Insulin pump is a very good way to treat diabetes, if not used properly, it can cause some adverse reactions, now according to the clinical work may occur in the situation, make a brief introduction.
First, the insulin pump with the pump before the preparation.
1, to understand the patient’s medical history: history of diabetes, history of insulin dosage, past medical history, age, sex, height, weight, obesity, etc. In 18-72 hours using medium and long-acting insulin, switch to short-acting multiple insulin injections, and use the pump as soon as possible for those with unstable blood sugar.
2.Insulin preparation: Put insulin at room temperature 6 hours in advance.
3.Set up the program: set up the pump basal volume with the large dose before meal, clock and other related data.
4.Serve insulin: and make sure it can be released normally.
5, skin treatment installation: abdomen: avoid the umbilicus and waistband area, insulin absorption is the fastest, more predictable, less affected by the activities of site replacement: other optional sites include the buttocks, upper outer thigh, upper arm, 3-5cm from the previous site) the needle at the front of the catheter into the subcutaneous and fixed with mucosal film.
Second, insulin pump installation precautions
1. Blood glucose test before installation: The blood glucose test is to determine whether the amount of additional insulin should be appropriate after the replacement of the site and the replacement of consumables.
2. Venting of the reservoir and opening the pipeline of consumables during installation: Since the insulin pump needs to use the reservoir to store insulin in advance, the exhaust of the reservoir must be done before installation to avoid the retention of gas; at the same time, since the pump needs to connect the pipeline, needle and body, it is necessary to open the pipeline through the reservoir or the special function provided by the insulin pump when replacing the new pipeline to avoid the residual gas in the pipeline, so that the insulin cannot be replaced. Therefore, it is necessary to open the pipeline through the special function provided by the reservoir or the insulin pump when replacing the new pipeline to avoid the inevitable hyperglycemia caused by the gas residue in the pipeline that prevents the insulin from being injected subcutaneously normally.
3.After installing the new consumables, you should usually test the blood glucose again: to confirm whether the insulin injection is normal.
4.Use period: Although it is pointed out in the manuals of various insulin pumps that the useable time limit of consumables is 7-10 days, the usual situation is that 6-7 days is a limit number of days, otherwise it is easy to produce subcutaneous hard knots, and at the same time insulin will be poorly absorbed due to subcutaneous hard knots, resulting in unexplained increase in blood glucose, so it is recommended that the interval between replacing consumables should be 7 days at most, and more attention should be paid to the fluctuation of blood glucose on the day of replacing consumables. Therefore, it is recommended that the interval between replacement of consumables should be 7 days at most.
III. Setting the insulin dosage of the pump
The most important thing before starting insulin pump therapy is to determine how many doses of insulin the patient needs throughout the day, i.e. the total amount of insulin per day. The insulin pump simulates the physiological secretion of human pancreas to the maximum extent, and it designs the basic secretion of human pancreas and the secretion of insulin after eating into the pump respectively. They are the basal amount and the premeal high dose respectively.
Under normal circumstances, insulin pumps installed in hospital need to detect blood sugar 7-8 times a day: before three meals, two hours after three meals, at night when going to sleep and 2-3 points at night; and if the family replaces the supplies, it depends on the time of your new supplies, generally before and after the installation of blood sugar detection should be in any two of these 7-8 points, so that you can generally determine whether the installation is normal and proper.
Fourth, insulin pump use precautions
1, the insulin used in the insulin pump is short-acting or ultra-short-acting (if the product of Novo Nordisk is Novolin R or Novolac), and not to use premixed or long-acting, medium-acting insulin, in order to avoid injury to the device. The difference between Novolin and Novolac is that Novolac has a smaller base volume and a larger additional volume; while Novolac is the opposite of Novolac, but because Novolac is still self-funded and more expensive than Novolac, it has not yet been fully popularized, but Novolac is the only insulin analogue approved by the FDA for gestational diabetes.
2, because the insulin pump is a long-term, small dose of continuous subcutaneous injection, so the dose of insulin used compared to the daily two, three or four injections should be less, and generally 75%-85% of the dose of injections used throughout the day can be determined as the amount of insulin used by the insulin pump throughout the day, of which 50% is used as a continuous small dose of injections throughout the day (we call it the basal amount, the same below);
The other 50% is used as temporary injections before three meals per day (we call it additional dose, or pre-meal high dose, the same below). In general, when the patient is hospitalized and the pump is installed, the doctor adjusts the basic amount of time and the related dosage for the patient, and this amount should not be easily adjusted after the patient is discharged from the hospital to avoid accidents such as ketosis; while the additional amount is generally before breakfast〉before dinner〉before lunch, and this amount can be appropriately adjusted by the patient, but the general principle should not be changed, otherwise it is also easy to produce accidents such as hypoglycemia.
3, insulin pump in the use of the process may appear blocking the tube, leakage night and other unexpected situations, so patients should be skilled in the use of the situation for the exclusion of the above-mentioned situation, if the exclusion of the device itself, the possibility of the following points.
(1) If the needle is stuck into the subcutaneous when there is blood reflux back into the tube;
(2) If there is a hollow feeling when the needle is inserted under the skin;
(3) If the needle is inserted into the subcutaneous fat layer shallow, the above situation may occur, in which case the consumables and injection site should be replaced in time to avoid hyperglycemia.