What is an Insulin Pump?

The insulin pump consists of a pump, a small syringe and an infusion tube connected to it. A small syringe can hold up to 3 milliliters of insulin. After the syringe is installed in the pump, the guide needle at the front of the connected infusion tube is inserted into the patient's skin (usually the abdominal wall), and the screw motor of the insulin pump is driven by the battery. Push the piston of the small syringe to inject insulin into the body. The basic purpose of the insulin pump is to simulate the secretory function of the pancreas. The insulin is continuously injected under the user's skin according to the dose required by the human body, keeping the blood sugar stable throughout the day to achieve control. The purpose of diabetes.

Insulin pump therapy is an insulin therapy method that uses artificial intelligence-controlled insulin input devices to simulate the physiological secretion pattern of insulin by continuously injecting insulin subcutaneously to control hyperglycemia. A short-acting or fast-acting insulin reservoir is installed inside, there is a display screen and some buttons for setting the pump program, and a sensitive drive motor slowly pushes insulin from the reservoir through the infusion catheter into the skin. Infusion catheters vary in length and securely connect the pump to the body.

(1) Simulate physiological pancreatic secretion function for better control

In order to simulate physiological insulin secretion, a continuous subcutaneous insulin infusion method was tried as early as the 1960s, and the mechanical insulin infusion device, the prototype of the insulin pump, was used in the late 1970s, but it was difficult to use it clinically due to its large size and complicated operation. Promotion. By the 1990s, the advancement of manufacturing technology made the insulin pumps smaller in size, easier to carry, easier to operate, easier to learn and use, and more accurate and stable dose adjustment, so they were used more and more widely in clinical practice. At present, insulin pump technology is more complete It can more accurately simulate the physiological insulin secretion pattern. In short, the insulin pump is controlled by artificial intelligence to simulate the basal insulin secretion in the body in an adjustable pulsed subcutaneous infusion mode. At the same time, during meals, the pre-meal insulin and infusion mode are set according to the type and amount of food. Control your postprandial blood sugar.

Insulin pump consists of 4 parts: artificial intelligence control system containing microelectronic chip, battery-driven

Mechanical pump system, reservoir, infusion tube and subcutaneous infusion device connected to it. The front end of the infusion tube can be buried under the patient's skin. In the working state, the pump mechanical system receives the instructions of the control system, drives the piston in the medicine reservoir, and finally inputs insulin into the skin through the infusion tube.

Characteristics of human insulin physiological function: trace, continuous insulin secretion.

The biggest features of the insulin pump: basal rate (micro, continuous), make the insulin fed more physiological, rationalize the basal secretion of insulin under the physiological state of the human body, it not only secretes a small amount of insulin every 3-5 minutes, but also has peaks and valleys throughout the day. Two crests and two troughs, that is: peaks from 5 to 6 in the morning and peaks from 4 to 5 in the afternoon; 10 am to 2 pm and 10 pm to 2 am are the least physiological requirements for insulin, self Minimum basal insulin secretion.

The insulin pump can simulate the secretion of physiological insulin, making the blood sugar stable, normal, and more perfect:

1. Because the insulin pump only outputs a small amount of insulin at night, no longer use intermediate or long-acting insulin, and there is no peak glucose-lowering effect of these two long-acting preparations at night, which reduces nocturnal hypoglycemia and can automatically increase insulin input in the middle of the night Early morning high blood sugar normalized fasting blood sugar and daytime blood sugar, and reduced the amount of insulin used throughout the day.

2. No need to inject multiple times a day.

3. Reduce the amount of insulin before meals, avoid overlapping effects of large doses of short-acting and medium-acting insulin in the body, and reduce the incidence of hypoglycemia.

Post-prandial hyperglycemia is often unavoidable even with insulin injection in patients with type 4.1 diabetes, and post-prandial blood glucose can be effectively reduced after using the pump to almost normal levels.

5. Avoid blood sugar fluctuations, reduce the level of glycated hemoglobin, thereby delaying or even preventing the occurrence and progression of multiple complications of diabetes.

6. It increases the freedom of eating for diabetics, makes life diverse and flexible, and improves the quality of life.

7. Enhances the health and nutritional status of the body, improves the patient's courage and confidence to overcome the disease, and significantly reduces the heavy mental and psychological pressure caused by the disease.

8. For some diabetic patients who have irregular life and work and often work overtime, night shifts, travel, and business flights, especially those working in the transportation sector, using an insulin pump can control blood sugar well, without the need to eat or eat regularly. No hypoglycemia will occur.

9. Completely normal metabolic conditions and almost normal or completely normal blood glucose levels can be obtained after using insulin pumps in well-educated diabetic patients.

1. Before use, you must have sufficient mental preparation and financial preparation:

Insulin pumps are expensive. Imported pumps cost 40,000 to 50,000 yuan each. Domestic pumps cost 20,000 to 30,000 yuan each. In addition to the cost of insulin, consumables (insulin reservoirs, connection tubes, special injection needles, special Paste materials) need to be changed frequently, about 100-200 yuan per month, currently not included in the scope of medical insurance reimbursement, at their own expense. If you do nt feel comfortable with the needle or do nt feel comfortable with the needle after using it, the insulin pump ca nt be returned, and tens of thousands of yuan will be wasted.

2. The insulin used by the insulin pump is short-acting insulin or ultra-short-acting insulin analogs, and medium and long-acting protamine zinc insulin or ultra-long-acting insulin analogs cannot be used. Short-acting insulin is a hexamer, which breaks down into monomers in the body to take effect. It takes a certain amount of time, while ultra-short-acting insulin analogs are dimers, which break down into monomers quickly. It is best to use an ultrashort-acting insulin pump Insulin analogs work faster in the body and closer to physiological states.

3 The insulin pump injects insulin or insulin analogs into the subcutaneous tissue. The absorption rate and absorption curve of insulin are similar to the subcutaneous injection of insulin with a syringe. The additional insulin before a meal reduces the postprandial blood glucose to the desired level. It is also very strong and can still cause hypoglycemia, so additional meals are still necessary.

4 The insulin in the solution is a hexamer, which breaks down into monomers relatively slowly. The ultra-short-acting insulin analog in the solution is a dimer, which breaks down into monomers quickly, so the 24-hour basal insulin injection distribution dose and the addition before meals At the insulin dose, the short-acting insulin is injected 1/2 to 1 hour earlier than the ultra-short-acting insulin analog (see Tables 26.1 and 26.2).

5. The concentration of insulin used by the insulin pump is 100 units / ml, which is the same as the concentration of human insulin refills. The concentration of ordinary bottled insulin is 40 units / ml, which cannot be used for insulin pumps.

6. Change the needle and connection tube regularly as required to prevent infection and blockage.

7. You can press the additional insulin button according to the meal time, and you can adjust the additional insulin dose at any time according to the amount of food.

8. If you are in a stress state, you can adjust the amount of basal insulin injection at any time. When the state of stress gradually improves, you must adjust the amount of basal insulin injection at any time to avoid hypoglycemia.

9. Always ask an endocrinologist or a professional doctor at the after-sales service point to check the use of the insulin pump and adjust the insulin dose. ^[1]

Stainless steel needle

Advantages: painless during needle insertion, good insulin compatibility, low price

Disadvantages: Occasionally pain in non-needle areas. Individuals may be allergic to nickel in stainless needle steel.

Hose needle

Pros: Psychologically easier to accept for patients who have a catheter placed under the skin

Disadvantages: 1. It may be painful when the needle is not inserted correctly (thin people should enter the needle at 30 degrees, and fat people should enter the needle at 45 degrees); 2. easy tortuous causes tube obstruction, which causes blood sugar to go up and down; 3. Skin pinholes are large and scars may appear; 4. The price is high and can not be used after skin extraction.

Selection principle

Stainless steel needles are preferred, and soft needles are used if the steel needles are allergic.

The needle is generally inserted into the subcutaneous fat tissue of the abdomen. The process of placing the needle of an infusion line under the skin is called "insertion." The infusion line is usually changed once a week, but when it is hot, it needs to be changed in two or three days.

The insulin pump infuses insulin continuously for 24 hours according to a program set for different wearers. A small amount of continuous infusion is called the "basal rate." This amount of insulin is used to control blood glucose between meals and at night in an ideal range. When eating, the user will set the pump to infuse a "large dose" of insulin that matches the amount of meal.

The insulin pump is not automatic, and the amount of insulin still needs to be determined based on the patient's condition. But the insulin pump is currently the most accurate, concise and free insulin infusion system. by

(1) It is mainly applicable to people with type 1 diabetes, especially those with "hard to control", "variable", and "fragile" conditions.

(2) Patients with diabetic ketoacidosis and hypertonic coma. It can increase the basal amount and shorten the "acceleration" time (once every 2-4 hours) according to the blood glucose level, and can replace the low-dose insulin intravenous method.

(3) Microvascular complications. Foreign reports can reduce the amount of trace protein and even disappear. Can be used for the treatment of diabetic nephropathy and retinopathy.

(4) Improve diabetic neuropathy.

(5) Relieve new-onset diabetes.

(6) It is suitable for pregnant women with diabetes or those who want to get pregnant after marriage.

(7) Severe diabetes type 2 can be considered when it is difficult to control or combine severe infections with the previous method.

(8) People with diabetes must undergo major surgery.

(9) For patients with irregular lives due to work reasons, insulin injection therapy is very difficult to control blood sugar stably.

Children and adolescents with type 1 diabetes must be treated with insulin. Almost all children and adolescents with type 1 diabetes have a marked dawning phenomenon. Subcutaneous injection of insulin treatment often causes midnight hypoglycemia and dawning hyperglycemia and dramatic fluctuations in blood glucose. Best for this crowd.

I. Indications for insulin pump therapy in children and adolescents with type 1 diabetes

1. Children and adolescents who are or will be on insulin therapy

2. Children and adolescents with persistently high blood sugar despite insulin therapy

3. Children and adolescents who have tried their best (including monitoring blood glucose multiple times a day, adjusting insulin doses, controlling diet, etc.) and still have difficulty in controlling hyperglycemia

4. Young women who want to become pregnant or already pregnant

5. Youth with extremely irregular lives and work (such as police, actors, firefighters, etc.)

6. Adolescents with diabetes who often participate in long-distance running, hiking, long-distance cycling, skiing, swimming, playing football and other sports

7. Diabetic youth in growth stage

8. Want to get better and tighter blood glucose controllers

9. The family has the necessary financial security

The key to the success of insulin pump treatment for children and adolescents is that parents choose the right treatment for their children.

2. When determining insulin pump treatment for children and adolescents, it is similar to that for adults in principle, but there are the following differences:

1. For children in the rapid growth period, in order to combat the rapid and large amount of growth hormone secreted after falling asleep, it is often necessary to increase the basal rate from dinner to midnight, and the adult basal rate at night usually increases from 3 to 4 am The maximum output rate is from 5 to 6 o'clock, which gradually decreases after 7 o'clock, and children often need to increase the basal rate from 1 to 2 hours before falling asleep depending on the time of falling asleep. Inhibit hyperglycemia at night and dawn caused by increased growth hormone secretion.

2. Children and adolescents need fast meals, in addition to three meals a day, in addition to three meals a day to ensure that there are enough calories and nutrition, so the ratio of the amount of additional insulin and the basal rate is different from adults.

3. Adolescence is the most irregular of "eating", "moving" and "sleeping", often accompanied by huge fluctuations in blood glucose.

4. Adolescents in adolescence due to the large secretion of sex hormones increase insulin requirements, changes and blood sugar fluctuations, especially girls and young women after menarche, often have blood sugar fluctuations during the menstrual cycle. Causes large changes in insulin requirements.

For this reason, it is very important for children and adolescents with diabetes and their parents to understand the treatment of insulin pump correctly before starting insulin pump treatment, because children's diabetes is more difficult to control than adults. Normal growth requires greater effort and patience to obtain good results.

Insulin supplementation in the early stages of type 2 diabetes can effectively control hyperglycemia, restore B cell function to a certain extent, and then alleviate the condition of diabetes for a period of time. Insulin pump is currently the most accurate, simple and free insulin infusion system, and it is also one of the main means of intensive insulin therapy. Compared with multiple daily insulin injections, insulin pumps can better control blood sugar, and the incidence of hypoglycemic events has decreased significantly. Patients can choose meal time more flexibly, especially for patients with poor blood glucose control due to irregular working hours, inability to take medications and meals regularly.

"Short-term wearing a pump" for patients with first-onset type 2 diabetes

Insulin supplementation in the early stages of type 2 diabetes can effectively control hyperglycemia, restore B cell function to a certain extent, and then alleviate the condition of diabetes for a period of time. In recent years, research on newly diagnosed type 2 diabetes patients has found that within several years after intensive treatment with an insulin pump, some patients can maintain a good blood sugar status by simply eating and exercising, and most patients get first-phase insulin secretion. Different degrees of recovery.

Wear a pump after oral hypoglycemic agents fail

The failure of oral hypoglycemic drugs is one of the problems in the treatment of patients with type 2 diabetes. Increased insulin resistance and

(1) Able to self-monitor blood glucose frequently (at least 4 times a day).

(2) Have good self-care ability and initiative to control blood sugar.

(3) Have certain cultural knowledge and comprehension ability, can understand the explanations of the training staff, learn the basic operation of the insulin pump under the guidance of a doctor, such as replacing the battery and the medicine reservoir, etc., and if there are some small problems, they can handle it by themselves. And can follow the doctor's requirements, seek medical treatment on time, and keep in touch with medical staff at any time.

(4) It must have a certain economic capacity, because the price of insulin pumps is relatively expensive, on average 20,000 to 60,000 yuan.

On December 19, 2014, Medtronic Diabetes Business Group signed a contract with the Qingdao Social Insurance Bureau to join the "Qingdao Special Medicine (Special Material) Rescue Access Variety Management Service Agreement". According to the agreement, the two parties will establish a co-payment mechanism for the latest 722 real-time dynamic insulin pump system in the Medtronic insulin pump product series, and officially include insulin pump therapy in the coverage of Qingdao social medical insurance.
From January 1, 2015, urban and rural medical insurance participants in Qingdao area, who have clinical diagnosis of type 1 diabetes and are under 18 years of age, can apply for special assistance in the insulin pump system. After the application is successful, the patient only needs to pay 30% of the price of the insulin pump when purchasing the insulin pump. The rescue fund established by the Qingdao Social Insurance Bureau will pay the remaining 70%. For the consumables required for the insulin pump, the same will be taken. The proportion is paid by the rescue fund and the patient. ^[2]

Pancreatic ^[3] island pumps have a history of more than 30 years since their invention, and Medtronic, the earliest operating insulin pump, has also developed for more than 20 years. With the improvement of technology, insulin pumps are getting closer to ideal artificial islets. Although its high price is difficult to be accepted by many patients, and insulin pumps are not in the scope of medical assistance in many countries, which limits its audience, but As a cutting-edge medical instrument, its practicality has been affirmed. The open-loop insulin pump requires users to pay attention to measuring blood glucose values on a regular basis, changing accessories regularly, and adjusting infusion procedures as needed. Often, many patients believe that the cost has not reached the halfway point due to the neglect of a certain point in life. Disable. The gradual maturity of the closed-loop system will surely make people have a new understanding of the insulin pump. Convenient operation and good treatment results will make many patients feel value for money. Since the publication of DCCT data in 1993, the number of insulin pump users has increased rapidly, and the care of related treatments has been valued by major hospitals, especially in developed countries. According to statistics, the number of patients with type 1 diabetes in Europe and the United States has reached 10 % ~ 25% [40], the market for insulin pumps is already clear. There are not many types of pump insulin, mainly insulin analogs. The total sales of insulin analogs in Europe and America in 2009 were 10.5 billion [41], occupying most of the market for diabetes treatment drugs, of which short-acting insulin analogs account for a large proportion, mainly short-acting and ultra-short-acting insulin analogs. Pump insulin also has great market potential.

Insulin pumps have not entered the Chinese market for a long time. Starting from Medtronic's introduction of insulin pumps with Chinese interface for Chinese patients, the production of insulin pumps in China has gradually developed, and soon has a place. Minimally invasive insulin pumps have also come out and have begun to compete with imported pumps.

The worldwide population of diabetic patients has been quite large, and most of them are still inconvenient for multiple subcutaneous administrations. Although the popularization of insulin pumps still takes some time, as the best method for diabetes treatment, the potential market for insulin pumps is very broad .