The concept of “diabetes is a chronic disease” has become almost ingrained in most patients, and there are many different ways to treat diabetes. Insulin injection therapy is one of the important treatments for diabetes, and insulin pumps can improve the quality of life of patients better than multiple insulin injections. However, what do you think is the problem of the low percentage of treatment with insulin pump in clinical practice? How to solve this dilemma? There are two main problems in the insulin pump market in China, firstly, the utilization rate of insulin pump is low, at present, the number of people with diabetes who choose insulin pump treatment in China is less than 1% of the total number of people; secondly, the indications for insulin pump use are confusing, for example, among the people with diabetes who choose pump treatment, there are more patients with type 2 diabetes than type 1 diabetes, there are various reasons for this, and the economic aspect is one of the main reasons. Type I diabetic patients tend to have a young age of onset, mostly minors, and the family income of this group is generally low. In addition, the national conditions of medical treatment, such as in foreign countries and other developed countries, if patients are suitable for insulin pump treatment, they can wear insulin pump for free, while in China, insulin pump is a consumable equipment, not in the scope of medical insurance reimbursement. Therefore, as a large diabetic country with the largest number of people suffering from diabetes, it is not a simple medical problem if we want to implement the standardized treatment of insulin pump. Recent studies have shown that 25%-50% of diabetic patients undergo multiple surgeries in their lifetime, and 10%-15% of middle-aged and elderly patients undergoing surgical procedures have diabetes. Today we will focus on the topic of perioperative glucose management. The perioperative period for diabetic patients is an absolute indication for the use of insulin pumps. However, the following problems exist in perioperative glucose management nowadays: firstly, surgeons’ lack of attention, mainly because of surgeons’ poor knowledge of diabetes; secondly, internal medicine doctors’ neglect, as the implementation site of perioperative glucose management is surgery rather than internal medicine; thirdly, the current perioperative management model is also not conducive to the glucose control of surgical patients. The current blood glucose management process is thought to be divided into three stages: preoperative, intraoperative and postoperative, with the preoperative stage regulating blood glucose in internal medicine, returning to surgery one to three days before surgery, and then turning to internal medicine to continue treatment two to three days after surgery, however, the impact of surgical trauma on blood glucose does not start in the postoperative stage, but precisely in the operating room, and the start of anesthesia is both the start of trauma, which is what we often call diabetic This is what we often call the stressful glycemic management of the patient. In the resting state, the blood glucose of diabetic patients is easy to control. However, when there is surgery, trauma, serious infection and other triggers, the body is in a state of stress. During stress, the sympathetic-adrenomedullary system of the body is excited and the release of adrenaline, cortisol, exogenous glucocorticoids and catecholamines increases, and severe infection or surgical trauma leads to the release of inflammatory mediators. These hormones and inflammatory mediators inhibit the release of insulin and promote gluconeogenesis, inhibit glycogen synthesis, and decrease the glucose uptake capacity of tissues, ultimately leading to an increase in blood glucose. The focus of perioperative glucose management is continuous monitoring of blood glucose and continuous use of insulin, and the preferred method of insulin use during this period is insulin pump therapy, and short-acting or ultra-short-acting insulin is recommended. Currently, the weakness of perioperative glucose management is the neglect of glucose control in the postoperative emergency state, i.e., from the beginning of surgery until two to three days after surgery. The blood glucose stability during this period is closely related to the postoperative safety and is also the critical period for the whole perioperative blood glucose control. Under the current mode of glycemic management for diabetic patients, patients are transferred to internal medicine to start glycemic control three days after surgery, and the best time for glycemic control is already missed at this time. Therefore, the principles of perioperative blood glucose management in the future are: continuous blood glucose monitoring and continuous blood glucose intervention, multidisciplinary blood glucose management mode, increasing surgeons’ attention to perioperative blood glucose management, and establishing a whole process, all-round and all-angle blood glucose management mechanism. What are the main stages of insulin pump applicable to patients in clinical application? How to choose insulin in clinical application? The clinical indications for insulin pump are as follows: 1. Patients with diabetes during pregnancy and lactation are also recommended to choose insulin therapy because the safety of insulin is higher than that of other hypoglycemic drugs; 2. Patients with diabetes in ICU, especially critically ill patients and coma patients; 3. Patients with diabetes undergoing surgical treatment; 4. Patients with severe diabetic complications. At this time, the insulin use mode is preferred to insulin pump therapy. Since the duration of action and glucose-lowering effect of different insulins vary, the best therapeutic effect can be achieved by choosing the appropriate insulin and setting the corresponding treatment plan according to the type of insulin during the insulin pump treatment. Because insulin pumps continuously and microinfuse insulin, medium-acting or long-acting insulin cannot be used, only short-acting or ultra-short-acting insulin can be used. Medium-, long-acting and premixed insulins cannot be used for insulin pump therapy. In addition, when choosing insulin, insulin instructions should be followed. In this regard, we have the relevant “China Insulin Pump Therapy Guidelines” for clinicians to make reference. How to use insulin pump to manage blood sugar in the perioperative period? For diabetic patients, the core issue of perioperative safety is blood glucose management. If blood glucose is not well controlled, surgery will not only fail to achieve the expected therapeutic effect, but also present serious safety problems and even threaten life safety. Therefore, perioperative blood glucose management requires two “victory devices”, one is real-time dynamic blood glucose monitoring equipment, and the other is precise and continuous insulin infusion equipment. The specific operation is as follows The real-time dynamic blood glucose monitor is worn 1-3 days before surgery to grasp the trend of blood glucose changes of patients in the perioperative period and obtain more than 480 blood glucose values per day, which can replace the daily 6-point method and 7-point method of blood glucose monitoring program and be used to guide the use of insulin. Wearing insulin pump when necessary, especially after the implementation of surgery, the stress reaction caused by surgical trauma is not conducive to blood glucose control and insulin function is suppressed, which is one of the best indications for insulin use, while the magnitude of blood glucose change is larger and faster at this time, which requires precise insulin infusion equipment.