Old Li is 70 years old and is a male diabetic. Although he eats the medicine prescribed by his doctor, he seldom goes to the hospital for review. He pays attention to the sweets in his diet, but basically he still eats as much as he can. One day before breakfast, I accidentally hit a stone on the ground while walking, and when I didn’t stand still, my right hip fell to the ground, causing a sharp pain and I couldn’t move! He was immediately taken to the hospital and diagnosed with “intertrochanteric fracture of the femur”. The orthopedic surgeon heard that he was diabetic and immediately checked his blood sugar and urine routine, and his blood sugar was measured at 26 mmol/L. There were also ketone bodies in his urine, and the doctors were on the edge of their seats, saying that it would be difficult to do the surgery because his blood sugar was so high and he had ketosis. Immediately invited the endocrinologist to consult. The doctor came, asked about his condition and immediately instructed to do a “blood gas analysis” and check the glycated hemoglobin, saying that he wanted to see if there was acidosis and what the blood sugar level was in the last 3 months, so that he could prepare the medication. The results of the blood gas analysis were good, saying that there was no acidosis, but ketone bodies, and hunger and stress are related. Because the blood glucose is too high, the doctor said that currently still can not operate, blood glucose should be reduced to at least 11mmol / L below to operate. The old Li and his partner were anxious to hear that, what to do, how can such high blood sugar be lowered? The key is that if we don’t operate quickly, the healing of the fracture will be a problem. What to do? The endocrinologist proposed to Lao Li that he must be treated with insulin, but the key is what method to use, and suggested that he use an insulin pump. Old Li and his partner looked at each other, only know that there is insulin and injections, insulin pump is a what? The doctor said: elderly diabetic patients are mostly accompanied by chronic diseases such as hypertension, coronary heart disease, chronic bronchitis, etc. Also, due to the influence of high blood sugar, it is more likely to produce osteoporosis and various fractures. During the perioperative period of fracture, changes in the hospital environment, as well as fear, anxiety, trauma, surgery and other stressful conditions can increase the secretion of catecholamines, growth hormone, glucocorticoid, glucagon and other insulin counteracting hormones, causing stress hyperglycemia and even acute metabolic disorders in diabetes, thus affecting the surgical treatment, while postoperative stress hyperglycemia can affect endothelial cell energy and impede collagen synthesis, resulting in non-healing incisions or fractures. At the same time, the phagocytic and chemotactic ability of phagocytes is reduced, and coupled with the long postoperative bed rest, secondary infections, such as pneumonic pneumonia, decubitus ulcer and urinary tract infection, are likely to occur, and the complications and mortality rate are about 5 times higher than those of non-diabetic patients. The level of preoperative blood glucose control can directly affect the occurrence of postoperative complications, and good or bad blood glucose control directly affects the success of surgery. For elderly diabetic patients, they can have surgery if their fasting blood glucose is controlled at 8 mmol/L and 2h postprandial blood glucose is controlled at 10 mmol/L. Emergency surgery is also required at 11 mmol/L or less. In general, small surgeries can continue to take medication to control blood glucose, but for the major surgery that Lao Li is going to undergo, insulin therapy is necessary, and he has such high blood glucose and acute complications like diabetic ketosis. As these major surgeries require epidural anesthesia or even general anesthesia, patients cannot eat for at least 6 hours, and general anesthesia is even longer, depending on the postoperative awakening time and the site involved in the surgery. The control of blood glucose is the most difficult for diabetic patients who do not eat and have surgery. Insulin pump therapy (CSI I) is an advanced means of treatment for diabetic patients. Its method is to bury a needle under the skin and connect a box the size of a BB machine with a thin tube, which contains insulin, and by simulating the normal pancreatic insulin secretion pattern, insulin is continuously input into the patient’s body to maintain the insulin level in the body, which is in line with the physiological needs, improve the stability of blood sugar control, rapidly control high blood sugar It is the best choice for diabetic patients in terms of preoperative preparation, surgical procedure and postoperative healing, etc. It also reduces the toxic effect of glucose, effectively protects the pancreatic β-cells, and ensures that patients have sufficient and safe insulin pumping without eating. The traditional methods include multiple daily subcutaneous insulin injections (MS II) and intravenous insulin injections. For patients who do not eat, the intravenous injection method is mostly used, because the intravenous short-acting insulin has a rapid effect, so the blood glucose fluctuates more frequently and requires frequent blood glucose monitoring for dose adjustment, and it is difficult to stabilize hypoglycemia and hyperglycemia alternately, and the postprandial blood glucose control cannot be satisfied after eating. Short-acting insulin is given before meals and medium-acting insulin is also a good choice before bedtime after eating, but this traditional MSII is difficult to control blood glucose concentration at a level close to normal without hypoglycemia for 24 hours, especially when eating irregularly, blood glucose fluctuations are easy to occur. With insulin pump, 50% of the insulin dosage for the whole day can be input at the basal value for 24h, and the basal rate of insulin can be flexibly adjusted; the insulin infusion is instantaneous, and if hypoglycemia occurs, the pumping can be stopped immediately for immediate correction; moreover, the body can pump more when it needs more insulin, and less when it needs less, and it will not be uncontrollable when it enters the body like subcutaneous insulin injection. It is more advantageous for patients who are fasting for gastrointestinal surgery. It is more advantageous for patients with gastrointestinal surgery who are fasting. After a meal, a large dose can be set before the meal according to the amount of food eaten, and at the same time, a large dose can be added according to the postprandial blood glucose level. In addition, because of the pumping method, even if the blood glucose is temporarily not under control, a certain dose of insulin can be pumped in at any time, thus eliminating the pain of injection. The results of clinical studies show that CSⅡ can control hyperglycemia more rapidly and correct acute complications compared with MSⅡ, resulting in less insulin required in the perioperative period, significantly reduced incidence of hypoglycemia, good wound healing at the surgical site, and significantly reduced complications such as pneumonia and urinary tract infections, and in addition, for surgical patients, especially those with orthopedic diseases, because of accelerated wound healing and shortened bed rest time. thus reducing the occurrence of osteoporosis. However, the doctor specifically pointed out that insulin pump treatment costs more than 100 yuan per day and is not currently covered by health insurance, so patients have the right to choose their own treatment method. After listening to the doctor’s detailed introduction, Lao Li, who was still disdainful of blood sugar, was amazed that high blood sugar can cause such serious consequences and insulin pump therapy has such obvious advantages. Why not? So he chose insulin pump treatment, and in order to facilitate post-operative meals, he also chose fast-acting insulin: menthol insulin (no need to pump insulin in advance, just eat and pump). As a result, his blood glucose reached the surgical standard in half a day and he entered the operating room. After the operation, under the careful regulation of the endocrinologist, he adjusted the basal rate and the amount before meals every day, and also continuously educated Lao Li about diabetes, telling him how to eat and how to strengthen his activities when he got well in the future. The most important thing is that such a good blood sugar but no hypoglycemia, of course, this and the old Li this time deeply educated, eating regular meals, not blindly eat is also very relevant! Old Li couldn’t be more proud of his choice. Old Li’s glycosylated hemoglobin was not seen before surgery because it could not be checked urgently when he was admitted to the hospital, but later it was quite frightening to see that it was 12%, suggesting that his average blood glucose in the past three months was around 18-19 mmol/L. The stressful situation such as pain and fear during the fall when he was admitted to the hospital aggravated the hyperglycemia. Old Li’s neighboring bed, Old Zhao, is also a diabetic patient, a patient with femoral neck fracture, who was also advised by the doctor before the hospital surgery, but refused insulin pump treatment due to the family’s financial difficulties. The wound healing seems to be much slower, so I can’t tell you how envious I am of Old Li. Old Li was discharged from insulin pump treatment more than 10 days after surgery, but due to years of poor blood sugar control, his islet function was seriously impaired and he was finally discharged with an insulin pen, but this time he no longer dared to mess around and became a most qualified diabetic patient, regularly visiting the endocrine clinic and saying to everyone that the fall woke him up and saved him, and the insulin pump took the credit.