How to use the insulin pump for good effect?

For medical professionals to read for reference, do you really know how to use an insulin pump? As a doctor in the Department of Endocrinology, you must be very familiar with insulin pumps.
However, Teacher Zhang Xingguang from the Department of Endocrinology, Army General Hospital put forward the "soul torture": Can you use an insulin pump? Of course it will! You probably will answer like this without even thinking about it.

Don't worry, let's take a look at what Director Zhang means.
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Affected by the medical reform, it is imperative to improve efficiency.
First of all, being in a hospital will definitely be affected by the medical reform.

Taking Beijing’s medical reform as an example, the medical reform has had a considerable impact on the proportion of medicines, the average cost per time, and the average length of stay in many departments, including the endocrinology department, in many hospitals, resulting in a reduction in the number of outpatient clinics.
The hospitalization day is uncontrollable and dare not admit serious hospitalized patients, so doctors need to improve efficiency to deal with them.

For endocrinologists, the most common disease is diabetes.
However, the proportion of drugs and the average cost per time for such patients are often high.
So how to improve the efficiency of diabetes treatment? At this time, you have to mention the insulin pump, which is a powerful weapon for endocrinologists to improve efficiency! However, judging from the current status of the use of insulin pumps, low use rate and poor use effect are common clinical problems that need to be resolved urgently.

It can be said that "will" use an insulin pump not only refers to whether it can be used correctly and rationally, but also whether it will actively use insulin pumps for patients clinically.

 The truth about the use of pumps, whether the pumps are good or not, Director Zhang said, because “I don’t want to use them, use less, don’t use them, and don’t expect to use them”, the use of insulin pumps in many hospitals has formed a vicious circle, and good tools cannot be adequately used.
use.

He analyzed and summarized the four major reasons for the poor use of insulin pumps: the need for patients to pay for it and some patients are unwilling to use it; some doctors believe that it has the same effect as the 1+3 basic-meal insulin regimen, and it is unnecessary; or that it is unnecessary.
It is troublesome to operate, and it is too lazy to use; or think that the insulin pump is used in the hospital, and other plans have to be adjusted when discharged from the hospital, which is inconvenient.

But this is not the case.
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The four major problems have been solved one by one.
The advantage of the insulin pump is highlighted.
Facing the first problem, Director Zhang gave us a calculation: usually the insulin pump lasts for about 7 days in the hospital, and it costs 120 yuan a day.
840 yuan.

But if the pump is not used, the blood sugar cannot be controlled in time and effectively, which increases the length of hospital stay, then one more day of hospitalization will require an additional day of expenses such as beds, nursing care, drugs, and meals.
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The second question, 4 injections of insulin a day The injection protocol and insulin pump are also different.

First of all, from the perspective of hypoglycemic efficacy, Director Zhang cited the research results of his team and found that among the 1652 diabetic patients included, the therapeutic effect of insulin pump (CSII group) was significantly better than that of traditional basic-meal insulin (MDI group) ) Treatment plan (P<0.
01).

 Figure: Insulin pump treatment is better than the basic-meal regimen in reducing blood sugar.
Several studies have shown that patients treated with insulin pump have a faster time to reach the target blood glucose level than the basic-meal regimen, and the occurrence of hypoglycemia is lower, in children.
Medium is also safer, with lower insulin dosage and lower insulin absorption variation rate.

This shows that the insulin pump has comprehensive advantages in many aspects, which is more ideal than the basic-meal insulin plan.

At the same time, studies have shown that intensive insulin pump therapy can reduce the risk of multiple complications such as diabetic retinopathy, diabetic nephropathy, and macrovascular complications, improve the quality of life of patients, increase life expectancy, and bring long-term benefits to patients.

 As for the third question, Director Zhang said that the insulin pump is actually very flexible to use.
It can add doses at any time, the basic rate is adjustable, and it also has a variety of high-dose modes.
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As long as the clinician can fully understand its application methods, they can find out The convenience brought by the insulin pump to the clinic.

Teacher Zhang also made a metaphor: Traditional methods and insulin pumps are like "elderly machines" and "smart machines".
"Smart machines" seem to be more complicated, but in fact, they can be used handily and with functions with a little learning.
More powerful, in fact, it is more convenient than the "elderly machine".

 Turning to the last question, Director Zhang pointed out that the conversion of the patient discharge plan is actually very simple.
There are many alternatives: it can be directly replaced with multiple insulin injections, combined with ultra-long-acting and fast-acting insulin to control fasting and post-prandial blood sugar.
Or use premixed insulin; it can be changed to oral hypoglycemic therapy, pre-meal (such as acarbose, metformin, short-acting secretion accelerant), basic (such as metformin, long-acting secretion accelerant, dipeptidyl peptidase) -4 Inhibitors) Step-by-step replacement to reduce blood glucose fluctuations; of course, oral medications can also be combined with insulin therapy.

 In summary, the four “obstacles” that patients pay at their own expense, are no different from the 4-needle regimen, are troublesome to operate, and are difficult to discharge from the hospital, which can be said to be self-defeating.

As for the various problems faced by endocrinologists after the medical reform, the correct use of insulin pumps can also be solved by reducing the average cost per time, reducing the proportion of drugs, reducing the average length of stay, improving efficiency, and reducing the burden on patients.

 So what other benefits can the insulin pump bring? Can patients of different courses benefit? If the hospital does not have ultra-long-acting insulin, how will the discharge plan be transformed? Is there a formula or trick to calculate the dose? Based on his many years of clinical experience, Director Zhang also shared in the course.
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