Diabetes mellitus is a common and frequent disease, which can cause multi-system damage for a long time, leading to chronic progressive lesions of heart, nerve, eye, kidney, blood vessel and other tissues, causing functional defects and failure, so effective blood sugar control can prevent and delay the generation and development of complications. Insulin pump, also called artificial extracorporeal islet, is being widely used worldwide as an advanced means of intensive diabetes treatment, which can mimic the secretion of insulin by human pancreas and can continuously control blood glucose and glycosylated hemoglobin in the normal range within 24h.
1. Clinical data
Forty-eight diabetic patients were treated intensively with insulin pump, 19 males and 29 females; age ranged from 23 to 80 years; medical history ranged from 3 to 35 years. Among them, there were 4 cases of type 1 diabetes and 44 cases of type 2 diabetes.
2.Care methods
2.1 Psychological care Most of the diabetic patients themselves have different degrees of anxiety, depression and other psychological barriers, plus insulin pump treatment for diabetes has not been widely used in China, most of the patients are willing to accept the treatment, but there are still doubts, and most patients do not know much about insulin pump. The author observed that 48 patients had different degrees of psychological burden before pump placement, which were as follows.
(1) 25 patients were worried about poor glycemic control, which affected the efficacy.
(2) 13 patients were afraid of hypoglycemic reaction.
(3) 39 patients were worried that carrying a pump 24h a day would cause inconvenience to their life.
(4) 21 patients were worried about the damage of the instrument.
(5) 18 patients were concerned about the cost. In response to these various psychological problems, the patients were introduced to the principle of the pathogenesis of diabetes, the theoretical basis of the action of insulin pumps, methods of use, precautions and common troubleshooting, etc. The patients were told that all patients who need insulin therapy can be treated with insulin pumps. Symptoms related to hypoglycemia and management measures are described in detail.
The insulin pump also avoids the pain of multiple daily subcutaneous injections and makes work and life easier and freer. The patient was explained and demonstrated the precautions about the pump and the emergency treatment after the machine alarm occurred. After patient and detailed explanation, the patients and their families gradually eliminated all kinds of doubts.
2.2 Treatment care
2.2.1 Preparation and care before pump placement The insulin pump is a computer-controlled high-tech product, and we selected patients who need insulin treatment and have a certain level of education as the target. 48 patients were first injected subcutaneously with short-acting insulin before meals and medium-acting insulin before bedtime 3 to 7 days before the pump was installed. At this time, patients should be urged to take a bath and change clothes to prevent skin infection.
2.2.2 Pump placement method and care
(1) Bring all the items used to the patient’s bed, ask the patient to take a lying or sitting position, and choose the puncture points on both sides of the umbilicus that do not obstruct activities. Disinfect the patient’s skin 3 times with 0.2% iodophor, and disinfect the operator’s hand at the same time.
(2) The nurse should assist the physician to carefully check whether there is gas in the insulin reservoir tube and filling hose during the process of pump installation. The nurse should master the installation and commissioning of different concentrations of insulin and the handling of common alarms, and infuse large doses for patients before meals at regular and quantitative intervals, as well as master the calculation and setting of insulin doses and the operation techniques of the pump and the handling of common faults.
2.2.3 Post-placement care
(1) Check the operation of the pump frequently and pay attention to the presence of infusion device drip, needle blockage, catheter fracture, insufficient battery power and insufficient drug solution. It is best to self-test the catheter system 1-2 times a day.
(2) Monitor blood glucose, pay attention to monitor the patient’s blood glucose 8 times in the first week, and adjust the basal amount in time; 5 cases in this group showed hypoglycemic reactions such as panic, sweating and hunger within 2 days after pump placement, which were corrected soon after timely detection and treatment.
(3) The site of tube placement should be chosen from the lower abdomen or the upper and lower limbs where the fat is thicker, to avoid affecting the blood pressure measurement.
(4) Local skin care. After the filling hose is kept under the skin for 2-3 (maximum 1 week), the placement site and the new subcutaneous hose need to be replaced, and the site should be more than 2-3 cm apart from the original injection site.
(5) Use the drug reservoir to extract the required insulin to connect the infusion device and exhaust the air, the drug should be extracted slowly and the air bubbles should be strictly prohibited to enter.
3.Experience
Insulin subcutaneous injection often brings great inconvenience to the life of diabetic patients, and for various reasons, the glycemic control of many patients is very unstable. Insulin pump is composed of several parts: microcomputer-controlled electronic information board, micro motor-driven spiral pusher, insulin reservoir, battery, and infusion catheter system.
The insulin pump provides 24-hour uninterrupted insulin infusion in microbasal amount, which reduces the local insulin “storage pool” formed during subcutaneous injection and shortens the “onset delay” of insulin absorption into blood from the injection site. Continuous subcutaneous insulin infusion can achieve ideal glycemic control in a short period of time and reverse some of the toxic effects of hyperglycemia. The insulin pump can continuously inhibit the anti-hormonal effect of insulin and provide more satisfactory control of the dawn phenomenon.
The application of insulin pump shortens the clinical treatment time, relieves the pain of multiple injections for diabetic patients, and maximizes the needs of patients. During the use of insulin pump, the nursing staff of our department has ensured the therapeutic effect of this new method through all-round systematic care. How to bring more benefits to patients is a new topic faced by the clinic.
The results of all-round nursing care for patients, from psychological and technical to family and social, with regard to the special characteristics of diabetes and insulin pump treatment, show that good systematic nursing care can ensure good glycemic control and improve the quality of life of diabetic patients treated with insulin pumps, which has important clinical and social significance.