin pump is relatively expensive, an average of 20,000 to 60,000 yuan.
[edit]Purchase of insulin pumps
Purchase of insulin pumps - safety
Because insulin is infused in the insulin pumps, the (non-operative) occurrence of no infusion or too much infusion can have serious consequences. Hyperglycemia, ketosis, ketoacidosis, etc. in the case of no infusion, and hypoglycemia, coma, or cardiovascular events caused by hypoglycemia in the case of occasional overinfusion.
So the requirements of the work and monitoring complement each other, a variety of alarm functions and reminders to protect the function of steady and persistent. Even if the operation is improper, timely reminder, timely detection, timely correction.
Selection and purchase of insulin pump--stable performance
Insulin pump is an electronic device, and it cannot avoid the drawbacks of electronic devices. This requires mature technology and stable performance. From time to time, this or that small problem (non-operational) will affect the therapeutic effect. The second aspect concerns the additional features of insulin pumps. Currently sold on the market are open-loop insulin pumps, major manufacturers are developing high-end insulin pumps (i.e., increase additional functions), the purpose is to allow patients to flexibly, better application of insulin treatment of diabetes, its operation is more complex. It requires patients to have an in-depth knowledge of insulin pumps (or computers) and healthy eating.
Selection of insulin pump - price
Price includes two aspects: the price of the insulin pump itself and the price of consumables a consumables
Insulin pump is a one-time investment, consumables is a long-term investment.
The first is the input of insulin pump, which should be determined by referring to the price of each manufacturer and avoiding certain interfering factors. Secondly, consider the long-term investment of consumables, as the saying goes, you can afford to buy a horse with a saddle.
Purchase of insulin pump--Service
Insulin pump is a special medical equipment, which needs good after-sales service. The first is the training after purchasing the pump, so that the patients can operate the insulin pump skillfully and avoid the treatment being affected due to improper operation, which requires special professional technicians (with in-depth knowledge of insulin pump and diabetes). The second is the ability to help in a timely manner with problems that arise during daily use. If a change is needed in a function that the patient has not mastered, timely help in adjusting it. Occasional problems with the device itself, timely provision of spare pumps.
Functions necessary for an insulin pump
Now there are at least 7 to 8 types of insulin pumps in the international arena, but in our country there are mainly 5 different types of insulin pumps made in the United States, Switzerland, Korea, and China. When you choose, the insulin pump needs to have at least the following basic functions so that the pump is safe and reliable.
1. The basal rate output must be very accurate and capable of delivering minute amounts of insulin in a very short period of time.
2. It must be able to adjust (increase or decrease) the basal rate very slightly, such as increasing/decreasing 0.1U of insulin per hour.
3. Be able to provide 24 variable basal rates - with the option to choose a different basal rate every hour, which is particularly important for children and adolescents with diabetes.
4. It should be easy for the patient to change the basal rate on their own, but not so easy that the basal rate changes incorrectly due to incorrect operation.
5. There are many different alarm functions, which can send out sound signals in time, such as no battery, catheter blockage, no insulin in the reservoir, failure of the electronic or mechanical parts of the pump, etc.
6.
6. The pump should have a safety protection function (reminder protection function), when it has been running for 10 to 12 hours, and the owner has not given the pump any instructions (such as not outputting the additional amount of pre-feeding), the "reminder protection function" will be activated to remind the owner whether he or she has forgotten to enter the additional amount of pre-feeding, or whether there are other unexpected circumstances. If there is still no instruction, the pump will automatically shut down. This feature is very important for those living alone with diabetes to avoid serious and fatal hypoglycemic events.
7. The pump should be easy to turn off and shut down, with an audible alarm to alert the pump owner when it is shut down and not infusing: "The pump is currently stopped", requiring the owner to turn the pump on and run it again. This feature prevents hyperglycemic events caused by forgetting to turn on the pump and stopping the infusion of insulin into the body.
8. The pump should be able to memorize, save and display all the insulin therapy information, such as the current time (x time x minutes on x day, x month, x year), the preset hourly basal rate, the current basal rate, the preprandial additions to the last meal output, the dose of insulin that has been infused into the body, and the current dose of insulin that is left in the reservoir, etc., so as to facilitate the query.
9. The pump should be sturdy, preferably shockproof and waterproof.
10. The pump should be light, small, convenient and easy to wear and cover.
11. The operation of outputting additional volume before meals should be simple and easy, and preferably can be done without looking through the pants.
12. The pump should ensure that there is absolutely no chance of an unintentional false change in basal rate or pre-meal volume increment by inadvertently hitting the pump buttons.
13. Pre-meal top-ups should be in small increments or decrements whenever possible (e.g., 0.5U/dose, sometimes 0.1U/dose for children) - this feature allows the pump operator to administer very small top-ups such as 0.5U or 0.1U prior to a meal, depending on the amount of different foods eaten, and this can be useful for children and adolescents who do not eat much. This is necessary for children and adolescents with diabetes who do not eat a lot of food.
14. The pump should allow the acoustic signals of all function keys to be turned off to ensure the owner's privacy when using the pump in a social setting, but not to turn off the audible signals of the safety alarms to ensure the safety of use.
15. The production and manufacture of the pump should be in line with the relevant authoritative certification of the production standards of medical devices, and through the international or China's relevant industry authorities, safety testing, registration and production approval.