CA2164582A1 - Device and method for suction-pressure injection including a system of its apply - Google Patents

Abstract

A device and a method mainly for the treatment of diabe-tics which need insulin by application of the needel-less pressure beam or jet injection, but taking care for the skin which is arised in a suction cup and thereby thinned and drawn off from other tissue, whereby the injection channel is rinsed with thinning fluid still during the insulin injection and difficulties are encountered, which arise by influence of suction toward the drug behind the nozzle still before the injection.
The necessity of a space saving concentration of numberous functions with the purpose, to satisfy also the high requi-rements of hygiene and of the simplicity of the operation, with an as much as possible automatic running up according a programming by coordination with metabolism measured values with data belonging to the life style which are in-put by the patient and by the physician, preferably attain-ing measured value as data relating to metabolism, all this demanding for a series of improvments relating to the equipment for a closed therapeutic system, as it is represented herewith.

Description

21645~2 - ~A ~vice and Me~hod for Suction-~ressure,Iniect'Ion-' - - inc-lud'ing a System of -its AFjply The invention relates to the medical technique, dealing especially wit~h the treatment of diabetics with insulin.
First, the invention is founded or, the o~7er p~essure or jet injection which came into fashion in 70's and was keept until 1983 for mass inoculation practice.
On the ore hand the irritations of the skin through repiti-tive use was caused by tissue lacerations, because the in-lG jection nozzle WGS pressed against the skin in a tissueccm,cressing manner.
In the Patent Application DE P 37 30 469.0 this need was f~lfilled. The present application shall ~emove a further cause of violent skin irritation: That is, the remains of drug and desinfectant residues in the i~jection channel of the skin.
Until the glucose measuring by means of laser rays through the skin is practically realized -which could p~ofit by t~ blood emptiness in the s~ction cup- the purpose of cl measurement through~the eye ccrnea is still er,riched by the inventive improvement of performing such measurements by means of a special spectacles, which places the measuring arrangement in the depth of the or-bi,t a~tomatically. Even there gaining of singular meas-ured values during the day is ccnsidered as burdensomefor the patient as the permanent body ccntact of a meas-uring device. Such metabolism measured values there are understood to be offered (generally cable less) to the ccmputer in the injector for evaluation and registra-3~ tion to guarantee the tctality of the therapeutic system.The more sluggisch metabolism in the eye chamber gives the inducement to watch for other pcssibilities of an injury-less metabolism control as supplementation.
The habituation on a d~ily urin sampling ccn be stimulat-ed by suitable a~xiliary means. But also the supplemen-tation of ar: injection by a separated injection of a kind of sensor bristle, m~inly inside of a suction cup, cculd be useful. _ 3 _ C~ 2164582 The production of sensor cannulas, that is to say, of can-nulas inside of which a sensor thread is shoved under the skin, is comparatively expensive, mainly exclusively for measuring purpose. Additionally, the sensor thread must be held particularly thin, because the cannula shaft or cover destines the diameter ard this even could be lower-ed to a diameter of 0,32 mn,. The main purpose for the treatment remains a painless and minimum invasive intro-duction of the sensor.
With this application, the functions of a suction injector s~ould be automatized sc far as possible. As arother unre-nuncable scope is set that one to open the lid over the in-jection nczzle which has an air tightened seat first imme-diately before the drug administering. Otherwise, drug fluid s~!ould be able to be sucked dc,wnward through the injection nozzle still before the injection into the suction cup space under the influence of negative air pressure ir the suction cup. In SUC}I a manner not only the metering could be incor-rect, but also air cc,uld enter from the suction cup space, inspite of the weak vacuum there-, into the injection cylin-der space. That cculd possibly interrupt the inection beam.
The necessity of a ccntainer as well for the thinning fluid ac for water for the cleansing causes an enlargement of the apparatus, for w~iat which encountering was necessary by space saving on other places in all functional fields.

~ 216~582 Prior Art Propcsal was made to measure t~le glucose ccntent before the eye lens through the ccrnea by the application of a special contact lens (March, Wayne Front, P 22 38 9&5;
U'; 3,958,560 M~y 25,1976).
The "device fcr the destination of the surface centre of an illuminated hc,le" refers remotly to the pIoposal for focusing spectacles. (Digital Systems Inc.Arc.Cal.
Ind.William Marautelte, DE 25 36 380). Nils Kayser (P 26 06 991, Febr.20,1976) has filed laser measur-ements including of glucose through a tongue spatula.
Arno Mueller attempted it through the lobe of the ear.
Wire less transmission of dcsages and vices found on Prestek K.and Franzeski M.(DE 30 35 670) as well as by Fishel and Ellentuch (P.32 47 233). Also to be mentioned are the numberous jet stream injectors, as DE P 30 30 671 filed by Hoechst and Mc Kinnon, Charles Neal (Bioject.
Inc.Euro Publ.0 427457A2), which is supplemented in this 2G invention with the suction cup and a step syringe, and means for cleansing of the injection channel.
In addition to the over pressure or jet stream injec-tion within a suction cup which I filed in DE 37 30 469.0, proposals for a kind of sensor bristle or capil-lary in a puncture grip are made in Euro Pat.Appl. Nr.
0 301165 (published Febr.1,1989). But these sensor ele-ments were introduced into the bcdy by an accompanying lancet or car.nula, which should dilate the injury un-der the skin by swinging mc,vements or rotations for a blood sampling, whereby in a special case, the measuring zone was tIansferred to the lancet shaft itself (Fig.59, 12). A skin squeezing mechanism is demonstrated in Fig.
61. The efficient introduction of a small s~nsor between the skin and muzzles, also in a humide area, is inten-ded with the invention now presented at nearly any bcdypart.

~ 216g~82 Summary Of The Invention The proposed task is sc:lved in an example by the emptying of separated piston-cylinder pumps through a common noz-zle. Caused by an electrical circuit contact, the pres-sure donator, here, a cclenoid or pressure spring, for the second piston in the cylinder with the skin af-finitive or friendly fluid, is tr-iggered shortly be-fore the first cylinder with the drug is emptied, so as lG the pressure beam is not interrupted.
The task of the determination of the triggering of the point of time can also be solved by a ccmputer oriented from the a~;ount of drug which is administered to the first cylinder. According tc metering one is fallen back, only for example, to the step syringe (the "pen" sy-stem), to avoid detours w~ich are not customary in the trade.
Du.ring the storage period and during the drug apply in-to the cylinder, the nczzle is closed by a lid which 2G has a sealing ring toward the ar~a of the nozzle and incandescent wire loop, which is embedded in ceramics, the heating of which by current application causes the evaporation of the water residues or. the area of the nozzle. This lid also prevents the air eccaping through ore of the two cannulas after the pa.ssage of a flap for each of the t~o mounted toward the metering (or injec-tion) chamber on the end of the cylinder, bu.t which takes place after the rinsing out of said air by means of tissue friendly fluid. Thereby the sa.id lid, of course, serves for prevention ar.d killing of pathological germ settlement. The c~-linders are closed toward the pressure dc,nator by a sealing membrane between the pump rod ar;d the cylinder ledge or rim for the infection pre-vention.
In the second example, two pi.stons are arranged or.e be-hind the other inside of a ccmmune cylinder. The drug is placed b~fore the first piston, as the rule twc scrts 21~82 of drugs are used, namely immediately working or regular insulin and depot insulin in different dosages. But skin friendly flaid is also still filled-in before the drug ap-plication until the piston ledge openings are disappeared above in the cylinder and therewith sealed. The space bet-ween the two pistons is filled up with tissue friendly fluid through the pcsterior piston. When the pressure dcnator is activated (it could also be a sc;lenoid as in the first example), the first piston, subsequent to the drug, is driven toward the nczzle by the main a~ount of the tissue friendly fluid. As soon as the pi-ston ledge openings are free, tissue friendly fluid pene-trates exceptionally from the interpiston space into the interstice before the nozzle, which is left, finally, nc. mc,re by drug. A chamber-nozzle cleansing is provided at last after each use by means of an injection (or better:ejection) stroke with clean water. The change be-tween tissue friendly fluid and clean water is achieved by valve or three-way-cock.
The second example fell back upon the mechanique as it WG~S derivated from a toy auto ard described in f~rther details in DE P 39 25 940.4.
The demonstration of the power way from the electric motor through different rigid and flexible shafts and toothed wheels on detail was therefore dispensed with, because that would be possible to ary skilled expert withcut difficulty.
Because the scope of the invention, of ccurse, is a pocket pcrtable flat shape, the drug e~;pelling cylinder is hcrizontally mounted and the nczzle is deflected on the end of the cylinder about 9O degrees from the c~-linder axis. It is also possible to stratify dr-ug ard tissue friendly fluid inside of a hoselet without separation in a ~cinner as today chemical substances are portioned ir the laboratory -even though separated by air bubbles.
If that is dc,ne quiet immediately before the injection, the mixing through of both fluids will be a desired in-216~82 ~, cc,mplete or.e; also a strong p~essure donator (perhaps a piezzoelectric one) can reach the effect of a rinsing out of the skin.
The proposed task of ar avoiding of suction influence to-ward the nczzle is solved by assigning a ~echanism forthe opening of the lid over the injection nozzle immedia-tely inside the space with negative air pressure in the suction cup.
This lid favorably clings a klind-like kind of leaf spring lG to the erd of the injection cylinder. This can be dis-placed now as well in a vertical motion as in a radial ore out from the area of the injection nozzle by means of a wedge slantily by a lever or directly -as by a bowden wi-re. B~t a ccrresponding drug passage opening in the blind cam provided is brought in a cGincident position with the injection rozzle shortly before its function. A nozzle which frontaly leads out from the injector c~-linder, if nczzle and blind axis lay excentrically or a sectoral gap, exists in the blind.
2G A kind of sector blind can also-be turned past the nczzle by an axis in the suction cup roof. The a~ditional tasks pro-duce special difficulties: namely, to keep the nozzle clean by means of a heating device after the injection;

2~ but mainly the necessity of an optical control of the skin with regard to the aptitude for the puncture and this just or. an area where the skin clings. The jet beam can thereby also be led obliquely inside of the skin knob, because it however depends or the lengthening of the distance, the in-3G jection produces a nearly hcrizontal projection from thesuction cup edge; in such a manner a particularly near and secured skin contact takes place~ but slight pressure staggerings can do nothing against this.
To keep the area of the nczzle clean with heating, a kind of second blind can be fitted over the just decribed one, which contains heating wires. The advantage of such a ~unctional division is that the second blind or cover can - 2164~2 be thicker shaped and can yet be turned or lifted out of the functional area before the skin is drawn up.
The optical survey can still occur in the raising place of the skin. In particular if a higher capacity of the ccm-puter of the electric and electronic control unit is in-stalled. In this case the natural skin field structure or patterns can be used as a kind of scale and the re-flexion quality (the reproduction of brightness) of the skin area, as it can be ascertained perhaps on a window in the suction cup edge, can be converted to the area which lies before the nozzle. With such a computer analysis, spotted skin cclouring (perhaps with freckles) can be ccn-sidered. The duration and velocity of the skin pattern mo-tion are q~oted acurately for such a (arithmetical) con-versionEven a pigment poor zone of the skin can be steered for the injection over an electronic ccntrol of a ventilation throttle for the suction cup, without the need to break off before the process of sucking of the skin and without need tc repeat it.
The minimum demand to an optical skin control is reached with the comparison of the brightness of the injection area and ar adjacent or,e, still suitably by the proceed-ing uce of device. (Thereby one can be placed on the op-tical glucometer as customary in the tr-ades). In a special solution, the light ray is projected from the suction cup rocf to a kind of mirror nose on the nc,zzle blind. After the reflexion on the skin, the ray path leads back to the sensor. The mirror ncse is moved away from the nozzle be-fore the injection. The measuring can also occur by alight ray w~iich projects from a light ccnductor end near the nczzle. In this case, the measuring and the ela-bcration of the result must be effected in the intervall between the blind opening and the injection.
Further features of the invention relate to the sort of pr-essure donator for the injection rod, the injection cy-linder, and injection piston shape for avoidance of pol-g C 216~582 lution in a permanent operation of the device, and the mech-anical gear cc,ntrol as well as the container shape.
Besides the treatment of diabetics, the device can be used for the administering of other drugs. It should be men-tioned here the periodical heparin injection for the aim of thrombosis prevention. The insulin cartridges were chosen as metering device, as they are broadly customary in the trade with so-called pen-systems, but one could use also any other metering systems. Stack ccntainers in row, that are folded bellows, are described as alternative for the employment of ste~ syringes. The cannula, which serves for the cc,mmunica-tion to the next cc~ntainer, can be removed. A folded meter-ing chamber or, the foremost ccntainer, which is connected with the drug inlet opening into the injection cylinder, de-ivers the drua in the total of single dc,sages. For that, the metering chamber is impulse-like, ccmpressed by an ec-centric gear or solenoid.
A water container was to schedule, because the metering pi-ston and (metering) cylinder as well as the nc,zzle had to be cleaned after each injection fro~ the salt of the thin-ning fluid (shortly: thinner). Thinner and water are suitab-ly stored in high elastic containers and cGmbined in an ex-change-container unit. Because also in this case no amount of air should enter into the closed fluid system during the container exchange, these elastic cGntainers must be beared in a further rigid cc,ntainer and must be exchanged in the said one. The inner ccntainer are suitably set under gas pressure in a further ccntainer of the device. This is orly allowed for the short period of the filling u~ of the in-jection cylinder or of the cylinders; in any case, such a timely limitation seems to be suitable for the purpose of -keeping the valve ecluipment simply.

~_; 216458~

Preferred fittings of the thinner and water cGntainers consist of tw~ folded bellows, which are separated one from other inside of a plastic or pasteboard cylinder by the pcr-tion wall of the latter. Therefore, a kind projecting collar 5 edge ir the middle of the pasteboard cylinder is pressed against a ccntainer seal. The two afflux connnecting pieces for gas are firmly installed in the device container w~ll.
The derivation of thinner respective water takes place from the folded bellows through cannulas which are connected with 10 hoses. The former pierce the stopper membranes in the centre of the cGver cap, which can be screwed on, and from the cen-tre of the bottom of the uptaking device ccntainer. The se-curity of the injection cylinder or the c~-linders on the in-troduction side of the piston against pollution is effected 15 by a roofing over with a membrane or a folded bellows.
The filling UE of water or other fluid in the interstite between protective membrane or folded bellows and the rear piston face is a new procedure to prevent the injection spa-ce against ar er.trance of air. For an er.abling to diminish 20 the a~ounts of auxiliary fluid (thlnner) and water, if smal-lest drug dosages are used, a amount or dc.sage limitation is introduced also for these. The limitation is approximately ccnversly proportional to the drug dosage. (A too frequent necessity for a cGntainer exchange or too big a volume load 25 of the device wculd otherwise be the consequence). The dos-age limitatior is preferably brought about here over a screw, which activat~s after the back mc,vement (or lifting) of the metering pistcns, and this is done through the roof of the protective folded bellows ard thightened to that.
30 When the cGntrol gear, in the here preferred linear arrang-ment, returns after the injection, the dcsage limitating screws are sunk again into their injection cylinders.
(The gear should not work to the screw the insulin car-tridges, as long as they are nct yet emptied or should be ex-35 changed).

~ 21C4582 In nearly each case, thinner is mixed to the c~-linder space, destined for the drug, so as the smallest dosages still can be turned into an injection beam.
A pressure gas source can be used as pressure donator in one S example for each injection cylinder of the device. Two strong pressure springs, one for each injection cylinder of the de-vice (namely one spring for the drug thinner mixture and the other for thinner which washes the skin out), serve for a pocket portable device dealed with here. The pressure springs are lifted to produce a strong but slow mction mcment through one or t~o wedge slides into their stop catch. The latter is bolted by a release fork. The release fork again is shot up by means of an auxiliary spring.
In an examplarv solution the shortening (or lengthening) of the switching distance in a Bowden cable opens the blind before the nc,zzle still before both metering pistons with ccnnecting straps between p~essure spring and injection cy-linder are released. The injection distance for both cylin-der can be adjusted by a slide (bar) which partially cGvers 2C! a release slot or the release fork, w~ereby this operation is coupled with the metering and adapted to the filling a~ount in the ~njection cylinder. Another solution uses three solenoids for direct stroke for the triggering of the three functions. But all three and further functions can also be operated by ore solenoid only by means of a rotation mechanism for a drum with ccnducting grooves (a thrust-tor-sion-mechanismj which causes a partial rotation with each stroke. The sw tching periods can still be essentially shortened by tensioning a tension spring during the stroke in a certain angled position of the hammer (connected with the rod of the solenoid). A rotating disk with sectorally radial passage can free the hook on the cross bar of the tension spring at ary desired functional phase for switching purposes.

21fi4~2 The activation delay of the sclenoid can be under bitten in such a way. (Frequently smelts with rotation mechanism in ball pens for the blocking of the w~-iting lead to a similar ex-planation).A gas jet pump is used for the negative pressure production in the suction cup. For the handy device, manual pressure is exerted against four pressure springs, guided in four tube sockets at the housing corners toward a kag which lies behind a separated ccver sheet. The produced over-pressure is transmitted through a valve to the container for the fol-ded bellows wi~h thinner and water during the drug metering.
Because the bag is broadly cGnnected as well with the lid as with the cover sheet of the hcusing of the device, its reexpansion produces a suction after the stop release of the four pressure springs, the suction being effective through the before mentioned valve in the suction cup.
The functional security pcstulates a short switching period between the raising of the skin in the suction cup and the injection release. When this was not produced by a special sc;lenoid, this task was solved by attaching the release c~
s-;ction and injection to the same operation wheel. The latter still works against a spring during the suction re-lease in twc examples. This period remains up to the over-2~ ccming the pressure pcint, that is sudden change of the mO-ximum spring tension for the decision for the injection on the electronic control unit or part -according to the infor-mation o~-er the skin contact by cGntact-switches immediately ncar the nozzle, and according to a foavourable result of the optical skin control. The spring accelerates then the phase of the injection release. But the release operation can still be interrupted before the turning over of the pressure over the pressure or summit point.

~ 2164~B 2 A centrifugal switch for the switching over comes intoquestion for two separated functional blocks - for a series of special operations- anyone of the ccnsiderable number of variations for the ccntrol gears.
5 A roll which has a switching pin (or slide) in a radial bore is driven by an electrical mctor. It depends or. its velo-city during the first rotations if the pin or sleeve is fixed or the inner axis-up to the er.d of a spiral inner groove-by a spring or by permanent magnets.
lGwith a high velocity, the switch pin or sleeve er.ters, out-side the roller, the worm formed groove guidance of the outer cylinder which surrounds the roller. The mctor power is trans-ferred then (in the related wcrking direction) either to the inner axis or to the outer cylinder, the rotation of 15W~iCh is mediated to separated functional blocks.
As an alternative, a three gear unit is demonstrated. Ter-minal thrust mctions, produced by a screw, are thereby t~ansferred to a control pinion of each functional block by means of a bar. The driving wheel or ccntrol pinion is 2Gshifted along the square motor axis -tracing the trans-mission toothed wheels for the reduction of the number of revolutions- one after another into the mesh with three operation wheels for the functional blocks.
This shifting ~cvement is rendered possibly over an over-25bridging sleeve of the control pinion axle as a prolongationof the motor axis. It is limited in each case by- a cross cam peg inside of a switching sleeve stationary to the shifting direction, the cam peg being guided in a slanting inner groove of the sleeve. The groove has nctches which corres-3C~pcnd to its meshing position between control pinion andoperation wheel, which hinder the cam mc,tion. Thè latter falls in a counter notch w~.ich hinders the return into its exit position with a slight rotation by the slanting of this ccunter notch under the influence of a pressure spring 35which counteracts to the cam movement.

216~82 '_ The cam is shoved i~to the next higher stop notch with anrenewed sliding mc~vement of the bar by the carriage of the last cc,nnected functional block in the final wcrking phase.
After t~o such shiftings, the cam falls back over a steep flange of the groove with following longitudinal groove in the switching sleeve into the exit position. The shift-ing mc,ment of the bar is maintained to reach the proper ef-fectiveness of the carriage movement of the next functional block by an additional toothed wheel which is shoved up to the bar and ccntrol pinion on the ccntrol pinion axle, sepa-rated from the control pinion by a pressure spring. This too-thed wheel has naps toward the ccntrol pinion which ~lesh with naps of the w~:ile ore touches the other, and the toothed wheel rotates freely around the axle. The additional tooth-ec wheel is t~en taken, by the pinion. If the pressure fromthe bar releases, the additional toothed wheel, which trans-itory enlarges the pinion functionally, leaves its nap mesh-ing with the pinion by working of the leaf (or pressure) spring between the additional toothed w~eel and the pinion 2G until a new bar shifting by the carriage of the next func-tional block in its final phase is produced.
The transport of the bar by the carriage -finally also the motor driven screw- takes place, for example, by leaf spring with wave pro-ile, on which the cross stay of the carriage temporarly rests durlng its passing over.
Another sclution allows a springing pin to mesh on a carriage between the teeth of a toothed w~eel (if only moving in ore direction of a ratched wheel) and effects a partial ro-tation of the latter during its passing over.
Both devices can also serve for the release of lid stops, tension stops for a squeezing device etc., over levers and tow lines. Especially, release operations can be also produced electrically by ore or mc,re solenoids in their re-spective traction functions.
The function ccntrol of the mechanical gear unit results electrically ~:ver ccntacts 216~582 mainly or. the toothed wheels for the electronic control unit.
Thereby, additional contact tracts arranged along to a slid-ing screw way can induce the mctor to running in staccato, to combine an altogether quick thrust mction with precision of the choice for the final point, perhaps in metering.
This acceleration of the running up is of i~portance mainly then, if the filling of the injection cylinder with the drug occurs fi-st during the skin contact. This can be suit-akly done for an alteration of the dcsage in the last second, lG but on the other hand a trace of thinning fluid can be de-livered out of the nozzle toward the passing past skin with the aim to reach an airless metering of the insulin w~:ich is now admixtured.
In other words. the dislocation of the injection or e,ection nozzle into the area of the suction cup edge is very advantageous. The injection distance without tissue ccntact is particularly long but without the choice of an oval o~tline for the suction cup along the injection direc-tion. Such an arrangement even can save an opening mechanism 2G for the lid blend which ccvers the nozzle or it can simpli-fy this. (The blind cGnsists, in an inventive example, of a ring which is shoved u~ward by the skin itself and on which the opti-~al control device also terminates).
Wher the nozzle lies already in the level of the damming up or upsettin~ area of the skin, then it is already closed up by the skin before the negative p~essure works in the suc-tion cup; during the suction, the skin passes the nczzle per-manently sealing the same. This process can be observed by means of a special window by light measurement. Light c~n 3C~ be projected thereby from an angular or bent las or trans-parent plastic surface to the skin, b~tt especially it c~n be reflected in a radial projection to the nozzle and from there transmitted to the sensor for measurement or ascertainment.

~_ 216~5~2 The electronic control unit, respectively the computer is abled to attach the okserved skin parties with the nczzle in respect tc its pcsition according to the skin patterns . ar;d to put it in relation to adjacent or ealier stored measuring results of the skin surface by comparing the brightness. But the pcsition of the skin before the nozzle can be shoved by influencing a nozzle or valve between the suction cup and the outer air in such a manner as to avoid ar injection into skin areas with suspected reflexion valu-10 es. If a "leak" of the suction cup space is planned-in from the beginning -but bcfore the reventilation- the selection of the injected skin area is effected by the choice of the mc,ment of injection. The same arrangement (e~-entually also additionally) can be made for the skin selection for measur-15 ing use, because measured values can be transmitted to theinjector nc,t or.ly through cables, electromagnetic or acous-tic waves from outside -perhaps as glucose measurements by laser through the skin from outside-, but such measurements can also take place inside the s~ction cup.
20 The registration of functional dates is nearly sufficient ard ensues again suitably in connection with the charging device for the battery from the mains.
With regard to the programming of the device one cc,mes back to the sc;lutio~ ways as they are given in PCT/DE85/00113.
25 The rings, which serve for program adjusting and w~ich were rowed one akove other are now replaced by knobs which are rowed side by sede along one device edge (better:
wall). A locking up knob is here also scheduled to release the allowed decisions of the user in steps.
30 An improvment in the direction of an increase of liberty for the live style consists of rendering possibly to sui-table users, to adapt also the dosages of depot insulin to the respective ccurse of day, that means a daily new pro-gramming. A screen raster of sensor contacts on a housing 35 broadside is therefore provided, supplemented by an -eventu-ally interrupted- fluid display ledge, which demarcates about a half or full day interval starting from the actual clock 216~82 time. The patient is ncw able to indicate his intendedfood uptake also with regard to the glucose contents re-spectively in triangle shape by means of spreading the sensor contacts classed with the intended time interval.
Illuminated diodes are suitably classed therefore to ma.ke the choice visible. The glucose contents cc.rresponds then to the breadth of the above standing t~iangle base, to the distance of the triangle pcint below the velocity of the glucose resorFtion. The extent of bodily activity is ex-10 pressed in la~eral rectangles time cc.ordinated in watt.Exceeding from actually measured glucose tissue levels and with cGnsideration of the input of individual working con-stants of insulin, the height and the mixture relation of the insulins are now made coincidently and are administered 15 by the cGmputer, unless it is not necessary to warn aqainst absurdities.
During the contact of the device with the charging device from the mains, the installed printer reproduces meas-ured values, patient inputs and delivered dosages in numkers 20 and graphics, and it permits the control.
The optical skin control can be er.sued also through a mi.rror over the nozzl.e or. a blind which is then drawn off. A heating spiral is alsc suitable for the environment of the nozzle, the former being eventually cGnnected with the blind and 25 capable of being shoved away before the injection.
An optical skin ccntrol is also important at the device before puncture. It can be directed, for example, from the suction cup roof through a mi.rror toward the injection area, but can also be effected through light ccnducting fi-30 bers, nearly parallel, near the cannula shaft (her: -nczzle).
Mainly advantageously the o~tical skin ccntrol is under-taken by a kind of blind visor with a central hole near a suction cup edge, so that the suction has still enough 35 elasticity to enter into this hc,le and to build a little buble against the pu.ncture area, where a light beam runs tangentially through the smal skin bubble to the sensor.

2164~8~

The customar~7 urine sugar control causes a~ inconveniencemainly in the form of the day profile (or sampling), be~
cause a large collecting ccntainer must be carried along everywhere. For that we recommend to urinate into a little folded sack directly over the toilet. The sack is then ccr corded up above and hung on a spring-balance, w~;ich can be integrated in the device, transferring the respectively as-certained weights, as approximate urine volume data di-rectly to the computer and data store. A customary test 10 strip is ins--rted then into the sack bcttom~manufactured), SG that its free end can be grasped from outside. The sack is opened below by tension on a prolongated belt or this free end of the test strip after a clock alarm; the sack is thereby emptied into the toilet. The test strip can be tied 15 off from the sack through a draining sheath, and a~ optical brightness ccntrol in the device can be directly transmit-ted to the cGmputer.
Eventual sugar contents of the single urine sample are cal-culated, but also the averidge sugar contents of all samp-les after the last meal, input by the patient, and the su-gar concentration of the urine from 12 resp.24 hours.
An addition~l test strip parameter, perhaps for urea, can be employed for the ccntrol of the correctness of the sampling.
But a sensor bristle, resp.a sensor thread, can be shot ~
through the s~in ~r~ the sl~ction cup ec~ge for ~ '_isC~le sugar measurement, which consists of material w~,ich can be reabsorbed. The bristle or thread can then be shoved fur-ther along into the subcutaneous tissue. (The entrance of the sensor bristle is rendered possible by a high initial speed similar to fluid just also for a flexible material).
At first, the thread must be embedded into a kind of chuck similar to a drill, with the aim to be able to pusch it with the chuck in the longitudinal direction without a _ 19 _ 216~582 ~"

lateral evasion of the thread. But the sensor thread can bc likewise produced as a drill with helical threads or.
its front end and can be led under the skin through a skin pore with rotation by means of such a drill chuck, perhaps by a weak rubber tube (end) with big walls, which is ccmpressed. For a further thrust, either the thread reserve is beared inside of a folded bellows on a kind of cross cdisks or or. supporting struts which project from wall segments of a longitudinal slotted plastic sleeve nearly touching one another. The latter are driven asunder with the wal 1 segments of the sleeve one after other by ccne. The point of the cone is connected with the end of the sensor thread, while the cc.ne base has a kcwl or nap for uptaking the gLiding pin for the thread thrust.
Because a cannula wall is saved, if a sensor bristle is used, the latter can be produced scmewhat thicker by meet-ing with the endowing of chemicals for influencing of the current and with the apply of a o~tern protective sheat against a diffusion of the c~emicals into the body. (The 2G skin which is thinned by the strétching during of its raising, eventually supported by adhesive or squeezing means, reduces moreover the extent of the scar by the injury). The arrangement for the introduction of a sensor bristle can be suitably coupled with the eguipment with a nozzle for the pressure or jet injection in one suction Material which can be reabsorbed are preferred, there-fore, because the breaking uc of a sensor thread can ne-vermore be excluded before by technical distubances before the retreat of the thread. The use of polymerizated tere-3CI phthale acid ard polylactacid is proposed to w~ich themeasuring active substances (as NPD-GCD-Perid for the active ard sepharose-convaline-A for the passive electri-cal sensor) can be bc,und. Mainly, the pclylactacid has distinct hygroscopic properties, which is important for the uptake cf tissue fluid. The threads or filamenta of the molecule can be turned as a drill before they are ccated with a protective film (perhaps with polycarbona-~_ 2164~82 te). In this way a kind of drill cculd be produced.An introduction of measuring substances into the body could be avoided, if a ~easuring thread which is not en-dowed with such substances cculd be shoved under the skin (a thread perhaps of silk, which is hardened for short time by formaldehyde of 2 to 5 per cent). The thread can be retrieved, if it is saturated with (body) fluid, into the hose end, and the ccntained glukose can be brought in reaction with the measuring layer, which is inlet in the bore of the hose er.d.
Threads which are endowed with a measuring layer contact a metallic ccat inside of the hose end after being retrivied therein. The current ccnduction to the measuring instrument is performed by the respective wires. If there are twc ccnductive zones longitudinally separated, the hose end must be secured against rotation because of the closing of electrical contacts (perhaps by deri-vations of the diameter from the circular shape).
The device for the introduction of a sensor bristle can be operated also with a ~as pressure-capsule. For the driv-ing of the sensor thread or bristle under the skin by the gas pressure beam, the bristle er.d must be enlarged and stopped at a narrowness on the end of the supporting slee-ve. The current measurements can also be done outside of the (supporting) sleeve between piled UF, stacking sheets after the sensor thread is drawn back from the skin. (This can be done but also here inside of the sleeve if the re-spective metallic coating interior is present with contact derivation outwards).
If a ~etabolism measurement (of any interesting substance, as glucose, kut also cholesterol ar,d others) is chosen by the reflex optical way with use of colour changing agents, two very s~;all cylinders c~n be punched out of two different reaction surface sorts customary to test strips. Two of these respective cylinders are then stuck together in such a way, that bcth colcjur reactive ~ - ?~1 -2164~82 layers bound the total cylinder each or. or.e side. Thetotal cylinder consists mainly of hygroscopic material (ac kieselguhr or silicagel). Such a reaction cylin-der can be firmly stayed onto a carrier thread or pin and still even pricked into the skin, w~!ereby the thick car-rier works like the disk o a drawing-pin. The metabolism measurement is performed after the input of the carrier thread by laser scanning on both ends; on the carrier side suitably through a (central) bore or channel of that.
The arrangement for the introduction of a sensor bristle can be suitably ccupled with the e~uipment for the pres-sure injection in one suction cup, those fittings facing then one with other. When the period for the saturization with tissue liquid can be held shortly enough, an additio-nal squeezing device, perhaps by means of two slides resi-lient one against other, can be saved. The pressure injec-tion otherwise ensues with a new sucking on after the me-tabolism measurement is completed. But the diagnosis with the sensor thread can also be transferred into a separat-ed device hc~using. If pulver inj2ction of solid drugs(perhaps in crystalized ccndition) is applied, pressure gas replaces the "washing out" fluid for the injection channel .
A measuring cannula can also be introduced ur!der the skin into the liquid sea over the muscle skins or fascia.
The cannula consists of a capillary which is drilled in or shot in. Such a capillary can be also endowed outside or inside with a measuring layer for metabolism measure-ments and it can also serve for the injection of fluids (after the measurement). But the capillary wall can be punched ard serve the drainage of tissue liquid toward a measuring zone in the sleeve for the capillary; additio-nally, of ccurse, to the injection of the drug or medication.

~_ 2l64~82 - The mentioned chuck for the mc~tion of the thin sensor brist- lqor thread consists perhaps of a thick walled soft rubber tube or hcse end which is compressed by pressure in a longi-tudinal direction. For the further advance, the thread re-serve is stored either inside of a folded bellows or' a kind of cross disks between the fold depressions or on support-irg stays, which nearly meet in the center and project from the wall segments of a longitudinally slotted plastic sleeve. The supporting stays are driven asunder, one af-ter the other, with the wall segments of the sleeve bya cGne.
The point of the cone is connected with the end of the sensor thread, whilst the cone base has a bowl or nap for the uptake of the guiding pin for the thrust in advance.
15 Because the Wa11 of the cannula is omitted, if a sensor bristle is used, the latter can be produced slightly thicker, what is opportunely for the endowing with chemicals for the influencing of current ard to the coat-ing with ar outer protective layer against the diffussion of chemicals into the body. (The skin,-thinned during its raising eventually also with adhesive or squeezing means, anyhow makes the remaining scqr¢s smaller).
Material, which can be reabsorbed, deserves the preference, because a breaking off (of the sensor thread) can never-25 more be totally excluded.The device for the introduction of the sensor bristle can be also operated with a pressurized gas capsule. If the gas pressure beam drives the sensor thread or brist-le under the skin, the erd of the bristle must be en-larged and ~rrested at a narrowness or. the end of thebearing sleeve. The current measurements can be perform-ed between piled up stacking sheets outside of the suppor-ting (or bearing) sleeve, after the sensor thread is pulled out of the skin. (But this can be done also inside the sleeves, if these are appropriately coated with metal interior with contact derivation outwards).

~- 216~82 The threads which are endowed with the measuring layer contact, after they are drawn back into the hose end, therein witn a metallic layer over which the current con-duction is performed through the appropriate wires or leads to the measuring instrument. There are preferrably two conducting are separated longitudinally by an insu-lating zone, resp.twc insulating zones.
If the period of saturisation with tissue fluid in the sensor thread can be held shortly, an additional squeez-ing device (perhaps by means of two slides or platesunder the suction cup edge springy one against the other) can he saved, when a suction cup is used.
In other cases, the p~essure or jet injection through a nozzle occurs after the metabolism measurement, interrup-ted by a renewed sucking-on of the skin.
But the dia~Jnosis with a sensor bristle can also be transferred in a separate device housing. If pulver of a solid drug is injected (perhaps in a crystalline shape), pressurized gas replaces the "washing-out" or thinning fluid for the pcint of entry into the injection channel.
But a measuring "cannula" can also be introduced under the skin into the liquid lake over the m~scle skins or fascia which consists of a drilled or shot-in capillary.
Such a capiLlary can be, inside or outside, endowed with a measuring layer for metabolism measurements and it can also serve for the injection of fluid (after the meas-urement). But the capillary wall can also be punched through (wi-h finest holes) and can serve to the drainage of tissue fluid into a measuring zone in the sleeve or capillary; additionally, of course, the capil-lary of such a t~pe can also serve for the drug injec-tion.
If a double-sided colour measured cylinder is used, the measuring is achieved by laser scanning in bcth ends of the cylinder ; on the side of the carrier suitably through a kor of it. Instead of a laser beam, a light beam can be used for the oFtical reflex measurement with ancillary lens (also by use of light ccnducting fibres, preferably with the method of optical soupling with crossing ard punctually welded fibres).
Mzinly advantageous is the fixation of a minute colour-changing sensor cylinder or. its tube-like carrier by shoving its one end irto the end of the carrier tube with a sealed connection (sticking or welding) of both portions. A Pen-like instrument with such a "drawing-pin sensor" needs not an optical skin ccntrol and has a round end around the nozzle for the shot-in of the sensor cylinder. Such a instrument can be pressed against ary skin parties with elastic subcutaneous conditions.

2164~82 '_ Short description of the drawings Fig.l is a schematical reprentation of a jet injector with suction cup in longitudinal section in a scale of about 2 : l with pco~c~e lid for the suction cup inclusive the nc,zzle.and with a dcuble injection cylinder and two sole-ncids as pressure donators.
Fig.2 shows in longitudinal section in a scale about 3 : l a ~et injector with suction cup with one dc,uble piston cylinder ard water cleansing device, driven by spring pc,wer, but indirectly by an electrical motor. Belo~- a val-ve disk for fluid in cross section.
Fig.3 shows in a plan view in a scale 2 : l a valve (circ-le) with ar ~lant lever. The latter is shifted between two lock pins with a frame with slot along a bar.
Fig.4 shows in longitudinal section in natural size a motor driven control gear for several operation. Above, to the left a cross section of three gear wheels with shiftab-le special housing.
2~ Fig.5 shows in a longitudinal section in a scale 2 : l a sFecial type of a double piston cylinder with an inner valve.
Fig.6 gives a jet injector with s~ction c~p in a longitu-dinal section in naturale size. Over the tublet~8) is drug filled into the anterior portion of a hc,se end. The latt~r is emptied by a sGlenoid stroke or a term-inal folded bcllows.
Fig.7 shows an injection cylinder with rectangularly de-flected nczzle in relation to a suction cup, to the left 3G in a longitudinal, to right in cross section, both in a ratural size.
Fig.8 gives a block diagram over an er.tire device as therapeutic s~stem with oFtical skin ccnrol in a suction cup ard wire-less connections between the electronic cc.n-trol unit of the device and separated transmitter-emit-ter pc,rtions, one of these on a kind of watch-bracelet.

216~82 '_ Fig.9 gives irl longitudinal section an overview over the mcin device connection of the single pcrtions of the de-vice, w~ereby the largest length is shortened about to 70 percent and the suction cup is respectively diminished.
Above in a detail with a special arrangement of the suppor-ting cclumns for the strong pressure springs as pressure donator. Above, to thè left, the lock pin for the auxilia-ry slide for the release of the twc pressure donators in cross section.
lQ Fig.lO shows the detail of a ccntrol gear for a jet injec-tor in longitudinal section in a natural size. To the right, the ro~ing up of the inner groove of the tube socket (786, in the longitudinal section) is shown in a scale of 2 : l.
~5 Fig.ll shows the variant of a centrifugaly operated switch in longitudinal section in a scale of 2 : l.
Fig.12 gives Ihe example of a lever thrust transfer to t~o release functions with a trigger slag m~chanism in a cross section and a scale of 3 : l.
Fig.13 shows details of a power transfer from a motor(not shown) to operating functions(not shown) in a natural size and a longitudinal section. Below, in a cross section and a scale of 3 : l a ratched toothed wheel with a partial breaking off to the left.
Fig.14 shows in a natural size, akove and in the middle in a side view pcwer translating tcothed wheel of the device according to Fig.9. Above the large toothed w~ieel for the sliding screw, which tighten the strong pressure springs as p~essure dcnators for the fluid ejection. Under that, 3Q in the middle a projection of pcwer transfer to the opera-tion w~,eels (for example for metering) in different sec-tion levels. To the right, a longitudinal section through the detail of any toothed w~eel (from the side view) are shown, cluite below an sideward (vertical) overview to demonstrate the overlapping of the toothed wheels.
Fig.15 shows in longitudinal section on a scale of 2 : l t~c exchangeable fluid ccntainer unit for water and thin-21~4582 - ning f]uid. Below, to the left and tc the right, preferred variations o~ the terminal pcrtions of the cGntainer as-sembly from ;~1bove is illustrated.
Fig.16 gives below, to the left, a partial longitudinal section through the pressure dcnator of the Fig.9, il-lustrating the power transfer from the outern strong pres-sure springs to each of the two injection c~linders.
Abcve, to the right, a cross sectional view is given to demonstrate the joining together of the injection cylinders into the common nc,zzle and the valve flaps behind the fluid supply tubes (not shown) into these cylinders.
Below a single piston injection cylinder is shown (in the middle) in the cross section with the mechanism for the metered infl~lx of thinning fluid and the folded bellows with a insulating fluid for the protection against pollu-tion. A~cve the detail of two beveled wheels as alterna-tive rotation transfer. Below, to the right a longitudinal section throu;3h the t~o injection cylinders in the level of the valve ~laps with the influx tubes for two drugs and the thinning fluid (dashed drawn).
Fig.17 shows to the left in vertical or cross section a detail of a pressure spring block or basket with a space ccmpensation through a slot o~tside over the housing wall during the release of the pressure donator.
Above, to the right, in a hcrizontal or longitudinal sec-tion the function of bcth release slides(268) for the pres-sure dc.nators are illustrated (c.p.Fig.9).
In the middle, above the possibility of a locking device for a inner and outer pressure spring is explained during 3CI the spring release. Under that, the stage of pressure ccm-pression is s~!own, all that in vertical or cross section.
To the left of the just described b]ocks or baskets, a side view is given toward ore of the release slive with the mechanism for an adjusting of the release interval 35 - between the two pressure donators. (Under the upper release slide vertical section through the latter along dif-ferent section lines).

2164~382 I_ B) Below, to the left, a schma~ic vertical or cross sec-tion the variation of a pressure dc.nator with lever trans-fer of spring tensioning by a wedge slide is shown.
C) Below, to the right a further variation of the pres-sure dcnator bzsket is schematically shown with a shorten-ing of the heighth by a clamF-like frame, to the right pzrtially in different functional stages.
Fig.18 shows above, to the right, a further detail of the pressure donator basket (c.p.Fig.9) in a cc~pressed (above) ard relaxed (~elow) condition with the wedge slide for for t~.e press~re tightening and a partial view of the bag(257,c.p.Fig.21) for the s~ction production.
Abcve, to the left, a slant lattice net is illustrated for the support of the p~essure springs (or dc.nators) in a ver-plan view.In the middle, a hcrizontal or longitudinal section is given through the lowest portion of the strong pressure springs and a plan view toward the wedge slides and the roller bearings for the lattice net on the former.
Below, to the left, the transversal section through the functional divided wedge slides along the section line A - B of the horizontal section.
Below, in the ~iddle, again a the mechanism for a delaying of the release of the inner strong pressure spring is shown on a vertical or cross section.
Below, to the right, a sketch is given of as pressure do-nator release by an articulated support, which ccn be tilded.
Fig.l9 describes, above in a vertical section, in the mid-3C~ dle and below in vertical sections the cc,nfiguration ofa valve control for fluid and air, if a bag (Fig.21) is used for the production of as s~ction for the skin fold ard ar overpressure for the flashing out of fluids.
Fig.20 demonstrates in a kind of block diagram the distribution o~ s~ction and overpressure from the bag and the c~ange between the transport of thinning fluid or water into the injection cylinders.

216~82 Fig.21 shows a vertical section throug a device according to Fig.9 with the illustration of the bipartite bag fcr the manual producktion of suction and overpressure between a firm ccver sheet of the device ard a lid which is movable acainst four pressure springs (from wich two are shown by the section line near the side wall of the hcusing.
The locking and release device for the mentioned pressure springs is s~ill demonstrated (Above to the right a tlansversal section through the detail of the locking car-riage over that). Above the detail of a connectionbetween the bag and the lid rep. ccver sheet of the device.
Fig.22 shows schematically three sGlenoids working against three release f~nction: above for the auxiliary slide for the pressure dc,nator release; in the mlddle, for the expansion of the suction producing bag; below, for the re-lease of the drug ard fluid ejection stroke.
To the left the detail of the end of an injection cylinder with sectorally slotted blind for the opening of the noz-zle be the wedge slant of the release slide.
Fig.23 gives a ~crinzontal section through a double working solenoid Wit`l a thrust-rotation device for the the opera-tion of any functions one after the other. Below a trans-versal section along the section line A - B of the horizon-tal section.Fig.24 shows an er.larged the electrical cur-rent transfer o~-er a enlarged toothed wheel with sliding contacts for the message to the electronic control unit.
Tc the left a transversal section is given, to the right a hc,rizontal section.
Fig.25 shows, above in a vertical section, a suction cup with a dcuble blind for the injection nczzle ard a octical skin control device. Below a hc,rizontal section through the details of the t~c blinds is given~enlarged).
Fig.26 shows an enlarged vertical section t~!rough a suction cup (and a side view toward an injection c~linder) with ar.other nozzle blind and an alternative for the opti-cal skin con~rol. Below, to the left a partial hcrizontal section is given, to the right a further enlarged detail '_ 216~582 of the blind area.
Fig.27 shows ar er.larged vertical section through a suctior.
cup with ar annular blind w~ich raises, when the skin is sucked up. The optical skin control device is mounted on the blind, which is shown to the left in an elevated, to the right (half) in the lowerd stage. Below a plan view to the b~ind.
Fig.28 shows vertical section near an injection cylinder, w~!ich is laterally installed, through a suction cup.
lC The optical skin control by a p~oto emitter ard sensor oc-curs here or, a window, which is as an enlarged detail represented below.
Fig.29 is a plan view to a control pannel of a device according to Fig.9 and another devices. The adjusting 15 w~ieel are sectioned, through the breaking of near the suction cup two injection c~linders. (The sleeves with sensor threads an small folded bellows on a c~ain belongs to a device a~ in the Fig.47-54). To the right a the vir-tual image of a computer calculation with the programme inputs for planned meals and work capacity in relation to a metabolic e~fect by insulin.
Fi~.30 shows the enlarged detail f~ the program key ar;d its arest~ng ledges according to a control panel as decribed in Fig.29, akove in a vertical section, under that in a hc,rizontal section. Below a side view in the direc-t~on of the arrow.
Fig.31 gives a schematical side view of a device composi-tion on a reduced scale. To the left the hcusing of a jet injector in wire-less ccnection with a hc,using with the *is shown electronic control unit ard the stacked on additoninal recording eqipment in a wire connection with t~le electrica~ charging device with recorder.
Fig.32 is ano~her functional block diagram of a device cGmplex compr~sing an suction injector with skin squeezing mechanism, a metabolism measuring device with changeable sleeve with sensor thread (c.p.Fig.47-54) and the respecti-ve electroniC control unit or p3rlogramme control-2164~82 Fig.33 is a horizontal section through a jet injector forsingle drug cartriges using a suction c~p. Below, to the left~ a pressurized gas stream pum~ for suction pro-duction. Above, to the right, the detail with cartridges for a pulver jet injection in serie. Below, tc the right, a detail of the locking mechanism~for switching over to rew injection, if a step *is shown syringe for multip-le dosages is used; this is dc,ne in an enlarged vertical section alon~ the carriage(9lO) with the hinged locking t~ pulledbY the tow line(gl2) Fig.34 shows spectacles for diagnosis by laser investiga-tion of the anterior eye chamber. Abcve, the frontal view against such spectacles on a face is demonstrated, in the the longitudinal section of the right half of the device on the level of the head-band with the singularity of schematic f~ontal section through the left eye with photo enitter and photo sensor ledges. Below, to the left, a partial plan view under the longitudinal section in the level of the blind visor, quite below a~ tc the right cross sections through the respective adjusting wheel are shown. To the right, a much enlarged eyeball with a lateral ligh~ projection ard evaluation for the adjusting of the light ledge for the metabolism measurement, from wich below the left or.e is shown in further er.large-ment, both i~ a frontal view.Fig.36 schematically shows the detail of two laying pres-sure springs as pressure donators for twc injection cylin-ders on a hc,rizontal or longitudinal section with operatio-nal details.
Fig.36 shows, akove, in an enlarged detail on a horizontal or l~ngitudinal section a two chamber injection cylinder, which is e~!pt:ied by means of a piston driven by pressuriz-ed gas.
Below, in a partial horizontal section, arother variation of the tw~-plston-cylinder is shown and quite below, t the right, a similar sc;lution.
Quite below, to the left, a solution is given, in which the two piston are replaced by folded bellows.

~ 2164~82 -Fig.37 gives an alternative and and cc.mpletion of a mecha-nical ccntrol gear in a hc,rizontal section.
The enlarged wheel in cross section, below to the right, belonges to the control of a fluid valve. In the middle a variant of an iniection cylinder is showen with ar influx control for thinning fluid (to the right in a vertical sec-tion). To the left, in a hcrizontal section in the level of the conne~tive strap, the mechanism of the swivelling of the latter is shown over the folded bellows and away from it. Below, to the left, a hc,se or tube brake is il-lustrated, above in a~ enlarged horizontal, under that in an enlarged vertical section. Below, to the right, a trans-versal projection of the tccthed wheels is given. (The latter was above shown in a tipping up).
Fig.38 shows very enlarged in a hcrizontal section a solu-tion for a bolting of a cperation wheel (or function) in a fixed position.
Fig.38 shows in a hcrizontal section a special ccntrol gear with an additional intermediate gear for a speed reduction.
Fig.39 shows a separated metering device driven by two s~all solenoids, w~!ich works agaist wedges of a respective wheel (shown in a rolling up), to transform the thust mo-tion in a rotation for thc metering screw. (To the left through an additional intermediate gear for larger a~ounts of drugs).
Fig.41 shows in an enlargeded and schematic hc,rizontal sec-tion with a pressure spring and a lever t~ansfer toward the pressore donator.
Fig.42 shows very enlarged a piece of a tape for the data registering with printed o~,t input and measured date and other e~sential calculatated data.
Fig.43 shows a table for a schematic calculation of ne-cessary insulin quantities by a computer relating to input data (Information page) Fig.44 supp'ements the Fig.43 with input data.
Fig.45 supplements the Fig.43 ar~d 44 by calculation data.

~, 2l6q~82 - Fig.46 gives a principle set up of an optical skin ccntrol using the reflex photometry.
With Fig.47 begins the demcnstration of an supplementing device for providing of a jet injector with metabolism measured values, especially with tissue sugar values.
This is done on a somewhat reduced scale in a rolling up on a hc,rizontal or longitudinal sectional view. A~cve, tc the left the top of a sensor bristle bearing sleeve at a naturale size. Below, to the left, an enlarged vertical or cross section for a locking device against the retreat of the br-istle, laterally with a partial side view.
Fig.48 is a schematic vertical or cross section through the device of Fig.47. Below, a hc.rizontal or longitudinal section is shown through the detail of the pressure dona-tcr support.
Fig.49 shows in ar, enlarged detail two functional stage of a special oush-rotation mechanism fcr device according tc Fig.48 on a horizontal or longitudinal section.
Below, to the left, the four switching positions(A-D) are schematically detailled projected-in a side view.
Fig.50 schematically illustrates a much erlarged sensor capillary and its o~eration in a hcrizontal or longitudi-nal section by hand activated syringes.
Fig.51 gives much enlarged a special sleeve for a sensor bristle ar~d an additional device for the injecting of it in a hc,rizontal or longitudinal section. Above, to the left, a shortened detail of the sleeve in the stage of being broken c~ff. Quite to the left, a vertical or cross section is shown through this sleeve.
Fig.52 shows on similar conditions as Fig.50 the variation of a jet injection of the bristle by pressurized ga~. Above in a cross section stacking sheets~for the elec-trical ccntact with the bristle in two stages. *are shown Fig.52 shows ~he variation for the introduction of the bristle (enlarged details above to the right) as a drill.
Fig.54 to the left a ~ristle device a a carrier for a s~;all measuring cylinder, to the right, enlarged the reflex opti-c~l e~-aluation. Fig.55 gives a auxiliary device for urin sampling, Fig.56 an alarm device against low nightly sugar.

21~4~2 Detailed description of drawings - ' Figure 1 is a schematic representation of an injector in the longitudinal section at a scale about of 2: 1 (where-by the nozzle and drug channels are further er.larged). The closing stopper(2) is shoved into the suction cup(l). The area of the nozzle(3) is closed by the china socket with the incandesce~lt wire~4) by means of the sealing ring(5).
The leads(6), ~ymbolized with dashed lines, lead to ar electric plug and then to the current transformer (not shown). The tissue friendly fluid is also filled into a step syringe(7' as customary in the trades and can be metered by a pressure button (nct shown). The screw cap for the cannula of the step syringe is connected with the cylinder(9) under the piston(10) through the rigid tublet (8). The valve flap(ll) is demonstrated during the filling up of the cylinder to make it more visible.
The connecting hose(l2) over the back valve(l3) in the wall of the suction cup is diverted to the folded bellows 2û (14), again for a better representation, The latter is fastened on the hcusing(l6) with the bottom sheet(l5);
the head sheet(l7) of the folded bellows is enlarged by the solenoid(l8) working by drawing and serving the sucking on of the skin. The anchor or rod (19) of the belonging solenoid is shown as pressure donator for the piston in the drug cylinder. The pressure spring (20) symbolizes the backward motion of the anchor or rod.
The hammer(21) for the plunger of the piston(10) is bent, because the pertaining solenoid lays covered as well as that of the folded bellows. The dashed lines(22) toward the plug for the cc,ntrol device or unit (nct shown) represent all wires of the solenoids.

Figure 2 shows a injection device in a schematically longitudinal s~ction at a scale about of 3 : 1 .
The inner cylinder(24) with the longitudinal millings on its end is shoved into the outer cylinder(23) with the 2164~82 nc.zzle(3). The lower piston with the annular edge mi.lling (25) above glides in the inner cylinder around the central plunger with the erd ledge(26, cross section bellow).
The plunger can not be drawn out of the central bore(27) of the uE~per piston in such a way, but it can be shoved i~. From both rotation (or disk) valves(28, see Fig.3) orly this is shown in the uF~per piston, which leads over the hose(29) to the folded bellows with clean water.
A branch of the w~ter ccnducting hc,se flows together with the c~annel for the drug, over the rotation or disk valve into the anterior cylinder space. The folded bellows tc the right with the tissue friendly fluid inside of the supply cylinder(31) is correspondingly fitted with hoses and valves. Pressurized gas bclster(31) with compressed CO2 promote the e~ptying of the folded bellows. The strong pressure spring(32) serves as pressure donator for the upper piston, which is supported upwardly against th~ rcof of the housing(l6) and downwardly to the piston bowl, shiftable in the housing and bearing cen-trally the pct(33) which is cu~ out to the left.The belt(35), which is fastened in the centre of the hc,using roof, is led thrcugh a central bcre in the pi.ston bowl and serves for the stabilization (or guiding stabi-lization) during the motion of the latter. The guiding pin(37), which pro~ectes from the piston bcwl, prevents the axis rotation in the housing slot(36). The piston bowl is lifted for the compression of the strong pres-sure spring by means of the screw(38), which is guided in the screw of the cross stay(39).
A toothed wheel is fastened on the lower end of the screw, in which the wheel is driven by the pinion(40).
The latter is shiftable along to the square operation shaft and s held into mesh with the toothed wheel by a kind cf g~~ding disks.
After the release bolt(41) is turned through the pinion(42), which works to its toothed wheel, under the edge of the piston bcwl, the screw is now turned downwards again in its exit position, to allow the relaxation of the strong p~essure spring(32).
After the retreat of the release bclt(41), the cut out pct (33) strokes tc the upper piston plunger(34), the piston of which is driven dc.wnwards and herewith toward the noz-zle. The pcwer transfer to the lower piston is achieved o~-er the fluid (tissue friendly or water) between bcth pistons. When the fluid between the lower piston and the nozzle is expelled to a greater extent, the fluid from the inter-piston space can be emptied through the ann~lar edge or marginal milling(25) on the upper piston and late-rally through the lower longitudinal millings on the inner cylinder(24) over the the chamber before the upper piston and the nozzle without an interruption of the beam.
After each injection, a maximum chamber respective cylin-der filling is effected after a ccrresponding opening pc-sition of the disk-shaped three-way ccck over the flexible shaft(43), so as the clean water is filled, near the noz-zle, into the lower cylinder by tne influence of the pres-surized gas bolster(31) and bcth pistons are lifted. After the three-way ccck is closed, the disk valve(28) in the upper piston is opened and the space between the pistons is filled up. (The piston strokes are additionally actively lifted in the derivated application examples). The moment of release of the syringe emptying by the screw bolt(41) can be determined by the user. During the preparation for injection, the chamber behind the nozzle is filled up, whi-le it is closed by a lid or closing stopper(see 2,Fig.l) from the folded bellows with the tissue friendly fluid (per-haps~physiok~ical salt sclution), first, urtil the lower chamber or. th~e inner cylinder is closed by the lower piston, perhaps relation to the the illustrated position. The drug is transported out of the cartridge through the cannulas or rigid tublets(8) into the space behind the nozzle by the rctation of the micrometer screw(44). The inter-piston chamber is filled up in an analogue manrer as the clean 21G~582 water (or drug) after the opening of the disk valve (45,below in the cross section). The sucking of the skin over the suction hose(46) preceeds each injection. (In this case by a larger injection syringe, not shown). As soon as the skin knob touches the three contacts lateral to the nozzle exit -one of these is shown in Fig.8- the operation of the release bolt(41) is activated.
The mechanical mction transfer -as it perhaps occurs bet-ween the flexible shaft and the toothed wheel(47) for the drug meterin~ and the cross shaft in gear m~sh with the former- is omitted and a box(48) for the electric mc,tor and the ccntrol gear (which are minimally calculated) is drawn in. From the numberous electric ccntrol contacts, orly the counter pin(49) and the correlated cc.ntact spring t50) on the hcusing are indicated, which ccntrol the drug metering.
Figure 3 shows ir a plan view on a scale of 2 : 1 a valve (circle) with ar slant lever(~ine). The latter is shifted *(313) betwen two lock pins(314,315) with a frame(316) with a slot along the bar. (The Fig. demonstrates a possibility of fluid cGntrol in a device according to Fig.l and 2).
Figure 4 schematically shows on natural size the control gear of the invention according to Fig.2. A free change between the functions ard functional periods have been pro-vided in ccmparison with the solution in DE P 59 25 940.4.
The task was solved by operating the work driver for the cc,r.trol pinion between the different operational w~ieels by a chaine whiich acts on occasion of a pcle c~ange of the mc,tor, shifting against the wcrking phase of the pinion axis. The driving direction is only counteracting on the pinion axis(~l) and the mc,tor axis(53) in each case.
The rotation direction of axis and chain is respectively inverted or. 'he final phase of the pinion shifting similar as by a tape of a typewriter. The ccupling for the change in the switching pcsition is transferred into the axis.
The reduction of the rotation speed occurs from the motor 2164~82 axis(53) through the translation toothed wheels(54). Thecpupling is effected for the switching over of the motion direction between the main operation wheel(55) and the large toothed wheel(56) through the distance ccupled pa-rallelly shiftable pair of toothed wheels(57) or -for an inversion of motion- over the derivation toothed wheel triade(58).
The latter is demonstrated in its special housing(59), which is shown above in a cross section. The hatching might replace the representation in the depth planes (or cutting). The diagonally hatched wheel halfs show the pla-ne onto mesh which is destinated for the drive of the lar-ge wneel(56). The transverse hatched half indicates a mid-dle tocthed w~:eel which reaches with its perpendicularly hatched half the toothed w;:eel which is destinated to mesh with the main operation wheel. The special hc,using is slided along tc the sqare bar(6C;).
The switching hook(61, in dash-and-dot lines) is taken with with its fork ends or. the final phase of the motio of the cc,ntr~l pinion. The motor is driven staccato and e~7entually charged with c~rrent under pole changing until control contacts (not shown) record the f~711 meshing of the teeth.
The ratchet -coothed wl-.eel are simplificated by the hookes with axle fastening; the belonging ring of ratchet teeth was only indicated. One thoothed wheel is driven from each of both switching aggregates, which bcth mc,ves the trans-pcrt wheels of the control cnain(52) by a cross drive with toothed (or beveled) wheels. A counter acting ratchet and pawl mechanism, but also here, provides the necessary tun-ing. The axis of the ccnrol pinion has a cross pin inside of the large toothed wheel(56) which is cushioned against both sides and shiftably by lateral pressure influence.
The cross pin meshes with a projecting driver edge inside of the bushing bore cf the large toothed wheel. The cross-pin rotates freely, after the axis is laterally shifted, because the large toothed wheel is secured against lateral 216~8 ~, - shifting by a fork(65). In such a WG'Y a coupling effect occurs. The row of the operational wheels is o~!itted, to which the control pinion meshes, to one after other; just as little the common axis parallel to the axis(51) of the control pinion is nc,t shown.

Figure 5 shows a cylinder with double piston for the in-jection similar to that in Fig.2 in the longitudinal sec-tion at a scale about of 1 : 2 (with an exaggeration of the nozzle diameter). The cannulas or rigid tublets(8) terminate from both step syringes (with drug an body fri-endly fluid) near the nozzle in the c~-linder(67). The orifice into the cylinder chamber is closed by the valve flap(ll) each to the other. Tissue friendly fluid is also filled into the inter-piston space through the upper pi-ston over a hose and the disk valve(28). The valve disk (68), which closes the central bcre of the lower piston, is closed by the tension spring(69), that is, pulled near the piston. The valve rod can not be drawn out of the in-ncr bcre(70) in the upper piston (as in Fig.2). The valvedisk or cone(68) shows below an insected star-shaped~pro-file for the fluid passage. The lower chamber with the-~~~
drug is emptied, first, if the upper piston plunger is stroked with pressure by the pressure donator. The plunger over the valve disk(68) on the end of the inner bore(70) finds then resistance or! the end of the inner bcre(70) of the upper pi,ton and the valve disk lets the fluid pas-sage central 'L y free.

Figure 6 shows a solution without valve mechanism between the drug a~d the bcdy friendly fluid for the overpressure injection in an about naturale size in the longitudinal section.
Folded bellows and hose end(71) are replaceable pcrtions which are filled with body pleaceable fluid. After a cover cap on the hose end(nct shown), the latter was introduced in the screwing on tube(72). A small lateral opening in 216~82 the hc,se wa~ made coinciding with the drug admitting can-nula, while following to a marking. The cap(73) is fasten-ed or the screwing-cn tube by means of a bayonet clamp.
The tension sheet(75) is in an adhesive ccnnection with the adjusting screw(74) The latter is screwed back relat-ing to the dosage, while hollow space, produced by the metering, is filled up from the step syringe which is part-ially shown. The piezzoelectric sclenoid as pressure dcna-tor is approached along the slotted ledge(77) to the cap (73) and then loaded with current. The folded bellows is e~ptied through the nc,zzle by the three pressure pins(78), the drug first.

Figure 7 shows,in natural size the preferred position of the nc,zzle, to the left, in longitudinal section and to the right in cross section. This nozzle(3) lies on the end of the cylinder and laterally in it, so that more space is disposable for the pressure dc,nator which is also laterally positioned, in this case a strong p~essure spring(32), in a pocket portable~and flat shaped housing.

Figure 8 is a kind of flow chart of an injection device in its totality as a therapeutic system.
The injector, which is mainly symbolized by the suction cup(l) is fitted with an optical cc,ntrol device for the aptitude of ;~he puncture area tc exclud pathological skin areas. The l-ght beam which is projected from a light scur-ce(LED) through fibre bundles is subdivided into t~o projec-tion areas and two measuring areas. The one of beam(78) projects against the puncture area, the second(79) to an adjacent area. The comparison of bcth brightness values -eventually compared with measured values of the proceeding use- speak for the aptitude of the skin if they are near-ly corresponding. The pressure donator(81) is activated over the control part or unit(80). The metering of the drug was taken before with the keys of the ccntrol unit under display control. Pin and cc,ntact spring(49,50) 2164~82 transmit th~ related ccntrol values with the rotation ofthe mircrometer screw. Dosages can be input as well from a ~ire-less transmission part or unit as such or other da-ta can be tLansmitted from the injector to the transmis-sion-receiver part or unit(83). From there or or the de-vice, glucose measured values can also be input, in such a ~anner in w~;ich a programmed ccrrrection of the drug amounts, which should be ir.jected, is pcssible.
10 The drug dosages ard other dates can be time proportional-ly documented mainly by the occasion of the battery charg-ing on the m2ins.
/The optical skin control is suitably repeated after the injection. In case the fluid beam has not pene-15 trated the s~in or not completely, the measured lightbrightness values differ very from those before the injec-tiuon caused by fluid reflexes. This lack is reported and registers should the occasion arise. If this lack re-peately occurs, the injector is blocked in its function by 20 means of the control part or unit.
The arrangement of the three cc,ntacts for the "earth cir-cuitry" with the skin is shown in Fig.7.
Figure 9 gives in the longitudinal section an overview over the principal device cc.nnection of the singular por-25 tions of the invention, whereby the greatest length isshortened to 70 percent and thereby the suction cup is also accordingly diminished. Above, a correspondingly scaled detail is s~own with the representation of the screw(l25,c.p.Fig.13) for the thrust of the plunger in-30 side of the drug or insulin c~rtridge(ll3). Just aboveto the right, the detail of the stop krob(270) of the re-lease stop is still shown in the natural size. The latter is operated by a tow-line from the ccntrol gear (see Fig.12), to release the mc,vement of the release slide 35 (268,below) asainst the pressure spring(269).
T~le latter ii displaced by influence of the pressure spring(260) nd becomes free, shortly one after the 216458~

other, the locking blocks(847,848) for the pressure donator or springs(261,262) of the cylinder(9) for the injection of drug-thinner mixture and of the cylinder for the injection of the thinner(c.p.Fig.17).
5 The release slide and the locking blocks are daubly installed symmetrically as any other functional pcrtions.
B~t the same is valid for the sliding screw(352), which is turned out of the screw sleeve(850) by the strong toothed wheel on the screw sleeve. A wedge slide(850) is shoved 10 under the pressure danators on the roller rail(852) by means of the slide carriage(851), so that the pressure donator springs are lifted and tiahtened(c.p.Fio,.17,10). The vigor-ously constructed control gear(279,c.p.Fig.14 in the frontal section) becomes its motion mcment over the smaller toothed 15 wheel(853). The latter is driven from the pinion of the con-trol aear(c.p.Fig.10) over the tIanslation toothed wheels(54) from the motor axis(53). The switching over from the func-tional block A to the functional block B takes place over the shifting of the switching bar(789) at the last phase 20 without a further lifting function of the wedge slides; that serves to the purpose to drive the screw(121) for the in-sulin metering and additional auxiliary functions (c.p.Fig.
12,13). The already described release functions fall in the initial phase of the functional block A.
25 Also in the detail above, the support column(854) is arrang-ed outside of the pressure donators and serves with tow analoguous columns to take up the spring pressure inside of a special frame(c.p.855,Fig.9 below). The connec-tion strap(856, strong lined) serves to the equal power 30 transfer from the outer pressure donator(261) to the injec-tion cylinder(9). Two of these three connection straps(266, 267 below) lead, under the iust described connection straps, from the screws for the limitation of the metering plunger or piston movement.
35 The supplying of t;he syringe (or iniection) cylinder with drug or thinner -after each injection also with weter for _ 43 -,i 2164~82 cleansing- ensues from the folded bellows for thinner and water (90,190), which are skoved into cylinder, which again on their part are finally connected with an uptake cylinder(858) c.p.Fig.7). The supply of the folded bellows with the over 5pressure and the suction production are performed from a bag (263) when the lid(260,Fig.13) is lowered. The four tube socket(258) for the uptake of the pressure springs(259) are drawn in. An oval shape of the suction cup (c.p.the detail above) is chosen a~ variation.
lC The battery(155) and the electronic control unit(80) are still positioned inside the bcx-like housing whereby the wires and hcse ccnnections are omitted for lucidity. Only the housing ring(202) is described from the valve for the control of pressurized air and fluids. Ccnstruction and function are 15 described more exactly in Fig.11 and 12.

Figure 10 shows in natural size, the longitudinal section of another solution for the switching between functional blockes. Because in this case a switching happens in 20 three different operation wheels, a siiding switch is not necessary for the spooling back of the metering screws. The metering screws are positioned for forward and back motion for functional block B or C, respectiv-ely. The free turning toothed wheel with the leaf spring 25 (785) may approach to the pinion(351) through the switch-ing bar(789) -on the final stage of the sliding function of the block A(c.p.Fig.13)- by tightening the pressure spring(495). The forementioned toothed wheel lies in front of the pinion(351) on the mctor axle of ccurse, 30 in close connexion with the gear transmission or reduc-tion gear. This g~ar drives with sliding seal on the axis the oFerating gear wheel(293) for the block A
Because the cam(733) moves into related recess, the pre-ceeding toothed wheel is rotated by the pinion. This drives the operation gear(293) when the pinion is shoved to the right toward the operation gear(790) for the , switching or functional block B. The cross pin(788) ofthe motor axis is maved and mounted in the (also rotat-ing) flanged sGcket(786), inside of the coiled groove (787) with three recesses correspanding to the switch position. Each recess offers support, first, against shifting to the right of the mator axis and in the oppo-site direction after the shifting motion is released.
The last backward movement to the left is achieved by the tension spring(784) between the cross stay(791) and the hausing wall. As shown in the detail to the left at a scale of about 3 : 1, the cross pin is restored to a position corresponding to the functional block A after the functional stage B.
The pressure spring(495) is relaxed by releasing the pressure on the switching bar(789). The leaf spring(785) in the recess of the toothed wheel creates a division of the forementioned toothed wheels, so that the nap(783) leaves the pinion. Halding plates(124) can secure connec-tion to further toothed wheels for the transfer of opera-tional functio~s. The sliding sleeve inside of the motoraxis is nc,t drawn.
For variation, the flanged socket(789) can be secured against rotation. The mc,tor power is then transferred to the pinion from a parallel axis through a gear wheel which is lead with the pinion in a holding plate connec-tion. Thus the pinion(351) like the operating wheel turns freely around the axis.

Figure 11 reproduces, in a longitudinal section at a scale 3C~ of about 2 : 1, the detail of a centrifugally operated switch as described already in Fig.9. The ratched gear wheels in pairs(703,702) and (707,706) were shifted to the left on the sl,~ding switch(717;c.p.Fig.29); thus the me-tering screws ~an be spooled back this way. The direction of the motor chooses one of the two. Over a toothed wheel to the roll(69~) the drive runs from the oear transmis-sion wheels(54` after the mc,tor over a toothed wheel to _ 45 -~ 2164~8~

the roll(699). The slide(606) which is formed as pin de-termines the choice of the functional block, as the case may be either in the worm guidance (shaft) of the inner axle(715) -as drawn-or in the worm groove of the outercylinder(699).
The slide(606) qontains a portion which is permanently mcg-nctic and is he~d in the roll in a more centripedal pc,si-tion by permanent magnets. With centrifugal pcwer it is pushed with th0 motor rotating speedily outward into the worm groove guictance of the outer cylinder, in order to rotate the outer cylinder when the end of groove is reach-ed. (During the continuation of the rotation direction, the speed of rotation no longer makes a difference for switching function). The switching situation shown would transfer, with rotations against the worm groove, the pow-er over the inner axle(715) and the toothed wheels and the free-turning axle sleeve(781) over the switching chain(52) to the functional block A for the cannula retreat.
If the direction of the motor is changed, it would solely alter the direction speed for switching chain slightly.
(The motor retardation can be reached through electrical resistance or through an interrupted staccato current sup-ply). With a more speedy run, a pcwer transmission is ach-ieved through the outer cylinder and the wider gear wheelto the gear wheel(701). The c,lear wheel rotates its axis and, through the axle sleeve(781), the ratchet wheel (703). The bevel gear wheel(704) is driven over the gear wheel(782) and another gear wheel rotating on the same axle. Thus the bevel gear(709) is driven on the cross axis toward the corresponding mctering screw (functional stage B). This happens through a border toothing of the bevel gear(704). The r~tchet wheel(702) goes out of function be-cause its cam(783) has left its counterpart on the turn-ing bevel gear on its axle. The mc,tor turning in oppo-site direction is transferred by the ratchet wheel(707) in mesh with the toothed wheel(708) over the tube seg-~ 2164~82 ment to the other metering screw. (The thread directionof the metering screws are suitably coordinated against each other in s-;ch a way nc, switching over is necessary on the centrifugally operated switch for changes of meter-ing). With the manual operation of the sliding switch(717),the ratchet wheel(706) is pushed to the left over an annnu-lar groove into the axle and has thereby lost its axle mesh.

The symmetric between the periphery of the wheel and the lG device wall expanded tension spring(796) can produce a kind of release point, that is, a delay between the relea-se functions which can be used for the optical skin control.
The leaf spring(797) on a cam of the driving bolt(798) in a bore of the slide presses the release bolt against the tooting of the wheel segment. The latter shows there a locking effect for the influence of the bolt in one direc-tion; the backward movement is brought about then over power mc,ments of another mechanism (not reffe,~ed to here) which is eventually classed with another functional 2G block.

Figure 13 shows in about natural size, in a longitu-dinal section, the detail of a power transfer to a func-tional block from a mc,tor (not drawn) and an operation wheel. The operation wheel(792) chosen is specially large and lies under the pinion(80û) which is driven from the former. In the demonstrated functional stage, the lateral naps(783) of the pinion approache likewise naps of the toothed wheel(802) firmly ccnnected to the screw(8G1) about which the pinion can rotate. This is done to rotate said toothed wheel(802) ard therewith the screw.
Hclding plates(124) prevent the toothed wheel(8û ) -which without transfer function can also be a disk- from shifting laterally. The toothed wheel(803), is like a toothed wheel(804), connected with the screw(801) but able to rc,tate about that. The screwed sleeve(8C4), in which ~ 216~582 the screw(805) projects, is firmly connected with the toothed wheel(803), The plunger for the thrust of the pis-ton in the drug cartridge can be moved directly over the 5 bar(806) which is connected with the screw(8û5).
Opposite working ratchet wheels(702,703) can overtake the transfer functions for the drive of a metering screw(c.p.
Fig.9 in connection with Fig.14) in tooth meshing with the toothed wheels(803,801) for example over flexible 10 shaft5.
(The coupling of the latter t~o with the metering screw is then effected over separated toothed wheels which lay on a common toothed wheel around the metering screw radially offset to their common drive axis as well as the ratchet wheels(707,706). If the pinion(800) is shifted on its screw(801) totally to the right, after the mc,tor has chang-ed its running direction, the naps(792) of the screw(801) mesh with one such on the toothed wheel(803). The latter and therewith the screwed sleeve(804) is rotated now. The 2C!screw(805) is now shifted to the right with its rota-tion preventing linkage(808). The~thrust motion of the pinion(802) is transferred over the bifurcated rod(809) of the switching bar(789) while its cross pin(811) en-geges the corrugated leaf spring(810). The latter, with 2sits bar in the pierced socket .is therefore shiftable and jointwise connected with the switching bar(789) which hes n;~ng axle stationary on the housing. The pick-off of an additional ratchet wheel rotation is to prevent the transfer of mc,tion functions in the position of the pinion 30(8CO) meshed ~ith the toothed wheel(802). The function, which in any ~ase, is secured over the corrugate profil of the thread wheel(814) pressed or, by a pressure spring against a rotation locking of the former, is coupled off b~ pulling of the nap disks(815,816) asunder. The nap disk 35(815, or the nap wheel) is in axle mesh laterally shiftab-le to the ratchet wheel. The nap disk(816) turns free or the axis and stands in axis ccntact with the wheel with - 4~ -~ 2164S82 corrugated profil preceeding the toothed wheel(814) overthe flexible shaft. (The corrugated profil is drawn again below).

Figure 14 gives, above, a frontal sectional view imme-diately b~hind the housing wall near the motor of device according to Fig.9. The large toothed wheel translation (279) which is driven from the motor through the small toothed wheel(853) causes the analogue sliding screw to the left, in comparison with this to the left, having to be fitted with a counter running thread for this space distribution.
Urder that, to the left in the middle, and to the right of this in a longitudinal section, but below in a cross SE ction, a detail is reproduced of the power transfer from the motor axis(51) through the operation wheels(790, 703;707,706) ard other propulsion elements.

Figure 15 shows in the longitudinal section in a scale of 2 : 1 a container with folded bellows for thinner (90) and water(190) as a preferred type. The package cylinder has a partition(196,Fig. ) which can b~ shov-ed with its edge socket against the sealing ring(381) of the lower partion(382) of the container housing.
The edge socket is pressed firmly by the pressure of the middle cylinder(393), which again is tightened by the sEaling ring(391) against the lid cap(390) which is tightening pressed on by means of the bayonet catch(388).
; The thinner afflux occurs through a hose with the can-nula(385) on the end of the bottom lid(383), which is tightened against the lower partion(382) by the sealing ring(384). The cannula(385) is sealed toward the folded bellows by the elastic plug(394) which is suitably a portion of the folded bellows. The package cylinder(395, detail bellows to the left) for the uptake of the folded bellows (90,190) has around the plug(394) a gap or near 216A~82 the plug a hole(396) for the gas pressure exchange.
The lid cap is screwed on by means of the catch hinge (392) as customary in the trade, which deflects out of its longitudinal axis about 90 degrees b~ spring power ard bends laterally.
If the socket(397) with outer thread is added around a central recess as shown in a detail below to the right, the annular plate(398) can be stored in this recess on the annular seal(399). The inner edge of the lid ring (400) presses against the sealing ring(401) on the an-nular plate. For this inner thread of the lid ring meshes with the outer thread on the socket(397). The sealing rings(384 391) can be omitted in this suitable ccnstruction. The bottom lid(383) and the lower pcrtion (382) are then melted into one single portion as is also done with the middle cylinder(893) and the lid cap(390).
The gas apply to the folded bellows occurs separately through the gas afflux sockets(387,388), the fluid is applied through the cannulas.
The lid cap(390) is screwed off by means of the catch hinge(392) for the exchange of the package cylinder halves. A calibration difference of the inner cross section (perhaps hexogonal profile in the lower portion with adaptation also of the package cylinder halves) serves to avoid an incorrect supply of thinning fluid and water to the derivation hoses. The adhesive cover foil(404) which protects the hc,le(396) and the plug (394) against pollution is to drawn up before use.
If, as shown in the detail below to the right, a socket (397) with outern thread is set up at the bottom lid (383) t-len the annular plate(398) can be left in the annular seal(399) of this depression. The inner edge of the lid ring(400) presses against the sealing ring(401) on the annular plate. An inner thread of the lid ring meshes for this with the outer thread of the socket (397). The sealing rings(384,391) can be omitted for ~ 216~582 this suitable construction. Bottom lid(383) and lower portion(382) are then fused to one single partion, as with the m~ddle cylinder(8g3) and the lid cap(390).
The gas supply to the folded bellows occurs separa-tely through the gas admission sockets(387,388), the fluid supply through the cannulas.
For an exchange of the package cylinder, the lid cap (390) is screwed off b~ means of the catch hinge(392) and the drawn out package cylinder, which has left the cannula, is pushed away from the cannula(404). The new pzckage cylinder is pushed into the lower portion(382).
A sudden calibre charge between bath half of the pack-age cylinder or suitable differences of the inner diame-ter (perhaps hexonal profil in the ]ower portion with adaption also of the halfs of the package cylinder) serve to avoid a false supply of thinning fluid ard water into the derivation hoses.
Before use, one pulls off the adhesive or sticking pro-tective foil(4C2), which protec~s the hcle(396) and plug(394) against pollution.

Figure 16 consists of details which explain the ccm-; position of the injection cylinder. The half of the horizontal section demonstrates the positional rela-tions in the closing area of the injection cylinder(9) with the connecting stap(267) toward the screw sleeve (857). In the variation, which is shown in the vertical section below of the horizontal section, the screw sleeve does nc,t proiect up to the roof of the injection cylinder, but it is firmly ccnnected with the latter.
The screw(~97) is lifted and depressed b~ the rotation of the flexible shaft(863) and therewith the piston (10) which is connected through a rod with the plate against which the folded bellows or the sealing mem-brane is screwed together air-tight.

2164~82 - Water or another fluid is filled-in between the folded bellows and the piston, which ccmpensates the volume displacement in co]laboration with the folds of the folded bellows, that is, if the piston is moved and this for a protection of the space under the piston against pollution and entrance of air. (A rinsin~
socket for temporary cleansing the inside of the fol-ded bellows is omitted). The connective strap(267) mcshes with the thread of the screw(357). As the lower lû end of the cylinder(9), the opened valve(11) is drawn in with the supply hose for water(29) below it.
The connective strap(856) serves the power transmis-sion to the pressure spring(261, detailed in the horizontal section above), for the expulsion of wa-ter or the drug injection. The crossed beveled gear wheels, meshing with one another, indicate that the flexible shaft(863) can also be driven-on otherwise.
The flap valve(11), which can be also replaced by the customary valve ball, is skown iust below in detail in the horizontal section; for the opening of this, the rigid tublet(8) from the drug cartridge and a supply hose for water(29), in both cases lead in this direc-tion to meet there.
The detail just above to the right is a vertical sec-tion along the section line of the horizontal section detail tr) the left under that. It shows the joining together of the drug exit out of both adjacent injec-tion cylinders(9,67) in the injection trow(865), the nozzle of which is directed into the suction cup (not shown)-Figure 17 serves, with series A to C, the schema-tical representation of solutions for the blocking of the pressure springs(261,262) as pressure donators for the injection.
In serie A, the detail around and inside of the pressu--~ 21~

re springs(261,262) is rectangularly rotated against the representation in Fig.1 and a sleeve is shiftable along the support cc,lumn(854). But the stop bolt (104), here in peirs, reaches a nctch in a support co-lumn through the bore of a sleeve for arresting.
The support column is clearly or both vertical sections, in the middle, from which the upper or.e corresponds to t~e sta4~ with detented springs, but the lower stage to that is tightened. (The tension takes place by shifting under one or any thightened springs clearly visible in Fig.10). To the left of the fore-mentioned images, ore of the release slides (268), which exist in a peir, is shown. The small sli-de(273) or this can be adjusted with its working slant through a screw of the control gear(c.p.Fig.5 above to the right). The hatched rectangle on the release slide represents the respective ccntact with the edge pro-jection on the edge (also hatched) of the bridge(866) toward the sleeve with the slidable cross bolt(35).
When the edge projection is de~ressed during the moving past of the release slide, the bridge(8~6) is also low-ered and the bolt releases the depression of the in-ner bridge arm(867).
The inner ?ressure spring(262) is propped to the lat-ter. But the bolt(35) can leave the annular natch of the inner .support column(868) by making a way in the support cclumn of the outern bridge(866). (The functio-nal stages are better read from the representation in ;h~- m~ddle below toward the middle above). The profile of the release slide is evident from the row of hatch-ed cross sections alono the respective section lines.
To the right on the pressure spring baskets, the stop bolt(104) for the outer pressure spring(261) is marked in. The corresponding distance of the release slide has a wedge formed profiled narrowness (c.p.also the small detail above) for the blocking of the bolt.

~ 2164$82 Above to the left, a variant is shown for the blocking of the inner pressure spring(262), analogously to the so-lution (just described) for the outer oressure spring.
It is evident from the dashed drawing of the bridge(866) toward the support ring for the pressure spring(262) that this bridge can rise over the latter like a loop, when the springs are tightened and the device lid is closed (c.p.Fig.13).
The series B/C more schematically clarifies pos-sibiities for sclution with simply lined sketches forholding, as small as possible, the height of the device in the cross section. For this, the pressure springs (261,262), from which only one is outlined, must be tightened ard the device lid must be bolted in a lowered condition. The representation is given for A in the middle in the vertical section in about natural size.
The cage or the frame(855) nominates structural strenghtenings totally around the pressure springs in connection with the injection cylinder, from which on-ly cylinder(9) here is is skown, and to the suctioncup(1), from which roughly half was outlined. The clamp(870) permits the shortening of the height, which corresponds to the lowering of the lid.
The wedge slide(274) -with is again mounted in pairs-is laterally installed in the lid to B. The bag (257,Fig.13) must respectively be made smaller for this. The wedge slide is shoved away on the tongue formed ledge, which projects downward through a slot in the lid plate of the de~ice housing to the carriaye of the sliding screw. The latter has depressed functional stage the end of the hook of the lever(872) and therewith the pressure spring in the shown functional stage. The final bowl of the lever(872) is raised over the knob-like end of the folded bellows of the injec-tion cylinder ard is fixed by the stop bclt(104),whereby the countermotion is arrested by a locking device (symbolized by a triangle).

'~ 216458Z

(The exact locality of the stop can also be determinedelsewhere)~
On the end of the support column(854), the lever(872) can be tilted on a pivotal axle a~ainst the injection cy-linder and simultaneously shiftable in the pivotal axle.
The lid of the device can ncw be depressed inside of the free clearance of the clamp(870). When the lid is lifted whilst creating suction on the skin in the suction cup, the stop bolt(104) can be subsequently retrieves.
~ 10 The pressure spring(261) relaxes during the reduction of the folded bellows above the injection cylinder, that is to say, in operation of that.
The wedge slide(274) is arranged (according to C) on the device bottom. Inside the frame(855), the wedge slide lifts, wher, slidinq. to the right, the pressure spring (261) into the locking device (not shown). The clamp(870) remains thereby stretched out; the connective st.rap is lifted together with the support ring(869) while the lid (260) is opened.
2G In the middle representation, the lid was depressed, but also again the connective strap(856); the clamp was push-ed together and shortended thereby. (The lowest level of the device is reached therewith).
In the partial stage to the ri~ht, the lid was lifted for the suction production and the clamp was tired apart, so that the u~,per frame portion with the pressure springs was also l~fted. First now, but while the skin is sucked on, the filling up the in~ection cylinder can take place. If not a additional overcoming latch is mounted between the connective strap(856) and the connective strap(267,Fig.8). After the pressure springs are releas-ed, the functional circulation is again closed to the stage which is closed to the stage which is shown to to the left.
The double intermediate slide(876), which consists of ledges in ccntact with the spring basket with the ball ~_ 216~582 bearings(87F), extends over the cross bar(877) to theleft in the Fig.) in its portion, which runs beneath the release slide. The cross bar(777) is connected with the broad intermediate slide(273). The tow line(978), the 5 middle of three, runs from the bolts(980,9~1) over the circulation roll(979) to the control gear, so that the intermediate slide, as to the same time also the the outer slide(274) through the other tow lines, can be ccupled off-from the double intermediate ledge(876).
1~ The mechanism for the cc,ntrol of the release delaying for the pressure springs(262) in shown in the vertical or cross section through the final portion of the release ledge(269) and the lateral projection of the intermediate ledge(269; below in the middle).
15 The small slide(273) is shiftably on the intermediate slide by a turning screw on the intermediate slide with the follower pin(879). The latter is taken with by the ledge proiection(880) of the release slide. Its movement occurs by means of the pressure spring(881) after the re-20 lease stop(760) is activated by the cantrol gear.One can see from the frontal section (below to the left) in the section direction A - B of the longitudinal or ho-rizontal section, that the resilient bolt(832) permit the retreat of the release and intermediate ledge, whilst the 2~ sliding screw(352) takes the wedge slides(274,275) with, because the former has a rigid connection with the wedge slides.
On the sketch (below to the ria,ht) one cen see, in a ver-tica] or cross section, in which a manner the hinged sup-30 ports(883), which can be hinged in a flexible ,iointagainst a erecting spring, absorb the pI essure of the pressure spring(261) and transfer is to the release led-ge (what is drawn also in the longitudinal section).
The release ledge is, about to the half, drawn back to 35 the left. (But the ledges have a wedge slant on their ends). After the bolts are released, the wedge slides are 216~%~

then retrieved out from ~he proiection of the pressuresprings, which occurs by the s]iding screw.
The sLpports are pushed sidewards by the respective leaf spring(884) on the ledge for the eiection or iniection.
5 The analogous fitting of the inner Pressure spring(261) was omitted.
With the described device, it is taken into account, that the pressure donator for the injection cylinders broadly ~ exceeds in power the pressure spring(881) for the ; lG release slide. An alternative is described in Fig.35 also with an horizontally laying mountin~ of the pressure springs(261,262). The operational expendidure can be fur-ther reduced by a two-chamber injection cylinder adjusted to the load of the device size.
Figure 18 schematically shows in both upper figures the raising of the pressure donators for the iniection cylin-ders and their relation to the lid area in a cross or vertical section. Above to the left, an example is drawn 20 for the closing of the pressure spring basket through an oblique lattice net, on which the rolls of the wedges slides find slight resistance.
The lid(260) is lifted by influence of the pressure springs(not shown; 259,FiQ.21) in a vertical section 25 through the detail above. The bag(257) for the suction production with the aim to ]iftina uF the skin is enfold-ed. The pressure sprin~s(261,262) are also released. The wedge slide;274) with the s~iding rolls(874) still stands outside of the pressure dcnators for the injection cylin-30 ders. The stop bolt(104) lays drawn back in the releaseslide(268), the inner pressure spring(262) is shown to the left, the one for the outer spring(262) to the right.
Below the vertical section skows the stage after the wed-ge slide is mcved to the right and the pressuere springs 35 are tightened. The stop bolts are now urged in the re-spective arressting notches and locked by the release slide, which is drawn back before. The lid is lowered and `- 216~82 the bzg is compressed under it.
A corresponding representation of a variation of the re-lease of the pressure donators b~ the wedge slides is given under this detail image in a longitudinal or hori-5 zc,ntal section. The wedge slide(273) for the outer pres-sure spring(261) is bipartite and surrounds the wedge slide(274) for the inner pressure spring(262). But the above described lattice net is respectively divisioned,so that outer stripes extend bEtween segments of the outer (spring) and the middle stripe leans on a bow segment of the inner pIessure sprincl. The release slide lies ledge formed outcide (in pairs),parallelly to the wedge slides.

Figure 19 describes the cQnstruction and the function of ~ v~lve control for ~luids to a scale about of 2 : 1.
This is done above in a vertical section, .in the middle and below in a horizontal section.
To the left in the vertical sEction, the segment axis(201) is connected with the base ring(885) and can be rotated 20 around the housing ring(202), nQt shown, which is firmly mounted on the housin~cl. The latter ccntaines the fitting sccket of the supply and derivation lines or hoses, the latters from which are drawn in dashed lines. The supply hc,ses are introduced from the back in the szme level as 25 that of thE derivation hoses.
On the stage of the left vertical sEction, the pressuriz-ed air stream is set free in the direction of the folded bellows with the thinning fluid or the thinner(90). The thinner correspondingly flows through the valve bcre in 30 the direction of the injection cylinders(9,67).
The discharge for the water is locked in the direction of the injection cylinder. The stage, which is representated to the right, shows the ccnditions after the turning of the segment axis at ar angle of about 180 degrees. The 35 pressurized air is ncw able to flow toward the folded bel-~ 216 ~82 lows(190) with weter and the water stream through the lower fluid valve toward the shunt for the rinsing of the injection cylinder.
Under this in the lon~itudinal section, two oFposite facing insections are shown in the base disk or the base ring. The contacts(207,2û8) for the signal to the electronic ccntrol unit are drawn-in on the deepest location which contacts with the rounded spring tongue (drawn to the right) stabi-lizing the rotation stage. The base ring is rotated by a nap 10 pf the saw tooth ledge(886). The latter is moved there and back by a bar in connection with the related functional block (B and C resp.B or C) steered by the control unit.
The type of the tooth shaping determines in which running direction the segment axle is turned.
The lower representation shows a simplificating alternative of the mechanical power transfer (c.p.also Fia.5 ) The bar is replaced by a leaf spring(887) with rounded nap, which engages in insertions of the base ring. The valve seg-ment to the left is cut in a higher level ard illustrates 2û together the course of the valve bores whereby quarter circle switching turnings are assigned with the possibility of permanent rotation in one direction.
To the right, a pendulum running is assigned. The fluid stream to the iniection cylinder(9) through the valve flap (11) is achieved, as shown to the right, by the pressurized 9S out of the bag of the lid, this stream being introduced there behind tue very reduced folded bellows for thinner (90). The spring biased back valve(888) prevents a damming up up of pressure and essentially facilitates the clos-ing of the lid.The pressure toward the valve flap(ll) from the fluids is regulated by the motor velocity, the throttling perhaps by staccato or chopped electrical current supply, in such a manner that the stronger pressure from the drug cartrid-ges hinders the afflux or supply of thinner in case ofbigger drua amounts.
- 5~--216~582 Fiqure 20 ~ives a kind of block diagramm or flow chart on the functions of a valve, accordin~ to Fig.1~, to clarify the air and fluid stream.
During the valve stage A, the bag(257) under the lid of 5 the device is compressed. The overpressure through the con-nective hose(l2) closes the back valve(13) in front of the suction cup(1), in comparison with this, the back valve(286) was closed. The position of the valve segments, which regulate the supply toward the injection cy-10 cylinders, on the extent of the relieve of the air stream ; toward the folded bellows for water(190) and the streamin~
in the hose(25) for water. But because the pressure relief, by the ventilation with valve switching over to the func-tional sta~e A, these lines or hoses are pressure-less.
(The same purpose can be reached, b~ omitting the back valve(286), if the filling procedure in the iniection cy-linders is iust finished during ]id depression). The pressure regulation through the back valve(888,Fig.~9) is - si~nificant in this case.
Figure 21 shows in a cross section along the section line C - D of the lonqitudinal section of Fig.9 the arresting mechanism of the device lid in natural size.
The device serves to the air compression for the expulsion of fluids and for suction production for sucking the skin.
The attachment of the bag(257) above on the lid(260) and below on the covering plate(283) is achieved over a longi-tudinal ripe profile of the bag in a parallel arrange-ment, which is shoved in corresponding grooves of the at-tachment s~:rfaces. The profile is drawn at a distance, to~h~ le~t, in the form of a dovetail, to the right, meander like. Or. the base or socket st.anding on the bottom of the device, the carriage(288) is slidable along the rail(289).
The tension spring(290) prevents that the flanged nozzle (258) can b~ aepressed and with it the lid(260), connec-ted with the ~ozzle. The cGrd(291) must be pulled first ~ 216~82 by the control gear (functional block A) over the roll (292; flanged nczzle to the left). When the flanged noz-zle is depressed against the pIessure spring(287; to the right), the border ring(778) of the flanges nazzle hc,oks onto the carriage(288). The latter is represented with its rail guidance below in detail in a frontal section.
A rubber elastic mounting of the plates of the flanged nczzle on the lid represents a lid of kesser-mount(780);
in this way a pawer safety lid closure is renc'ered pos-sible by unequally (in time) pressing down the flangednozzles.
Figure ~'Lshows three solenoids in longitudinal section and in a sc~ematical composition for functional release.
Their functional organes come in approximate natural size as an alternative solution. The prolon~qation of the anchor or rod(19) of the pushing solenoid(556) demon-strates its operational direction with dashed lines.
The lid mechanism for the suction production was released by the pulling back of the carriage(288) by means of the ccrd(291) oYer the roll(292). Th'ereby the pressure sprinq (287) was effective after the movement of the flanqe noz-zle(258) wa~ released. The tension spring(290) has already brought back the carriage again in its lockin~ pasition.
When a border ring(778) is used as in Fig.21, an inadverte lid sinkin~ is not prevented with reventilation of the suction cup.
The solenoid(555) has nat yet released the release stop (760) between the front slive and a ledge of the injection carria~qe(731) and therewith the skin squeezing is nct yet achieved. Opposite the sc.lenoid(556) the detail about the fixation of the tension and pressure sprin~(8,732) is repeated from Fig.4. The classed with lock(765) is ac-tually activated after the release stop(760, above) and it should be in an er~aged position for the leanina on the tensioned sl;ring. (The latter are h~re in a released con-dition befo~e the activation of the solenoid(556).

21645~2 Figure 23 sh`ows in a scale atout of 2 : 1 in a longitudi-nal section a double working solenoid(563) for several sep-arated release functions.
The guiding cam(564) serves herefore, which is fastened 5 through the hook(568) with the retaining beam(566) for the partial rotation of the rotary iack(567). The rod of the latter is activated by the argle piece(569) on the cross stay(570) against a spring-loaded power transfer (nct skown) to a operation organ. The annular sleeve(571) is 10 moved under the cross stay on the prolongated anchor or rod(19) with the sclenoid activity. The up and down motion is simultaneously turned over in a partial rotation of the annular sleeve through a zig-zag groove on the inside of the annular sleeve by the guiding pin(542) on the prolon-15 gated sclenoid rod. The ring (plate) with the small(574)and large(575) sector slot is fastened on the annular sleeve. The small sector slot can pass along the argle of the angle piece(569), if the respective return position is reached. A further rotation lockes the return of the cross 20 stay urder the influence of the t-ansion spring(572) on the cross beam(573). As soon as the large sector slot permits the angle to pess, a releas function is operated by the tow line(303`. Further operating bars(576,577) can be ac-tivated, one after the other, by the partial sectors under 25 the annular sleeve. Pushing functions are possible as well through a swiveling angle piece resp. a cross pin on the rotation iack(567) as tension functions (by the cross pin on the rotary iack or the grasping through the sector slots(574,575)). The slots can be adjusted in such a m~n-3C.ner, that the release of the return of the angle piece(569) by its tension spring occurs in a shorter interval after an operation stroke by the solenoid as a second stroke of the latter (because of its response latency).

3sFigure 24 shows at a scale 2 : 1 a toothed wheel with electrical record and a clearance of motion, as it can be used mainly for operation gear wheels, the oFeration -~164~82 function Gf which works or.ly to one direction. The insu-- lin metering is an example of this. The axle(223) is surrounded from the electrical noconducting isolating ring(224). The drive pin(225) projects from the axle sleeve(230) and pushes against the stop pin(226) which is roofed by the spring tongue(227).
To the right of the frontal section, a longitudinal sect-tion is shown in the section line A - B. The toothed wheel comes between the leaf springs(228,229) on shifting lG laterally. The spring tongue(227) is suitable then, when drive peg iS adjacent to the toothed wheel; the side, turned to the latter, of the drive pin must be isolated then (c.p.cross section B - C above). The current flow over the axle toward the leaf springs(228,229) can be tap-ped. As suitable a tooth or any teeth either can bc iso-lated or not; the no-isolated allows ccntact with one or both leaf springs(228,229) that the number of rota-tions are ccntrolled. The current conduction over the drive pin perhaps to one or any no-isolated teeth(231) on the counter side of the drive pin allows the free clea-rance of the gear, perhaps on a function less passage of the contrel toothed wheel or pinion to the other operat-ing wheels.

Figure 25 shows, above in a vertical section to a scale of 2 : 1 and below in cross section in a scale of 1 : 1, two lid blinds for the nczzle, which, positioned or their own radia, are moved past the nozzle through the suction cup roof.
(Below in the cross section, the pressure donator(81) and the iniection cylinder(9) are omitted, but also the suc-tion cup(1) with the edge rounded for sliding past the skin, the i~ack valve(13) and the throttle valve(57B) in the ventilation channnel ard the skin, which is raised up under the influence of suction and drawn with dashed-ard-dotted lines.

~_ 216~582 The segment like skaped covering sleeve(337) with the heat-ing wire for the germs killing at the area of nozzle is yet drawn away (below in the horizontal section) from its posi-tion over and behind the lid blind(309, above in the verti-cal section) by the toothed wheel(582) and the inner axle through the suction cup roof. The follower pin(586), which ; proiects from the toothed wheel, now strokes (as shown in the vertical section above) against the radial slide and has tightened the tension spring(588) between the fastening ang-10 le(590) on the ratation disk(589) and the radial slide. The rotation disk ~s connected with the swivel arm(584) for the segment of the lid b].ind(309) through the axle sleeve(585).
(The axle sleeve is ti~htened in the bore of the suction cup roof ard toward the axis(591) for the swivel arm(584). The 15 sectoral shifting of the se~ment o~the cover sleeve(337) has taken place immediately before the suction is introduced in the suction cup. The tightening of the tension spring(588) is increased immediately before the injection to such an ex-tent, that the ball stop(592), which is resilient against 20 the suction cup roof, breaks out of-a stop notch.
The segment of the lid blind(309), which is not turned away from the nozzle, now activates the injection procedure.
(The injection beam into the suction cup is shown with fine dashed lines above in the vertical section).
25 For reventilation, the air escape can be activated later-ally urder the beck valve throuah the o,aening of the throttle valve(578) by a lateral air channel(593).

Figure 26 gives an alternative solution for nozzle cav-30 erinq outside of injection of drugs or ejection of wæter for cleansing. These covers are thereby lifted before the pressure dc,nator is activated.
Abave, a vertical section through the suction cup is skown to a cale 2 : 1 of, under this to the left, a horizontal 35 section to the scale of 1 : 1 in the level A - B (also in the level of the beam) of the vertical section as a detail of the ervirons of the iniection cylinder.Below to the right, '_ 216458~

the surroundings of the nozzle is mc,re illustrated ina scale about of 3 : 1.
The cross stay(554) is l~fted along the grooved rail(595) by the skin, which raises under the influence of suction.
5The sectoral like cover sleeve(337) with its heating wire loop together with the leads is also thereby lifted with photo emitter ard photo sensor with leads from the suction cup roof. (In the detail below to the right, it is in each case or,ly one lead end dEmonstrated and the ccurse of the lOleads inside of the suction cup in the longitudinal section above). The light beam which controls the skin condition, for example, projects perpendicularly on the inside of the sector of the 'id blind(597).
The cover sleeve(337) has the passage(597) for leading 15past of the mirror nose and the light passage. The equip-ment for the reventilation corresponds to that of Fig.27.
The photo emitter(580) and the photo sensor(581) is drawn-in with its laser ray connection for the injury free metabolism measurement, mainly for glucose, without lead ccnnections 20and the respective analytic apparatus. Relating procedures were filed to the patent in the Federal Republic, first, from Nils Kais~r (Untergarching) and Arnold Mueller (Ulm).
As alternative for the heating wire(239) in the blind (be-low), the heating wire was p~t around the nozzle above.
25(The latters can be otserved on the dashed-dotted drawn fluid beam). As alternative for the optical ccntrol, light ccnducting fibres(982,983) are drawn-in below near the nozz-lefrom the emitter to the sensor.
The wedge(334) on the release bar effects, if it is de-30 pressed (or in other cases, if it is lifted),a shifting ofthe strap of the lid blind on the guiding slot(558) and therewith the release of nozzle (3, which is outsized).

Figure 27 repr~duces, atove in a vertical section, below in 3sthe longitudinal section te a scale 2 : 1 a suction cup with a blind(889) for the nozzle(3), which is shoved uFIwards by the skin itself while it enters into the suction cup.The exit of the injection beam out of the nozzle of the in-jection cylinder(9) is marked with dashed-and-dotted lines.The annular blind(8~9) has bent hooked pro~jections(890) toward the skin ard a weak replacement sprin~q, which works as a pressure spring (that is to say at least three on the circle circumference), supporting the laying of the blind on ~he suction cup edge.

lG As shown in Fig.26, the blind ring can have a perpendicular rail ccnduction in the suction cup; it can receive photo measuring devices. But also an electrical lead can ccnduct to the heating wire(239), to liberate the blind i.tself and the suction cup ec'ge again and again from pathological germs. The material of the blind must be chosen with appro-pIiate heat resistant quality; perhaps coated here ard there with teflon. The ring contact with the suction cup edge can be intensified by magnet inlets. But also the form and the m2terial shaping can be useful to promote the sudden 2C! jerking of the blind, if the suction cup is pressed against the sk;n. But the resistance of the hc,ok proiections dLring the raising of the skin by suction can also support such an effect that the nozzle is quickly closed by the skin.
The blind ring can be ccnstructed smaller than it is drawn ard be additionally supported in its raising by cross *can ~ys(594). The air derivation occurs through the ccnnecti-ve hose(12) to the vaccuum source.

3û Fi~ure 28 shows an optical skin control mechanism inside of the suction cup (atove in a natural size) with (even-tually) controllable nozzle valve(378).
The in~jection r.ylinder(9) projects under the pressure do-nator(81, in deshed line bccause it lays behind) into the suction cup(1) being sectioned-on behind).
The transparent glass or plastic measuring window(579) lies immediate~y under the nozzle(3). Beside, -for exam-_ 66 -~ 21B~582 - ple, the area of the suction cup rim,- the light measur-ing arrangement with light emitter(580) and light receiv-er(581) are shown.
Below the detail of the optical control device is repeat-ed at a scale of 5 : 1. The skin fields or pattern are lattice like drawn under the window(579), additionally the light beam from the light emitter (or transmitter, as from a LED or laser) through the window, there reflected from a concave ec'ge against the skin back over its ccn-cave edge into the light receiver. From the cable connec-tions are reproduced in each case only t~o on its final segment. During the raising of the skin, the skin pat-terns are drawn past the window. The computer classifies, after the stand-still of this motion out of the stored ~5 skin portion measuring fields the over the nozzle resp.
over the diaphragm the area of the nazzle (or cannula if used) laying measuring field with the cc,rresponding light exstinctions considering the speed of skin raising. (A
task which is performed today by any PC-CAD-programme ana-logously). It cen bc determined in such a manner by thebreaking off of the functional running without injection before the lid diaphragma is opened (or a cannula is pierced, if any). In the cEse of mc,re imparts of pig-ments or in other kinds of imparts from comparatively normalskin, deviatin~ skin area -at a spotted su:rface p~t-tern (perhaps with akne or with freckles)- the skin knob can be lowered slightly by the opening of the narrowly placed nozzle valve(578) and the puncture can be perfor-mcd at the moment in which a probable healthy skin area lies over the (iniection) nczzle (or cannula if used).

Figure 29 shows a plan view of the preferred form of the device (c.p.Flg.9) after the arrangement of the inner mechanical eq~ipment is concised. The position of the suction cup(1) and the insulin cartridges(113,114) as well as of an~ cannulas (or sleeves with sensor threads, Fig.47-54) is shown through the break off, above which ~ 2164~82 the subsequent described surface equipment is continued. A sensor ccntact(817) corresponds to each circle on the rows of the device surface, with said sen-sor ccntact(817) reporting the finger contact,in the kind of eerth fault to the control unit, ard activates a shitch. The tcuching is suitably confirmed over a li~ht sc;urce, which makes the touchina pcint ]uminous. For this aim, a pin with flasky cclour face can be but roofed at the end by a transparent pot(818) which is depressed rl against a sprina and catches with an edge ring behind the ledge(819),1ightening up the colour field during its ~ix-- ing. (Detail atove to the right in a frontal section).
The ledge(8~9j has regular edges recesses, as the cross clears urder the detail. Suches ledges can extend ncw along in each a row and can be operated, mounted at a ccm-mc,n spring resilient frame, so that all pots are released for the upward movement. A similar (perhaps inverse func-- tioning) device renders possible the reading out of in-puts also tc, the blind. Display windows -perhaps as a fluid display~ ccntain a time scal~ w~ich mc,ves from abo-ve to below. The patient ins now able to report, coordi-nated to the intended meal, also with regard to ites glu-cc,se ccntent, to the control unit by means of the in-fluence of the pressure against the sensor contacts.
2~ Because the ~lucose content of the food is reduced during the progress of the digestion, an approximate triangle fi-gure with a large base be~low comes up to this operation.
The basis breadth should be indicated on a larger record-ing tape thereby with hi~her glucose ard starch content of the food. The precision of this programming can be auxi-liarily improved b~ ccmputer, but essentially that can be exercised mainly with the control of the results indi-cated on a recording tape(see below). The extent of plan-ned body activities is expressed, time related, in Watts on lateral rectangles by contact oFeration. Exiting from the actual measured glucose tissue level and consider-ing the input of personal insulin working constants ard _ 68 -;

216~8 '_ the working profiles of the used insulins, the height andthe mixing relation of the insulins is nc,w explored by the computer and the decreasing triangle of these is brought about in ccncruence with that, wl~ich the patient 5 has drawn in; if it is necessary to warn against absurdi-ties of the programming, the injection is performed accor-ding the dc,sage. For example, ar input of the food and labour charge is drawn-in in dzsh-and-dot lines, formed a~
two triangle-s and two rectangles betweeh the sensor cc,n-tacts. To the right, the virtual imaoe of the derivated computer operation is shown, The programme inputs are drawn in dashed lines, whereas the computing results are reproduced in dash-and-dot lines. Dangerous outline break-downs(821) induce the computer to warnin~ signals while it 15 marks the date in case the gape can be closed only with disproportionate dosage alterations. The pa-tient shall then cc,mplete the food or take a measurement at the questionable date.
This extension of the possibilities for programming ex-ceeding the condition of PCT/DE85/00313 on 1985, now allows dcsage adaption also of the depot insulin adjust-ed to the planned routines of the day by the p~tient and, therewith, a rrore independent life style.
The dosage intending special program blocks adapted to the course of day (sport or bureau day) and the fixa-tion for laying down of steps for emancipation of the p~tient related to his cooperation are, of course, the further fundament.
One of any given example for a trial ar;d error defini-tion of the constant or multiplication factor for a dosage of immediatiely working insulin, may be propos-ed: 60 rr.in. after a meal with 3 BE (bread units)and 90 min.
after the in-.ection of 10 Units insulin the meas-ured value <100 mg% may stand for K = 0,5, <120 mg%
for K = 1;<140 mg% for k = 2;<160mg% for K = 3;<180rrg%
K = 4. For this aim (of programming) the hand switch wheels(822) are arranged along the device well(16) to ~- 2164~82 ac~just, correlated to their scales, sensivity cc~nstants ~t ~th-~or warning) point with regard of the gluco-se content and correcting frame as well as program blocks. It shall still be mentioned that the device could be used also only for diagnostic aim (also with-out injection), perhaps for the control of substances excreted b~ the kidneys. But the device could serve ex-ceptionally for injection use, when accordin~c~ly simp-lified, for example, for the application of heparine.
The sliding switch(717) on its rail guidance is st.ill drawn-in above (c.p.Fi~.9).
Figure 3G gives a detail of the programmin~ board on the broadside of the device at a scale 2 : 1 atove in a ver-tical ~ection along the alongside of the device and below in a corresponding hc,rizontal section. The example makes more precise the sc;lution to Fig.29 and is a refinement of that. Over the cover plate(283) a further lid (219) is mounted on the side wall of the device detach-atle wi.th its marginal ledge. The plu9(220) stands in rcws with ccrresponding holes Gr. t~e lid(21)) into which th~ pegs project. The hole is sc; large, that the trans-parent cap or pc,t(818) on the peg(220) is downwardly shiftable against the wire or leaf spring(22~). On account of the leaf sprina(222) between the acjacent led~es(819) the latter makes way for the slant of the arnular collar on the end of the cap or pct(818) and the latter on the steep f~ank of their annular collar in a depressed posi-tion. A flashy (perhaps green) colour coat on the upper-side of the peg(220) is visible thIough the pot. In 3C, case ~;he input with pressure up on the pot(818) is cancel.led, the key(293) must be pressed there-fore against the pressure spring in the guide clamp(294) of the lid border or rim. The ledges(819) have regularly spaced incisions or notches(295), so that all caps or - 35 pots of the row return upwardly to the 0-position by mcans of tneir wire ore leaf sprincJs(221) if the key is ~` 216458~

pressed. The movement of the ledges is made possible by their recess(296,above). Each ledge is secured against rotation by the profil nose(297). The profil nose sur-passes the key sheet and can be turned between both pins (298,299). After the glock-wise rotation up to the stop, the profil nose can disappear in the slot(313) of the lid rlm.

Figure 31 s~ows schematically, in a side view to a scale lû about of 1 : 4, a device complex consisting of the hous ing of a pressure iet suction injector with the battery supply(255) and the space for the installation of the chip equipment as the electrical control unit(80) for mass production. For small series, the flat stacking en-casement is plugged into corresponding sockets of thehousing by means of the contact and coupling pins(679) with electronic equipment, perhaps a micro processor with the related storing elements.
To the right of the iniector h~using, the encasement of a charging device(677) is shown with its double plug to the mains and the lead connections to the socket(682) in the ercasement of the eiectronic control unit, the The course in the functional blocks of a device according to Fig.l -13 can correlate to the approximate following scheme. (Thereby +++ indicates the rotation or shifting to the right, and --- the same effect to the left):

I ++++ suction+eiection release/tightening of the springs for the pressure donator/tightening of the release spring ---- switching to II + piston retreat dosage 2/
release of the springs for the release slide /delaying slide back to 0/switching to II

3~ II++++screwing back of dosage l--idling++additional thinnin~q/
metering dosage~

---- idling/ delaying slide/ switching to I]I

2164~82 III ++++ idling -- idling ++ additional thinning/dosage 2 ---- fluid switching (between thinner and water) /
delaying slide / switching to I

Figure 32 is a schematical functional set-up of the elec-tric circuit control. The operation of the hand switch If the three sensor contacts on the rim of the suction cup(1) report earth fault(301), fed from the battery lG (255), effects the current to interrogate in the electro-nic control unit (e.c.u.300), if a locking or prohi-bition is programmed there. Influencing is only pos-sible then over a hand switch wheel(822) or over the key board on the lid(219). The next interrogation relates to the presence of a cannula before the funnel of the suc-tion cup.
The sleeves(691) for cannulas are suitably coated with metal so that the solenoid(155) on the groove before the funnel to the suction cup can escape. The conductive bridge, which connects the spring clamps(152) between the cannula on the groove and the ~eighbouring one(691) is tapped over the contact on the groove and the con-tact spring for that. The current stream between the groove and the contact spring confirm the presence of a sleeve with cannula. The counter or computer is able to ascertain from the total amount of cannulas and from the distance of each cannula from the spring clamps, which close the chain, and from the frequence of use, if a cann~la is yet an unused one. From the e.c.u.(300), the command starts for the opening of the seat valve(134).
After this, the question ensues over the light emitter (580) and the light receiver(581), rather the skin, is on the suction cup rim from inside. Light source and sensor can be directly mounted in the funnel of the suction cup;
but they also can admit there light conducting fibres and receive the latters(c.p.Fig.54). The measuring sig-nals are measured at least on two adjacent skin areas 216~58 (-(spots) and the grey-values can be compared one with oth-er, as Fig.46 demonstrates.
The squeezing mechanism for the skin is released then.
The sliding sheets(9) have a slight deflection of their 5 edges downwardly to the skin. They have a sharp bottom edges and a cross rippling of the edge region. One may eventually renounce the application of suction before the squeezing of the skin.
Before the suction release in the functional stage B of the hammer(121~ the release of the stage A is due to change a used cannula and to seal the funnel to the suction cup with a new one.
The interrogation from the light emitter and sensor takes place again by the e.c.u.(300) to cantrol the scheduled prick-in area. If the differences of measured values are too high, a command from the e.c.u.(3ûO) to the motor shall be emitted to produce suction again for a itinera-tion of the measurements while the skin is yet slightly drawn back.
Figure 33 gives a horizontal section through a device for injection, which can be operated with single drug car-tridges and can be used by several persons without the denger of tra~sferring infection transfer. The scale is 1 : 1 . Below ta, the left, the appropriate gas iet pump (442) is represented.
The gas jet cr beam pump stands in connection with the pressure control throttle after a pressurized gas cap-sule, perhaps with nitrogen, carbonic acid, or oxygen, through the supply hose(499) as well as the pressurized gas hose(893,894). The iniector itself is held together from a ledge frame(895). This pertains to the base plate (15) with the cylinders for the battery(255, not shown), which are distributed in two single pieces, surrounding the traction solenoid(555) up to the base plate(8g6) which is a little shortened and therefore drawn as if broken off. In the middle of the edge to the left of this base plate, a tube formed sc.cket(897) for the in-_ 73 -2164~82 jection cylinder is inserted. The in-jection cylinder builds a detachable portion together with the suction cup(1), the gas jet pump(442) and the electronic control unit(80) which are closed together by the bridges (898,899,900). But this portion remains in a certain loose unit with the base plate through the hose cannections and the dashed drawn electrical wires between the control unit and the battery, respectively the solenoid. The drug or in-sulin cartridge(113) itself has the nozzle(3) for the injec-tion on its free end. The cartridge can be grasped on its edge which surrounds the injection cylinder, and whereby the cartridge is bolted in both bayonet catches(901,902) from which the first is mainly essential and works against the sealing ring toward the suction cup. The base plate is in-terrupted by slanted profile slot(903), the edge of which is designed step-like , the reverse edge of the profile glot ha~n~ ~ ~ec~st9n~) f~c;nn to each step level.
Between the base plate(15) and the slidina ]edge(905), the folded bellows is inserted, again in pairs. As pressure dcnator this is preferably a metal folded bellows. The sliding ledge can be moved in the interstice between the base plate(896) in front and the ledge frame(895), and behind together with the plunger(906), which is fastened ~nto t~e ~liding ledge. This mcment is impeded by the peg ~907~. whi~h leans against the step of the profile slot and which can be shoved with the carriage(910) on the rail(906) of the sliding ledge cross to the motion direction of the latter by the knob(909). The carriage can be impeded in this shifting by the edge of a tongue, which is connected with the carriage through the hinge(911). This happens if the tow line(912) is shortened against a resilient spring by the rod of the traction solenoid(555), because one end of the tow line is fixed on the mentioned tongue. The suc-t;cn rup, the gas ~et pump, and the electronic control unit are connected with the ledge frame by the clamps which are sketched with 913,914.
The handle(915) is elevated from the base plate with circu-lar cross section ar,d bends then as if on a trowel to the 2~ 8~

solenoid. It can be clasped with four fin0ers, while thethumb shifts the knob(9C9). The carriage under the knob is partially drawn below in the vertical section to a scale of 2 : 1 .
5 On the detail below to the left, the construction of a gas jet pump is shown to about natural size in a vertical section. The gas stream runs frùm the supply hose(449) of the pressure control throttle throu~h the exit openings ~j:
or, the point of the hi~h valve cone(505) into the nczzle chamber (50Q). Air is dragged along out from the sucking-chamber(502) and thereby air is sucked on from the cc,nnective hose(12) to the suction cup(1), at the dist-arce to the ertrance into the funnel(505). The resilient back valve(13) prevents the air from ertering into the ~5 suction cup, after the jet pump is turned off. The latter is fitted with a suction switch to interrupt the gas ad-mission stream, when sufficient negative pressure exists.
This occurs after an appropriate negative pressure is dammed up behind the elastic membrane(503) throu~h the 2G suction lead(506) in connection with the connective hose (~2) from the sucking-on chamber.
A central pin is connected with the valve cone through the pierced support wall(504). If the suction essen-tially exceeds the intensity which is needed for the ~5 sucking of the skin the elastic membrane(503) and rais-es with it the valve cone. The latter closes at its end the lateral gas inlet openings and halts thereby the gas supply to the nozzle chamber(500). As a variant, the cone pin, which projects from the membrane can also reach up beyond the nozzle chamber, and it can stop the gas beam there (not shown). The suction dam-ming up inside the suction cup can be recorded by the appropriate contacts, which are moved by suction, to the control unit(80) and from there a signal can be re-leased. The s3me is practical, if the optical controldevice for the skin confirms from the segment of the _ 75 -2164~8~

ccver sleeve(337) unobjectionably anatomical condi-tions on the injection area. (As described in Fig.
25-28,53,54) the ccntrol unit releases the injection nc,zzle free.
A small folded bellows(916) is beared forward to the piston(10) with the tissue friendly rinsing fluid or thinner. The latter is pressed against a annular edge behind the nozzle opening and has a prepared breaking zone. When the knob(9~9), caused by the gas supply into the folded bellows(432), is moved downwards and release the mction of the plunger(906), the rinsing fluid is pressed through the skin (after the drug and the destruction of the prepared breaking zone) without interruption of the beam.
If the drug ampule or cartridge is destined for use as a step syringe, the small folded bellows(916) with rinsing fluid is omitted. The knob(909) is then moved upwards (that would mean in the drawing: to the right) and delivers the appropriate partial quantity of the drug through the nozzle(3), which runs ot,liquely in this case, into the upper skin with the formation of a skin bladder or lump there.
The suction cup is thereby placed on anew for each bladder.
The heating of an incandescent wire around the suction cup must be recommended for the germ extermination before changing to another user.
Above to the left, rectangularly turned toward the inJec-tion device in the middle, the detail of a variant for the powder injection is shown in the horizontal section.
The drug powder(984) is stored inside the cartridge(985), protected by protective membranes(986,987) against the skin(986) and behind (987) it. The cartridge is tied past in a chain with thread connection before the suction cup (1). The membrane(986) is destroyed in the trough or nap depression(988) with the heated pin. When the cartridge is fur~her transported to the funnel, it is pressed tnd sealed by the pressure tube(989) into the funnel.
_ 76 -2164~8Z

After the posterior membrane is destroyed by heating, the appropriate powder is shot throu~h the skin by a gas stroke. An addition of dosages with or without dis-placement of the skin is possible, while the funnel ori-fice into the suction cup is tightened intermittently by the cover sleeves(337).

Figure 34 demonstrates spectacles for diagnosis, as they 10 are suitable ~or metabolism measurement, preferably for the measurement of glucose in the anterior eye chamber.
Above, a frontal view is shown, in a scale about of 1 : 1 after the carrier beam(929) in which the device appears over forehead, nose, and ears, and it seems to be set up 15 around the eyes. Below the left eye, the arrangement of emitters and sensors resp. of the mirror ledge is shown with dashed drawn light ray way to the cornea dome, which is protuberant in the center, and to the eyeball curve whereby the eyelids are omitted.
2~ To the left, in the middle, a horizontal section in the level of the handle-like carrier beam(928) is drawn.
Below still further details are described. (Pro~jections lines for the attachment of the different portions for the different views are given dashed-and-dotted).
25 The spectacles are installed here for measurement on the right eye. The overlapping of the pcrtions of the head-band (9JO) and its spring clamp are not shown, because this e~uipment is known from every support device for medical frontal specula. The bows, which project up to behind the 3Cl eyes allow an additional fixation on the heighth, the nose bridge(931) securs against a lateral shifting. The elec-trical motor(478) lies inside of the electronic control unit(80) on the bow toward the ear to the right, the bat-tery(255) lies on the bcw to the left ear. The adjusting 3~ wheels(932,933,934) are fastened by projecting an~les.
From them, the distance screws are adjusted in the depth _ 77 -~l6g~82 through flexible shafts (which are only drawn in itsinitial portions) and through the cannective strap of the carrier beam(928, in the middle). Balsters(938) can be shoved UF to its curved knobs. The support of the S bolster(937) on the end of the distance screw(935) bet-ween the frontal bone and the eyeball on the upperlid ccrresponds to the adjusting of the adJusting wheel (939). The ad~justing screw serves also to the support by means of the bo~ster(938) on the lower lid between the cheek-bone and the eyball. (The belonging distance screw lies below the distance screw(935) and is therefore not shown). It is driven by a threat on the adiustina wheel (933) through the toothed wheel(944) and has also a cc,unt-er running thread against the distance screw(935).
The distance screw(936) is oFerated on the ad~justing screw (933) and the position of the bolster(939) between the cor-ner of the eye, the nose bane, and the frontal bone is therewith destined. (Under the distance screw(935), the eyeball is drawn, and this dashed for its always not visib-le portion. It corresponds (that is to say: their standingfor) to the springs and the distance screws, that the rounded end of those, or which these pressure springs lean, are carried from the respective inner pin and is pro~jected in such a mcnner against the face; this singularity is omitted in the drawing). The distance screw(932) promo-tes the curved bolster(940), which is put against the bow of the cheek-bone bow from outwards.
The distance screw(941) is driven through the screw sleeve (942) and the ~;ransmission toothed wheels(54) by the mator 3û axis(53). This distance screw(941) brings the frame(944) in a different distance from the eye by means of the angle bar (949)with the rail below the outer carrier beam(928). The inner rail(945) extends on and under the parallel portion of the carrier beam(929) into the direction of the headband 5 (c.p.the lower detail in a horizontal section). The blind _ 78 -215~2 visor(947) is tipped up between the double hinged ioin(946) before the metabolism measurement.
Both light ledges(951,952) are thereby erected toward the eyeball. A light scurce (not shown) is directed against the 5 eye through the central hole of the blind visor as assist-ance for fixation. The adjusting wheel(949) on the frame (944) permits an ad.justing in the heighth of the blind visor, the adiusting wheel(949) being therefore coupled through a flexible shaft to the adiusting wheel(950) (c.p. the detail of the adiusting wheel(948) in the fron-tal section, below, quite to the left, and the detail of th~ ting wheel(950), iust to the right).
The light ledges, w~ich are shown under the left eye, are again stressed below in its position toward the eye-~-5 ball in a scale of 2 : 1. The light ledge(952) might serve as a broadly and drawn with dashed lines radiating light source (the light is her drawn as dark hatching). If one has looked towsrd the fixation light of the blind visor, the cornea projects a shadow to the light ledge(951), 2û along the length of which sensors~are distributed.
The optimal depth adjusting for the metabolism measure-ment can be adjusted by rotation on the electrical mo-tor(478) according to the distribution of the measured values which are recorded from the electronic control unit.
If a second such light ledge arrangement is present, turned about a right angle, the adjusting of the frame (944) on the ~djusting screws(948,950,953) can be per-formed automatically with the help of the computer and the mctor, and with the interpolation of a respective control gear. During the putting on of the spectacles for diagnosis, the blind visor and the light ledges suitable are still held in distance from the eye, and they are carefully approached to the latter.
Just to the left, the light ledge(951) is drawn again in scale of 4 : ~ from above, to demonstrate the example of ~ 2164582 a glucose measurement. A light beam might be projected fromthe photo emitter(580) to the opposite positioned light ledge tnot shown) and it might be reflected by a small mir-ror(955) to a mirror of the light ledge(580). This proce-5dure can be repetite along the light ledge, but also on asingle measuring straigth line, then proportionally to the duration of the light flash. The photo receiver(581) is able to ascertaine the contents of glucose on the basis of standard comparisons of the differences of the measured 10 values. One can utilize either the alteration of the pola-rization plane by sugar or the alteration of the dispersion angle of laser light or other known methods. Of course, the spectacles for diagnosis can also abe installed exchangeab-le for the other eye or can be elaborated for both eyes.
~5 The electrical-electronic control unit(80), suitably con-taining a recording device, an alarm -clock or flashes-, a memory for the ascertained measured values, and a trans-mitter which works in the directiuon to the injector or to the common or system recording device, which unit is, 20 as the rule, connected with the charg~`ng device (on the mains). The electrical wires between the control unit(80), the light source on the blind visor(947) and to the bat-tery(255) are drawn not resp. interrupted.

25 Fip~re 35 shows schematically the detail of two pressure do-nators by means of laying pressure springs(261,262), which are parallel to the device. (The other functional portions are omitted; a broadening of the injector could be the result of this solution in its total conception).
30 Nevertheless, the pressure sprin~s(261,262) can be connec-ted with auxiliary spring segments(962,963) through cross stays(960,961), which are fastened on rigid connective bars, so as the vacant spaces in the device can be used.(The au-xiliary spring segments were diminished to about 8 : 1 be-35 cause of the need for space). This connection of sprinosin row can be productive for this, because the level or ex-216~C~8~

tent of the piston(10) stroke figures at between 10 and 20mm totally.
The power transfer occurs through both angle bars(964,965), to which final plates the pressure springs(261,262) support respective to which final plates the connective bars(958, 959) are fastened. The counter bearing of the pressure springs(261,262) is built by appropriate strengthening of the housing wall(16).
The pressure syringes are tightened completely through the sliding screws(352) by the rotation of the screw sleeve(850).
Both solutions ~or the injection cylinder(9) are analogously valid for the iniection cylinder(87). The locking of the bars occurs by the release slide(268), which is urged away from the cam(966) on its roof-like wedge slant(961) in the des-cribed functional stage.
The annular grooves as locking insertions on the angle bars are shifted to the left relating to the piston lowering.
The release wheel(968) therefore operates an eccentric l.ever 2Gwhich brings the release slide again -in a locking position toward the angle bars with the annular grooves, which are shoved to the right. This happens over that cam(966) and the forementioned wedge slant on the counter side of the release 25slide. Tension springs and tension spring segments in row are also able to serve as a pressure donator for the iniec-tion cylinders, if the power transferring elements are cor-respondingly adapted. (The small stop fork to the left of the release wheel(966), which is operated by a tow line, 3c,wcrks against the eccentric fastening axis of the eccen-tric lever, if its spring serves as releacing power). The symmetrically arranged springs and spring elements can be ccnnected with a common angle bar, if a single injection cylinder with a two-chamber system is chosen as describ-ed in Fig.36. In this case the order of symmetry of the distribution of spring pcwer is invalid.
- 8~ -,_, 2~6q~B~

Figure 36 shows in a horizontal section, through the detailof an injection cylinder according to the two-chamber sys-tem, an alternative for the sclution of the problem of the cleansing of the injection channel by thinning fluid on a 5 scale 2 : 1 .
An oval or square housing(431) with partition(430) for the clinging of the folded bellows(432) serves as pressure dona-tors for the double piston arrangement inside the injection cylinder. The folded bellows(432) centrally contains a pas-10 sage for the screw(435), the thread-less portions in the ham-mer bcre(70), which does not completely continues. The lat-ter belongs to the upper piston and has a disk-like erlar-gement or collar on its end. The screw is driven by a pin-ion in the thread of the partition(430) by means of the 15 toothed wheel(438). The pinion les over this in a sheet connection and is driven along by the screw, if the this is depressed.
The latter is connected with the pair of toothed wheels(441, ; 442) through the flexible shaft(439). The pair of toothed 2~heels, runinng indepently, is also rot~ted by the operating toothed wheels for the metering of both insulin sorts. But this occurs in both rotational directions of the pinion by mens of an speclal operating toothed wheel(441).
(The toothed wheel(443) is a portion of the ccntrol gear, nct further discussed here). The stored pressure in the folded bellows(432) is introduced throu~h channel connec-tions (to the left only indicated with a circle) from a ; pressurized gas bottle through the pressure st.orage con-tainer(457). The bolt or inner slide(472) is slanted asainst the edge pro~jection(459) and stands under the in-fluence of a strong pressure spring, which is surmoun-ted, finally, by the gas store pressure.
Thereby the small bolt is activated by the bowden cable (462) and taken into the slot on the box bottom(448).
Thereby a blind hefore the nozzle(3) inside the suction cup(1) is also shoved away (c.p.337,Fig.14).

~,. 216q582 The elastic protective membrane(445) is stretched outover the piston(10) between the hammer sleeve(436) and the thinner. The upper piston(970) takes this in account with slight conical taping. Longitudinal srooves(971), ~.~ich terminate blind downwards to the nozzle in the pis-ton(10) during the ejection are coincident with correspon-ding longitudinal(971) and bottom(973) s,rooves of the in-jection cylinder, so that the thinner can be expelled by t~,e nozzle.
lG ~he filling up of the chambers takes place, bElow through the flap valve(11) for the insulins and the thinner, re-spective water, and through the connective hose(449) for thinner resp. water.
Below in the middle, the detail of a two-chamber cylinder is reproduced in which the elastic protective membrane i.s replaced by the folded bellows(445,c.p.Fig.16). The con-nective hose(449) for thinner is cciled, conducted in-side the folded bellows through the piston(970) to the valve flap in tha space above the piston(10).
The variant, below to the left, dispenses with both pis-tons inside of the injection cylinder(9) and replaces these by a folded bellows, which is compressed in the middle a little by the annular spring(974). The fluids are filled-in on both sides through the connective hose (449) resp. the valve flap into the folded bellows(975).
During the emptying by pressure from the side of the pres-sure dcnator, the spring ring(975) already oFens and is held open by the entrance of the acutely locking or opening pin(976), which is centrally inserted on the bot-tom of the cylinder(9), so that finally then thinner alone is urged ts the nozzle(3) instead of the drug.
In a variant, below to the right, the elastic protective membrane is replaced by the folded bellows(455), which extends from the side of the rod of the piston(970) to 5 the ec'ge of the cylinder(9), The rod has a thread, in ~ 2164582 which the rotation by the nut activates the piston mc,tion.This nut is secured against a lateral shifting and has an outer screw that is driven on.
In all cases, water or other clean fluid can be filled 5between the wall of the cylinder(9) ard the protective membrane or folded bellows, which is not replaced bet-ween the single uses.
In the case of an exclusively elastic membrane over the frontal surface of the piston(970), a second sealing lG membrane is necessary between cylinder and the backside of the piston.

Figure ~ deals with an alternative to the mechanical control gear. Abave to the left, the detail of a valve 15 segment is repeated in a horizontal section to a scale about of 2 : 1 (c.p.Fig.l9).
Below to the left, a valve is shown as a kind of hase or tube brake, above harizontally, below vertica]ly cut, to demonstrate possibilities of diminishinpJ the 2G streaming of fluid into the iniect.on cylinder, if higher insulin dosages are applied.
To the right in the middle, the detail of an injection cylinder is pJiven in a vertical section ~simplified by one iniection piston, c.p.Fig.16).
25 Above over .he breadth of the page, a horizontal section is shown through the entire gear, below still special as-pects.
The power flow runs from the motor axis(53) through the transmission toothed wheels(54) to the toothed wheel (643), then to the toothed wheel(642) on the square axis (627). On the latter the toothed wheel(630) is resilient in a bush ar,d shiftable with this and connected with the sliding socket on the square rod(644) by connecting sheets. The square rod directs a wedge against the spring 35 tongue on the pinion(80C, detail below in the middle).
Below to the left, the projection of ary toothed wheels UF to the drive of a toothed wheel(645) for the meteringscrew is representad in a frontal section.
Above in the horizontal section, a upwards folding of the axles was executed, to clarify the function. From the four operating toothed wheels (above in the horizon-tal section) both outers are destined for the drive of the forerunning thinner into the injection cy-linder. The derivation from the operation wheel to the left was conducted.
In connexion with the ratched toothed wheel(702) on the same axis follows the punched disk(446) with the bent slot, in which the cam peg runs for nearly for one rota-tion urtil it transfers its rotation to the toothed wheel (648) for the operation of the hose brake (detail below to the left) through the translation toothed wheels(54, atove to the right). The coupling for the idling between an operation function and the gear is omitted here; it was dealed in Fig.13 (814,815,816). The resilient brake(998) against the operation wheels should be superfluous. The metered forrunning, that is to say the elevation of the ccnnective strap(267), also occurs through the axis of the ratched toothed wheel(702) by the screw(357) in a thread bush, which is fastened on-to the injection cylinder (9) over the flexible shaft.
The connective strap is here not connected with the pis-ton(10, detail to the right in the middle), but it stops the upwards movement of the piston inside the folded bel-lows(445) which is filled with fluid. The combination of the lifting of the piston with the hose throttling or s~ueezing with the ccrresponding coordination of both functions can te still more favourable. Whilst space is permitted for the piston lifting because of a low drug dosage, the hose valve slowly opens for the thinner stream into the in~jection cylinder.
The construction above the third o~eration wheel termin-ates in a ratched toothed wheel with postponed punched ; disk for the valve cycle (c.p.Fig.19,20) durin~ the other 216~582 metering screw (c.p.121,122, detail above, Fig.9) can be operated by the adjacent middle (second) operation wheel.
The toothed wheel(645) serves with its flexible shaft to the lifting, which occurs proportionally to the mctering, 5 of the connective strap(267) by means of the screw(649), the thread bush of which is lifted, pick-a-back, by the screw(357) and which is correspondingly connected with the upper bush of the screw(357), the former being ad-justable in the height. The connective strap can be rotated.
The ccnnective strap is rotable around the end of the screw(649) and is formed of a dcuble of the fork piece (650) with a wedge on edge, adapted to the forerunning of the stroke of the pressure dcnator (nc,t shown). The fork pieces are held together by a spring-suspension (here as tension and pressure springs) above the folded bellows (445) with the effect to imped the latter. The flitting down of the pressure donator urges the fork piece side-wards by the wedges on edge, before it depresses the folded bellows and therewith the pist~n(10) for the ejec-tion. (The double point-and-dash lines for the demonstra-tion with arrows refer to the connectedness of the vertical and the horizontal section through the in~ection cylinder(9) ard, that is to say, of the plan view toward the altered region of the connective strap).
The swivelling away of the connective strap can also be achieved through a lateral tow line or a rod, one of bcth being activated before the pressure donator has toached the folded bellows(445) or its strengthening plate.
3~ The solution in Fig.16 needs the rail guidance of the thread bush or screw sleeve(857) along the cylinder wall inclusive the spr-ng braking as resistance against the pressure of the fluid which streams into the injection cylinder, what weakens the impact of the pressure dcna-35 tor ~, 216~$~2 The construction of the valve as tube-type brake, below to the left, principally corresponds to that as customary in the trade for drug infusions or approximately to the hose pumps in the blood transfusion matters and in the laboratories. The hase is led within and out throuoh bor-es (which lay behind the section plane in the vertical section) in the valve pot, whereby the hose segment is stored at the edge. The hose is gradually narrowed on a radial partial sector and the fluid stream is throttled because an expansion of the pot wall (in the horizontal section sickle-shaped) through a cross sleeve which is introduced from the turnable lid (here spring biased).
The fluid v~ , above to the left, is suitably driven as a double pump which is arranged as a store, one over the other, by the same axis. The supply of water or thinner to the injection cylinder can be completely hindered by them. The leaf spring(654) serves to the sta-bilization of the respective valve position; the leaf spring(887) serves to the transformation of a thrust mo-vement into the sectoral turning by carrying along with it an excentric cam. (If the rotation of a toothed wheel is translated to the rotation center through a flexibel shaft or similar one, the leaf spring can be omitted).
The motor rotation is transferred not only from the toothed wheel(643) to the toothed wheel(642) and there-with to the square axis(629) with the pinion(8ûO) for the function of the control qear. The rotation of a ~ toothed wheel which is positioned under the toothed wheel(643) is simultaneously transferred to the tooth-ed wheel(630), which can be shifted along a further square axis and which permanently meshes with the pinion (800) by the connective or holding plates(124) with the toothed wheel, and which is slided along with the latter as a driving e]ement for the pinion.
The representa~ion, above the toothed wheel projection in a frontal section, relates to the carrying with or transport of the pinion(800) by means of an elastic ~_ 216~82 spring or tongue and is a clapping dowm for the explica-tion of the conditions around the square rod(644), which are above merely drawn in the total representation with irregularly dotted line. The springy wire bow(655) on its dEvice base ledge is shoved more upwards and erec-ted and supports the stabilization of the position of the toothed wheel(630) meshing with an operation wheel in each case. The springy wire bow exists also quadruple in a stag-gered arrangement.
lG When the motor is activated, the pinion(800) shifts, for example, to the right on the screw(8nl). Its spring tongue transports the sliding socket or sleeve on the square rod(644) as long as that meshes with the first operation wheel, a circumstance which is recorded through electrical contacts (not shown) to the electronic control unit. By pole change, its rotation direction is now al-tered, and the pinion(800) is lifted to the left as far as it corresponds to the programmed operation function through the operation wheel and the ,ioined toothed wheels. The intermediately ratchet tnothed wheels ar ncw able to let through the motor rotations during the shift-ing of the pinion to the left without function. They transfer then the operation function during the return of the pinion(800) to the concerning operation wheel after the motor poling is once more changed to the right until the pinion contacts with the respective operation wheel.
A further shifting of the pinion to the right leads the tocthed wheel(644) up to the contact with the second op-eration wheel by the thrust of the sliding socket.
But the second operation wheel can also be passed over by bringing, of course, the toothed wheel(630) into mesh with the second operation wheel by use of the spring ; means cross to the motion axis of the toothed wheel(630), but the former being then further immediately shifted to the right (still in the tolerance field of the idling 216458~

of the punched disk). (A short chopped or staccato poleor direction chance at the motor is suitably to support the clearance from the operation drive during the passage of the operat~on wheel. When the pinion(800) reaches the toothed wheel~803), the sliding socket before receives resistance with its stroke, and the spring tongue of the pinion crosses the wedye nose of the sliding socket. The toothed wheel(803) is activated in the mesh of its lat-eral naps(783) with the naps of the pinion, and there-lG with, through the toothed wheel(793), the control gearup to the screw sleeve(850), the sliding screw(352) for the sprinas of the pressure donator, The pinion(8aO) must be led back under the passage of the toothed wheel(630) through all operations wheels to the toothed wheel(802) for the return of the sliding screw t332). This is done with the aim,to rotate them together with the screw(801) in the counter direction (to that of the toothed w~,eel(803)). During this backward motion of the pinion(800) to the left, it is possible to command 2G dosage corrections by the control onit according to the above mentioned filtered pendulum method; but also the return of the screw(649, detail o the injection cylin-der) is possible. Two ratchet toothed wheels(as 656) can be radially displaced arranged in a counter running 2~ working double for the exchange of the druy cartridges.
They can be used against a spring back stop for the change of the effective direction through a fork bar (dashed-and-dotted indicated under the screw(801)) on the ! slide switch(717,c,p.Fig.29).
As the ends of the fork of the drawn or outlined bar in-dicate, an automatic sliding by the pinion(800) is also discussed. For that, a stationary relisient roller(348) is used on a roof slant(156) which is shved past under that by a bar.
But two additional operations wheels with opposite work-ing ratchet toothed wheels can be used for this purpose.

Because the metering process does not occure simultaneous-ly, the necessity of additional fluid valves arises.
It is derivated also from the hitherto described practice to employ the way of the pinion, which is indeed already destinated, for functions, which are fixed relating to the number of rotations or the extent of sliding distances, and from the practice, to use the screw rotations for in-determined functions. The high translation for the slid-ing screw of the pressure donator but could then have the consequence of an overlenght of the screw or the necessity, to activate, also in this case, the sliding screw only intermittently in strokes by pendulum motions of the pinion and the ratchet toothed wheel.

Figure 38 continues with a detail in the horizontal sec-tion in a scale of 4 : 1 the task and its solution of Fig.12. Mainly, where separate drives are used for the metering(c.p.Fig.38,39), for the main drive for the tens-ioning of the spring of the pressure donator, the prob-lem is given, to arrest sliding mavements activated bythe bolt.
,, If the wedge slide(274,Fig.18) is moved by means of the sliding screw(352,Fig.9,28) both final extents remain avalaibly for other operation functions after the lifting of the pressure springs. In comparison with it, an addi-tional sliding device would require an overcoming latch, if the sliding screw lead pressure springs(261, 262,~ig.35) in a lock. After the screwing back of the tension device for the pressure springs, remains an eli-3Q gible extent for a switching function with highly posi-tional stability. The fixation of a connective strap (267,Fig.37, detail of the injection cylinder without the screws(649), against the fluid pressure in the injec-tion cylinder, requires, for example, such a stop.
The wheel segment(794) is rotatable together with the eliptical disk segment(667) around the axis(795, which is transferred upwards into the arrow direction). In a radial slot of the wheel segment, the rectangular tube ~16 158~

, socket with the cross bar(666) is mounted against a pressure spring. The cross bar was inside led past along the stationary bent ledge(665) with undular profile, when the wheel segment is turned on the cam(663) by means of the thrust rcd(661) by the sliding screw (not shown) to the left. Therefore, this cross bar is locked about in the middle of this ledge(665). Further pressure from the thrust rod has allowed, that the latter mc,ves over the curved end of the cam(663). Thereby the disk segment (667) was shifted away so far, that it leans from the inside with its larger extent of the ellips~to the cross bar(666) and fixes it on the curved groove of the ledge (665) with the result of a locking of the motion.
The release of the stop happens, if the thrust rod(661) overcomes the cams(663,668) and transportes again the cam(668) back to the right.
A further cam(669, indicated with a dashed line) can be mounted on the disk segment, against which the thrust rod pushes during its mcvement back, resp. to the right, and whereby it pulls the projecting e~ge of the ellipse away _ from the cross bar. But the lever is fastened on this for the activation of the operation function.

Figure 39 shows in a longitudinal section on a scale of 2 : 1 a small solenoid(478) with high speed, whereby the motor axis(53) transfers its rotation through the intermediate control or reduction gear(9g7) to the trans-lation toothe-~ wheels(54).

3Q Figure 40 shows in the longitudinal section on a scale 2 : 1 a metering mechanism(c.p.121;Fig.9). TWG solenoids (554,555) are joined together to the aim of metering screw. The sGlenoid anchors or bolts wcrk against small wedged teeth of a gear wheel (shown in a partially roll-ing-up) with its spherical end. The gear wheel(637) is 2164~82 rotated by the solenoid to the left(554) over a ratched wheel, said gear wheel driving the metering screw(157;
Fig.33). The action of the s~lenoid(554) happens respec-tively, but the rotation effect is increased by the inter-5 mediate gear(997). The ratched gear wheels arranged to run in opposite direction effect one with other the rota-tion of the geasr wheel(637) or at ].east not hinder one the other. Coarse and fine metering and therewith the total metering can be effected quickly in such a manner.
lG The rotation and the arresting of the wheels shown in a rolling-up are secured by disks with wave profil in which the leaf spring(654) engages respectively with arresting effect as shown to the right on a vertical view of such a disk with spring. The leaf spring suitably touches elec-15 tric contacts inside of the notches of the disk and thereby reports to the electronic ccntrol unit the posi-tion of a perhaps connected metering screw and the number of its rotations. To turn back again the metering screw out of the insulin cartridge after the drug is emptied, " 20 the angled bar(163) projects from the bolt of the sole-noid, the end of which meshes to the wheel(161) with wed-ged teeth (shown again in a rolling-up), if the latter is approximated to the angled bar over the sliding bar(162) on the cover plate of the hcusing. The operation gear 25 thereby takes the sliding bar with parallel axles from the mesh with the laterally fixed gear wheel(160) which had driven the :netering screw over a shaft with gear wheel. The operation gear wheel(260) is brought into mesh for this with the toothed wheel(637) over the sliding bar 30 (the springing along the axles being not shown), the for-mer driving the metering screw over the shaft (not shown) with toothed wheel. This is done correspondingly to the other wedge tooth position in an opposite direction.
Figure 41 shows a schematical longitudinal section to 35 demonstrate the possibility of an combination of different working way distances between the strong pressure spring (261) and the trust rod(661) by the localisation of the _ 92 --- 216~582 rotation axis(660) which destinates the effect of the lever(872). The latter is joined with the spring(261) ard the thrust rod(661) with hinges (drawn with circ-les).
Reporting to the Fig.32 and the Fig.47-54 the following can be understood, whereby the hammer(121) stays for an guiding pin of sensor elements:
In the case the measuring differences are still to high, the alarm(304) is activated.
The button(306;Fig. ) can be pulled then over the tow-line(305) emerging from the seat valve(134) over the roll (307) on the cover plate, to ventilate the suction cup, in case the commands to the mc,tor for a tensioning of the tension springs(729;Fig. ) was not yet succesful.
After suitable skin condition has been confirmed, the so-lenoid with the hammer(121) is operated at the functional stage B and thereby the cannula is pricked into the skin and the sensor thread pushed under the skin. The solenoid remains activated for 2 - 4 seconds resp. for the time ~ for saturation of the sensor thread with tissue liquid, then the sensor thread is retired.
The current, derivated from the sensor thread, is admit-ted to an amplifier to the measuring instrument and the measured values signals to the e.c.u.(300). After the measured values are ccmpared with the metering programme, the solenoid(554) and the metering mechanism(125) re-ceive, if need be, impulses for the injection.
The injection amount is counted and controlled on the contacts(654). After the injection is completed, the sGlenoid with the hammer(121) is activated again by the e.c.u.(30C) at the stage D and-thereby the sleeve(691) is retired and the suction cup ventilated and the retreat of of the sliding sheets(9) by the tension of tension springs(729;Fig. ) is initiated with impulse to the motor.
The device can be used advatageously at night for pro-tection against low sugar levels during sleeping. For this, _ 9~ _ ~_ 2164~82 this fastening rings or loops on the housing are provided through which retaining webs are drawn. The device can be fastened now with the suction cup against the skin of arm or leg. The three point contact on the suction cup with the skin activates the measuring function and falling short of a determined measured value causes the alarm to be activated. Because the sleeper is in the habit of turning, the device usually comes out of place always to new skin areas.

P r o g r a m m i n g According to the dosage programming of at least t~o sorts of insulin, be advisec' of the suggestions in WC 86/
01728 (In,jection device with sensor, PCT/DE 85/00313).
One proceeds there, first with the processin,q customary in medical practice, whereby different insulin,sensivity is considered with correcting factors on programming.
2G The advanded computer technique wit~ chips also for spe-cial single problems today allow further improvements for patients cooperative.
Thanks to the ~mplifications described in Fi,q. , one can discern, for the future, between alterations of the basal 2~ secretion or the level of the basis rate of insulin (set forth with page 95) 216~58~

and the individual sensitivity for insuli~. Additional to - a timed input of planned meals with triangles and of working energy with a stronger ccmbustion of carbon hy-drates in rectangles, a one point input is made always by push-button in the centre of the panel or key board be-longing to the planned date of the next meal.
The computer compares now the fed planes -triangles for the carbon hydrates ingestion(supply) narrowed at the margins by rectangles for the energy ccnsumation- to the rhombes -relating to the working insulin resorption-which are altered by the individual correcting factors, and tries a surface masking first for immediately working insulin. If the chosen date for the next injection lies out of the duration of effect of immediately working in-sulin, the computer shall attempt a correspondance of the surface with depot insulin, which it supplements with im-mediately working insulin for the initial hours. If the planned date for the next injection lies in too great a distance from a still sufficient effect of depot insulin, the ccmputer activates the alarm function and indicates an earliér date for injection. In the case that the patient uses the injector earlier as planned, the computer ccn-siders the supposed effective rest surface caused by the antecedent injection for the new programming. By effec-tiveness checkings of the insulin after determined test meals with a step-like increased load with carbon hydra-tes, an eventual decrease of the insulin effectiveness can be ascertained. It can be placed to account for the existence of an estimable basal secretion. On this base the insulin treatment is essentially improved in the future.
The patient shall alternate timed notices of meals by in-put with the key(top,c.p.Fig.15), if he took up other car-bon hydrates a~ounts as planned originally, that is ear-lier. The computer shall take into consideration these corrections while calculating the next insulin amounts. Aswell as for the input of planned meals as for their sup-_ g~_ 216~5~2 plementary correction -of course also according to the date- the patient can use the auxilary means of a food-stuff table Otl the underside of the device. Pressure to the respect:ve symbol or picture for quality and quantity (bread or roli, egg, glass of milk a.s.o.) effects the data exposition of bread units (b.u.) on the display -perhaps on a sidewall of the device classsed with a re-spective number of the key board or panel similar to a grid square of a map, on the condition that the patient, before he compiles his bill of fare, signifies the corre-sponding period of input with the coordinated key (or top) to the left, with which the computer classes the point coordinaion. Of course the informations or inputs relating to the planned body stress shall also be correc-ted past and considered from the computer.
The plans as well as the corrections, as arbitrary addi-tional dosage;, glucose measuring results, the allowed play and the use of this as planned and administered in-sulin amounts are made visible on time or topically, pre-ferably on the cargo device in c~n~tact with the mains but also in battery operation of the recording device.
The characterLstic lines -traced=fully executed;
dashed=planned; dash-and-dot lined=ccrrected- of the re-cording facilitates the interpretation of this:
Laying or prostrate triangles again for the carbon hy-drates feed, prostrate rectangles for power (output) whe-reby the under ledge of the strip can also be used as centre line. 'rhe glucose value of the blood or tissue liquid are suitably printed up in columnes raising from the lower str~p margin, the insulin metering in hanging downward columns from the upper recording stripe margin.
The recording tool is peferably mounted across the paper stripe ~r tape transport. Differences between ex-pected (calcu~ated) and measured values can be clarified by hatching. But the calculated insulin resorption sur-faces are slgnified together with their composition of different insulin sorts. (All this is demonstrated on Fig.56) - ~6 -~ 2164582 Figure 42 shows a segment of a recording tape of a recor-ding device(80;Fig.31) with minimal indices belonging to said device which are described on page 89. The standing column with 150 mg% identifies the ascertained tissue glu-cose level, the hanging columnes with 40E and 80E depot,the administered insulin amounts. The dashed triangle (the half of this one which has, been input into the panel) stands for a carbon hydrate load of 3 bread units, the triangle with dash-and-dot lines m~rks the, a little 1~ later admittedly eaten 5 breath units. Above in the quadrangle, the planned work achievement of 120 Watt is drawn-in, inside of quadrangle and next to it the ad-mittedly from 120 Watt to 90 Watt reduced, and a little shortended and time-shifted achievement. The planned next time (dashed circle) has been postponed until later (lined circle). The glucose level was banked with 210 mg and ccrrespondingly banked insulin amounts have been admini-stered. The calculated deviations of sugar values and insulin metering from the earlier exspected values,and flashed the with signal connected warning with the pro-posual to the pa',ient of an advanced later (next) control time (circle wit~ dash-and-dot lines) are shown.
The time grid has bEen omitted.

Figure 43 sbows a tabular calculation of the insulin dosages in consequence of the imput loads with meals and achievements b~ the patient. A PC was used with the pro-gramme QUATTR0 PR0 5,0 from Borland for a simplified form and a an atypical case.
3c, To the left column, a time scale is shown with time date to which 6 hours should be added. The column for the sugar values follows with still underlaying insulin ef-fect of earlier insulin treatment. Alway read from left to right, three programm column succeed with planned meals for 3 bread units(BU), 1 BU, 6 BE and 5 BE for the '- 2164~8~

lth.,3th.,and 13.th hour (real time 7, 9, 13, 19 o clock).
One supposes that the effect of immediately working b~ginns first after 30 minutes and its working decreases in 3 hours (whereby the sugar increases in 20mg% per BU).
The 4.th (broad) program column shows the influence of a work achievement of 50 Watts for 3 hours, which ifluen-ce decreases therethrough in further 2 hours (16 to 18 o clock). Just to the right, the column re-presentates the insulin levels, as added with the data by the computer, which increase again because a outsized dinner.

Figure 44 takes the over the calculation results of the last column of the table Fig.57. One assumes, that imme-diately wcrkung insulin depresses the sugar level about4 mg% per unit inside of an influence period of 2 hours.
The values for depot insulin amount to 2 mc% in 12 hours.
At the 1th operative column, the computer calculate the the difference to 160 mg~ as the upper desirable value, a~d then at the 2th column the ~alue accumulation out of the tolerance limit, whereby 180 mo% are defined as ~he upperst tolerance value and 80 mg% as the lower limit. It results the recommendation for 28 unit an 33 unit of immediately working insulin for 12,30 o'clock and 18,30 o clock. The sugar level column as intermediate value is now ifluenced by the apply of depot insulin, as the subsequent column elucidate.
At ~Idsll (difference sugar) are in each calculation 10 tolerance windows are ccmbined, so that the injection 3û of 35 unit depot insulin at 17 o'clock is recommended to be sure with a warning because of low sugar level.
According to the countin~ rangel 5 tolerance windows were combined for immediately workin insulin.

Figure 45 diagrammes a statistic variance function for the ascertainment of the time points for the in~jections ~ ~16~82, using a time scale of 2,5 hours for immediately workinginsulin and a such of 5 hours for depot insulin.
(setting forth with next page) Figure 46 shows a schematical set up of a device for a skin control to the aptitude for a puncture.
A circuit leads from the battery (volt) to the light source, the light through a lens to the test area of the skin, and is reflected through a second lens to lû a photo-diode a~ receiver. From there a circuit leads to the amplier and voltage meter als measuring device.

Additionally to Fig.29 shall be noted, that the tri-angles and rectangles, which the patient is adviced to ~5 input to a panel, shall serve, mainly, to the cleari-ty. It may be suitable in the reality (because the re-stricted nunber of possible keys on the panel) that as well loads with carbon hydrates as thus with work achievement are input by respectively two points in a distance of a zero-line or by numbers. The computer is able to make visible on the display as well the differences of the chosen dimensions by the relating latice reproduction ac the input straight lines as Figures, perhaps beside the calculated planes which relate to the decay quote of the insulins. The patient is enabled to make running back the time quan-tization on the p~nel. The computer can calculatory dislocate the input triangle base or the exit point of the loading straigt line for carbon hydrates accor-3C ding to the resorbtion delay to a later time line.
But actually, the linear functions may be transferred in such being exponential with increased experience and further functions may be comprised into the program processing.
_ 99 _ 2164~82 Figure 47 demonstrates in the horizontal or longitudinal section, and in a natural size (in a lateral rolling-up of the functional portions), a device for the injecting of a sensor bIistle into a skin fold. To the left, the wedge slide for the retreat of the sensor to a scale 2 : 1 is shown. Above, a special configuration of the sleeve cap is demonstrated, the same below to the right to a scale of 3 : 1.
The movement runs from the motor axis(53) through the translating toothed wheels(54) for the reduction of the velocity on the square axis(627), then through the slid-ing socket(125) and the square bar(644) to the catching follower sheet(126) for the turnable slide(127). The toothed wheel(128) is mounted above the follower sheet on the square bore and meshes permanently with the pi-nion(800) by means of jutting and connection disks. The pinion is shoved along the screw, has lateral naps, and meshes with the toothed wheel(803), which has, on this place, only the function to rotate the screw in one di-rection. The rotation is permanently transferred through the toothed wheel(802) to the intermediate gear(129) ard from there to the nut(130).
The sleeve(691) was still maved against the conical bore in the suction cup(1), and both strong pressure springs (261,262) were tightened against their four support columns(854).
The relaxing of the springs is prevented by the bolt (472) which ccrresponds in construction approximately to those behind stop knob(270). But the sliding ledge (134) is depressed with the sinking of the grooved sli-de(132) by the fork(133). The sliding ledge is fixed by the stop knob(270) against its tension spring then.
This is possible first then, if the tension spring(235) is released and depressed on the end of the bcwden cab-~ 35 le toward the grooved slide. (The small pressure spring - behind the the stop knob stores the stopping moment).
The leaf spring(136) is in reality turned about 90 de-,_ 21C4~82 grees around the axis of the groovec' slide and secures the stability in the height of the latter. The bowden line(135) between the grooved slide(132) and the wedge slide(137), again with pawer storing in a spring, ef-fects the lowering of the latter. (To the left, the lat-eral view of the slide frame elucidates the function of the thrust effect toward the collar(139) during its de-pression). The bowden cable(140) lifts the elastic pis-ton(91), which bears the sensor bristle and has an exca-vation for a spherical end of that cable. This happensthrough the central bore in the screw bolt(352) whilst the folded bellows with high elastic septa between the fold depressions -into which the sensor bristle is stor-ed- is compressed.
~5 The enlarged detail above to the left shows, t,hat the sensor bristle is surrounded by the rubber hose end(92), `~
which itself is surrounded from the sleeve(691) after an air gap. The sleeve cap(111) projects with inner proiec-tions through slots in the sleeve(691) toward the rubber ; 20 hc~se end and tolerates a certain pressure, exerted from the sleeve sufficiently to narrow the channel of the rub-ber hose end around the sensor bristle with the purpose, of pushing the latter with high speed through the skin, which is drawn up into the suction cup(1).
The detail below to the right shows the rubber hase end ; (92)directly laying onto the sleeve(691). The sleeve cap is downward enlarged and has inside naps which corres~ -pond to such outside naps on the sleeve(991). The projec-tior;s which reach through slots below in the sleeve(691) to the rubber hose end(92) czn be fitted above with ton-gues to cover the slots against slipping out rubber.
The annular ~leeve(577) goes in a thrust-torsion-device which effects an axis rotation about of 90 degrees with the turnable slide(127) after each lowering, and which respectively brings the pro~jecting tongues(93) in ccntact either with the grooved slide(132) or with both grooved slides(94,95) for the release of both strong pressure springs through the bowden lines(96), of which only one ~ 2 1 6~ 58 2 is shawn(c.p.Fig.48) The thrust-torsion mechanism is more described in Fig. 0. The sleeve(691) is PUt into the groo-ve(151) by hand and is drawn away again after consumption.
But the invention aims, of course, toward the fitting of automatic sleeve or grip change analogously described in Fig.9 to 36 of the European Patent Application No.0 301 165 (published on Febr.2th.89), though for the vertical grip or shell storing.
Figure 48 gives a cross or vertical section through the de-vice according to Fig.47 in the level above, of both bolts(472) and in a natural size. Below the detail of the bearing of the strong pressure springs(261,262) is shown on the support columns(472).
The housing wall(16) is there drawn-in and the space for the battery(255) and the electronic control unit(80) is nominated. Between the stop knob(270) and the tension spring(235) the release for the sliding ledge(134) is positioned with the tension spring for the rapid retreat of the sensor bristle out of the skin.
For this the fork(133) embraces the bcwden line(138) and is dislocated by the grooved slide(132). The latter is shifted, as well as also the grooved slides(94,95) in an-other switching position, by means of one of the opposite tangues(93) in both directions, whilst it is taken by the tongue insertions between the follower sheet(126, Fig. 1) and the toothed wheel, and whilst the power is transferred from the electric motor(478) to the pinion (800) with the shifting of the latter along the screw(801, Fig. 1). When the toothed wheels(802,803) are reached, the nut(130) is activated on the sliding screw(352) through the intermediate gear(129) by the pinion at the time in opposite direction. The functional operation between left (=below) and right hand (=above) is:
tightening of the springs(261,262)------>
/<------release of the springs(261,262) ~elaxation of the springs(261,262)---->(switch.over of torsion) /<-----thrust of the sensor bristle /----> retreat of the sensor bristl.+shell(69)+torsion ~ 2164~82 - Figure 49 shows in a longitudinal section to a scale of 2 : 1 the sleeve(571) of the thrust-torsion-device with the hammer(121) for the explication of the switching over between the particular functional stages A - D.
The sleeve(571) shows the inside of the zig-zag groove in which a small cross peg of the prolongated sclenoid anchor or bolt engages and effects a quarter-turn of the sleeve with each stroke, as far as the solenoid bolt is secured against rotation. The rotation is transferred over the coiled spring(l41) ar,d the flank with spherical seat(142) of the hammer to the latter. The hammer shaft is rect-an_ular to the right (that is: distal) and is prevented from rotation in the fixedly mcunted bush(143). In the demonstrated û-position of the solenoid bolt, there is a circular cross section or radius inside of the bush(143) so that the torsion effect can operate. (ûf course, with-out coiled spring, if the connection between solenoid bolt and flank with spherical seat is respectively elastic).
The hammer area in both detail images below shows a mechanical stop sleeve(144) which a~; a half groove stops, in each case, the rotation over a respective operatinq member (A - D). For this there is an angled piece with a passage for the stop sleeve(144) and for the horse-shoe-like bent around pin(146) with terminal disk for the biased pressure spring.
The lower image shows, as the cam(147) of the hammer has lifted the sleeve(144) against its spring, that the axle rotation is released by the coiled spring(141) yet tensioned over the sleeve(571) and eventually held in a permanent pretension). The cam of the hammer meets re-sistance then on the next positioned sleeve(as 144) because the latter lightly springs back against the hammer rotation. Thus the stop mechanism can be found radially distributed. Below, to the left a cross section in the level of the four sleeves(144). The stop of the hammer end for the operating stroke is demonstrated with the four switching stages A - D.

216q5~2 Figure 50 schematically shows in a longitudinal section a device for the sucking on of tissue liquid and an even-tual in~jection of drug fluid through a capillary(106).
This is much enlarged with its sleeve(691). (Mainly, the latter is additionally shortened). The crosses inside the wall of the sleeve symbolize the measuring layer with chemicals which react with substance (as glucose) in the tissue liquid. The capillary is punched to facili-tate the afflux of liquid from the subcutaneous space (not drawn), if the upper syringe piston is pulled. The valve slide(107) is iust open. When the measurement is performed (over wires to the measuring instrument, not shown), the valve slide must be pushed (fine hatching) and then the piston of the syringe, which is filled with drug. The supply tube from the valve to the orifice of the sleeve is drawn with dashed lines.

Figure 51 sho~s the variant of the sleeve for the sensor bristle relating to a device of Fig.47 and others in a scale of 4 : 1 in the longitudinal~section ard a breaking off mechanism for the sensor bristle reaching from the right up to the left lower half. To the left, a sleeve is shown, shortened in the length, during the sensor thrust and quite above to the left, a cross section of the slee-ve.The sleeve(691) consists of any tongues(152), which are interraupted by longitudinal gaps, of which only three are demonstrated. A row of props pIOj ects from each tongue, which centrally enclose the sensor bristle. The entire sleeve is covered with a high elastic membrane against pcllution, which membrane is not shown.
The piston(91~ which is shoved foreward into the sleeve, conically rises above outwards and it spreads the tonoues (135) asunder whilst the sensor bristle is pushed fore-wards. The wedge slides(13~) behind the collar(139) of the sleeve are spread like a vice in a hinge(not shown).

2164~2 ~, .
The proceeding shoot-in of the sensor thread (or bristle) is activated according to a mechanism as in Fi~q.1 ,2 .
The rubber hose end(92), which accepts the pressure from the collar of the sleeve(691), is supported against the support(153). The support ring again can be rotated and is connected with the frontal slides for the production of skin folds (respective the suction cup) by means of the props(154), which are indicated there only weakly as araloQously described at the cup in relation to the nut lû (131,130;Fig.47).
The pressure which is stored on the hose end, first nar-rowes the channel around the sensor bIistle. The electric tracting solenoid(555) is operated by the electroric con-trol unit through a contact (not shown) perhaps in front of the strong pressure spring(261). This is done through the lever(159), the curved wedge slide(155), which activa-tes a counter-clockwise sector rotation of the support ring(153), so tha~ the projections(157) come to be situa~-ed over the gaps(158) of the support ring and can PasS
through. The passage of the projections can be facilitated by relating slants in the vertical direction. (Below to the right, the plan view is shown from below to the bEar-ing disk on the supporting ring). The sleeve is now pres-sed against the sleeve cap(111),-and the sensor bristle is shot through the skin. Before the removal of a sleeve, the solenoid(555) must be activated for traction. The props (120), which pro~ject from the skin fold shiver (or the suction cup), and are shown perhaps too weakly, let the support ring(158) roll up behind them. The staying bet-3C~ ween the support ring ard teh props(12Q) is not shown.Inside of the rubber hose end(82), the conducting layers are indicated white dashed lines which continue in the wires(84) on both sides and contact there with leaf springs for a transmission toward the measuring instru-ment. On the case of the method of the abduction of tis-sue liquid by a kind of wick, sensor layers would corre-spond to the white dashed lines, perhaps for the reaction with the glucose of the tissue liquid.

216~58~

- Figure 52 shows the variant of the introduction of a sensor bristle according to a bore in natural size in the longitudinal or horizontal section. Above to the right, the ccnstruction of the sleeve for the transport of the sensor bristle drawn out in a scale of 2 : 1 . Below the prefer-red variant of simplificated sleeve.
The demonstrated stage is that of a sensor bristle which is drilled under the skin in a suction cup(1). The elec-trical motor(478) with the translating toothed wheels(54) 10 stands firmly :n the housing bottom (omitted) for that;
the square axis for the driving wheel (233) is slidable through the latter and connected with one of bath carria-ges, which itself again run along the (dashed drawn) rails The power clos~ng runs from the driving wheel(233), which 15 rotates freely, to the elongated toothed wheel on the screw bolt(352). The latter can be moved away from the suction cup by rotation inside of the prolongated nut(13û) and takes with it the sleeve(6~1) in a squeezing seat of its collar(238~ by means of the squeezing sleeve(238).
The rubber hose end(92) around the sensor bristle is ccm-pressed, first through cross projections by the sleeve (691). The inner sleeve(97) around the rubber hclse end is supported against balls against the sleeve cap(111) and turns with it, whereby the screwed end of the sensor bristle pierces the skin.
For the largesi; extent under the skin, the sensor bristle is mcved through the screw bar(235), which happens inside of an inner thread of a ]arge toothed wheel which is fix-ed between the nut(130) and the transverse spar(251), whereby the screw bar(235) is moved through this transver-se spar with its end. The related small drive wheel(234)is driven by a second motor (not shown) or through a ccntrol gcar from the motor(478). The rapid retreat of the sensor bristle takes place by influence of both pressure springs (237) between ~he projecting ledges on the suction cup and ~64~

on the carriaye(236) each, which are twice moved upon arail. This occurs after the bolts(472;c.p.Fig.48,there is only one shown) is released by a solenoid. (The latter is also not shown as also the vacuum source is omitted).
The variant of the frontal end of the sleeve(691) shows the sleeve cap(111) firmly integrated around the suction cup orifice for the sensor bristle and this, indeed, with a ball bearing for the inner sleeve(97) which absorb-es the pressure of the rubber hose end. The rubber hose lû erd rests on the sleeve(691) with a sudden calibre change, and rotates with the inner sleeve.
Above to the right, the detail is shown of a preferred solution between sensor sleeve and suction cup in the sca-le combinatior of 2 : 1. The rubber hose end(92) is firm-ly fastened with its one end in and on the sleeve(691).The latter has a fine thread on its end, which works against that one of the nut(130), whereby both threads are adjusted one against the other with regard to their gradient.
An inner thread of the inner sleeve(111), which is a por-tion of the device, correlates to the outer thread of the screw bolt(352). The inner sleeve(250) is tightened on the socket(117!, which projects from the suction cup.
A sealing ring lies also between the inner sleeve and the sleeve(691). The rubber hose end is compressed during the rotation of tha sliding screw(352) and likewise rotates the inner slee~e(250) with the carrugated end of the front side. The inner sleeve is thereby removed from the suction cup and thus an extent as the sleeve(691j approaches the former. In use of the device, the sensor (thread) is shoved out a certain distance of the inner sleeve by the screw bar(235). (The problems of the safety covering befo-re use are omitted: they can be sGlved by the drawing off of a cap or by an glowing wire loop). The skin (with dash-216458~

ed-and-dottered line), which already clings to the top of the sensor thread or bristle in the punched disk(254, Fig.7) is able to evade to the free thread end first. The thread end is then thrilled through the skin by the rota-5 tion with the screw nut(130).

Figure 53 shows the variant of a device for the shooting-in of a sensor bristle under the skin by means of a pressure gas thrust, and this is done in a harizontal or lonaitudi-1~ n~l section to the scale of 3 : 1. Singular images of thestacking sheets are shown above (as detail) in a vertical CIOSS section, the sensor bristle is beared on those sheets for a time. The device can be suitably operated from a C02 pressure oas capsule and can make use of ad-15 ditional devices, as such are described perhaps in Fig.36,but also already in the European Pat.Appl.Nr. 0 2210 O5(Fig.13,17,19 etc.), mainly in that from Mc Kinnon which was cited above.
A gas thrust is conveyed out from the pressure gas hose 2~ (893) into the channel of the sleev-e(691) through the tube into the channel of the sleeve(691). The pressure beam advances ~he end plate(214, very exaggerated on the sensor bristle and the latter before itself, wherby the final plate is not able to pass the narrowness(215) on the sleeve end.
The clamp(253) which is conically shoved between the col-lar(139) of the sleeve and likewise a tube, serves for a gas tightly coupling the conical tube end with the fun-nel of the sleeve(691). The retreat of the sensor bristle follows from the tension effect at the sclenoid(555) which takes plsce over the lever(159) to a ledge on the carriage(236). The latter is mc,ved along the rail (252) and in the same. (The way is drawn shortened).
Whilst thereby the wedge ledges(99) are drawn back by the carriage, the eheets are approached against their spring 216~582 bcws(85,above in a vertical view) during a pushing off onthe bars(355) such a distance, that the sensor bristle is embraced in the narrowned channel between the stacking sheets(86) which are alternatively stringed from above and from below. Thereby a current derivation occurs from the su:rface of the sensor bristle. Through the electrical (in-tegrated) lines (84), the sheets transfer the current by ccntact of the conducting rings one with other to the measuring inst.ument. Each of the lines thereby re-sponds to a contact on one sensor bristle side.The stacked sheet, which is shown to the left, with its slots(98) for the wedged bars(9g) demonstrates the singu-lar shape (for the spreading of bcth rows of the stacking sheets). To the right, representations follow of two adja-cent sheets in the stage of the wedge bar retreat and af-ter the introduction of these into the slots(98).
The solenoid(5~5) is switched off again after the metabo-lism mcasurement, and the carriage(252) returns in the shown position under the working of the pressure sprinq (237). The wedge bars thereby spread again the stacking sheets, so tha~ the sleeve can shoved over the sensor bristle. (Mainly if the suction is introduced from the iet pump through the pIessure gas hose(893). A repetition of the sleeve retreat permits i~s rsmoval for a repIacement of an unused one.
The chamber(354) arises between the cone for the uptake of the sleeve in the section cup(1) and the pLnched disk(254).
this chamber is plate-like downwards, and closed by the suction cup edye. One demonstrates the slightly cembering of the skin ag~inst the sensor bristle through the open-ing of the punched plate or disk. The light beam(353) can be reflected on this small skin bLbble and projected along (or through) to the related sensor before the shoot-in of the sensor bristle. The optical skin control is e~sentia-ly facilitated in this manner because surface irregulari-ties can also be better detected. (A hair bulb follicle cculd perhaps not pass the small opening of the punched p~ate or disk).
- lû9 -216~582 F;~ur~ 54 S~OWS a natural size in a horizontal or longitudinal section, a device for measuring purposes in which the sensor bIistle is shortened to a small double or sensor cylinder(216), the bottom surface of which has measurin~ layers each of different sensibility reach for glucose. The carrier thread (of any aiven material, if it is solved from the sensor ].ayer for the measurement) with the sensor cylinder -which is here stacking in the skin- is drawn very overdimensionally because it has lG in reality a diameter about of 0,3 mm).
Quite to the right in a scale 4 : 1, the carrier thread, that is to say the carrier capillary(217), is shown inside of a measuring guiver. The latter consists of a stationary basic cylinder(219) and the cap cylinder(218) which is shoved onto the former, bath armed with laser sources as photoemitter(580) and photosensor(581, or eventually with use of light ccnducting fibres with auxiliary lenses and postponent coupling toward the sensor as schematically drawn above. The electrical wires (6, each doubled) run to 2~ the measuring device (not shown). The shoot-in device re-lates perhaps to that which is described in Fig.6, whereby the sleeve(691) for the bearing of the carrier capillary or the carrier thread is shortened.
The sleeve(691) is connected with its collar(139) with the collar of the pressure tube, into which leads the pres-sure gas hose(8g3), by means of the clamp(253). After the sensor cylinder is saturated with tissue fluid, the bolt (472,Fig.1,2)is retreated and the tension spring moves the sleeve(691) ba~k by means of the carriage(236) on the rails (252), so that the sensor cylinder leaves the skin and the suction cup is reventilated. (The suction sources are again omitted because it is known and anyone used).
The sudden calibre change between the small sensor cylin-der and carrier prevents the passing through of the 3~ skin; the frame of the cylinder in the end of the carrier serves for the security against a break off of the cylin-der.
~ IO

Below to the left, the dome-like end of a diagnostik pen with a large carrier with a final small sensor cylin-der, which can be shot in the skin, after the pen is pressed against a skin part over resilient soft tissue, so that the fixation of the pen top occurs in a trough of skin.
The sensor cylinder can be shot into the skin by oas pressure or spring and the broad carrier works as a kind of drawing-pin. The measuring evaluation can be performed in a device as shown in Fig.7 to the right.
The central beam(108) leads as a laser beam (dottered-dashed drawn) through the central channel(dashed).

Figure 55 shows below, to the left, the device for an urine sampling and a metabolism check-up to a scale about of 1 : 5 . To the right thereof, the detail of the - lower portion is given to a scale of 1 : 1 . Just above, the sampling device an over view is given to a scale of '1: 3, below two stages of the sampling operation in a detail around the test strip.
The tennis-racket like holding frame(606) -perhaps for woman- can be sticked througlh under the toilet seat and can be held by the grip(611). The grip has lateral inser-tions to be folded down before use. Inside of the frame a paper sac(616) is attached with a free upper portion which canbe constricted and thereby closed by a lace (608). A test strip(614) is inserted through a slot into the bottom of the sac so that the measuring reactive layer is able to contact with urin. On the free end of the test strip outside the sac, a string is fastened and fixed by an adhesive plaster(609) wh~ gF~ten~g~
the slot. On the erd of the plaster, the string(61û) is bent in the counterdirection first, and leads then in a loop(613) which can be hanged on the hook of the spring balance before the filling of the sac by urinating. The loop of the lace(608) can be fastened on the hook of the spring balance before for the asce~tain-,_ 216~58~

ing the urine weight, which is recorded to the computer, in particular if the tube(602, below to the left) is at-tached to the injection device perhaps by clamps(not shown). After the~alarm which indicates the running up of the reaction period, the sac is held over the toilet, the plaster is is rolled and pulled away by tension from the string. The slot(612) is such a way opened, so that the sac can be e~.ptied. (Second stage as shown under the first one). The test strip can be evaluated by the pho-lG tometer of the iniector after it is stuck in a specialmeasuring casing(not shown).
The cc,mplet view demonstrates the spring(6ûl) of the tension balance with the sac(616) on the hook.inside of the the tube(602).
The detail gives a longitudinal section through the cen-tral pin(617, interrupted and shortened), the hcllow piston(603) which slides along the central pin ar.d is fastende with the spring(603), while the central pin is ~ :
stationary above on the tube(602). The sliding spring 2~ (618) renders the weight measurement possibly by using a kind of Whitestone bridge.

Figure 56 shows a low sugar werning device for the use at night. This is done below in a longitudinal section, above through a detail of the measuring drum in a cross section. The ball(619) is fastened in the center of the drum(621) by an elastic wire. Four contacts(622) are dis-tributed around the circumference of the dru~.which is mcunted in the housing(16). (The latter is buckled on an ar~ or leg or an other body portion by the belts(623).
With each touching of the ball with one of the four ccn-tacts(622) on the drum, a current circuitry is closed to the condensator(625) which is laden over wires (dashed lines) from the batteries(255). An alarm(628) is activa-ted from the control unit(80), if the condensator load 216~8~

inside of a destinated period exceeds a regulated meas-ure.
The influenc~of an increased perspiration causes the cur-rent amplify between two poles (+/-) on a special Pad 5(629) of fabr-ic which can be taken under consideration and repulated for the alarm by the user. (Wires or leads are dashed sketched, the plaster is clapped foreward from the underside of the housing in reality facing the skin.
The iniector (with its dia~nostic device) might be acti-l~vated through the leads(631) instead of the alarm.

The invention shall not be narrowed to the given examp-les, but the claim for protection should be expand to similar solutions, mainly to combinations bLt with 15 prior mentioned inventive elements. In this manner, a sin~le slide can be moved against another which re-meins fixed on the housing. A linear Piston-cylinder pump can be used for the suction production, instead of the mounting of a rotary Pump (as such from Wankel 20 type) The skin fold can be raised'also by adhesive means as shown in Fig.1 of DE P 37 08 031.8. The opera-t ng functions may be distributed in any manner between ~ors and solenoids. The torcion-push-sleeve can be multiply its functional staaes from four to five or to 25 any more, if needed, as in the example of Fi~.55.
A multi-functional solenoid could permit the chan~e bet-ween single an Permanent functions as described in Fig.
9-14 of DE P 37 08 031.8. The examples could be set forth and should be comprised all inside o~ the claims, which are in 30 the followin~l are set out:
, _ 113 -

Claims (20)

1. A system for diagnosis and therapy of a living being on condition of metabolism alterations c o n s i s t i n g of at least one housing with injecting means for drugs through a nozzle through the skin of said living being with at least one container for said drug and at least one injection cylinder with pressure donator for an expul-sion of said drug and matter for the cleansing of the injection channel, by an expulsion of a portion of said matter following the drug injection with the same injec-tion beam, which matter, if fluid, is also used for a body friendly thinning fluid for the drug, means for the production of a skin fold to guarantee space for the drug under the skin, cleansing means for said nozzle to prevent a pollution of the drug, metering means for said drug and for said cleansing means, means of a mechanical and electronic programme control including the control of dosage with power source and a kind of programme panel with switches, and preferably means for an optical skin control for the adaption for the puncture, and preferably means for the metabolism control, interacting with said electronic programme control.

2. A device according to claim 1 , wherein said injection cylinder contains an intermediate piston to separate the drug from a fluid serving as said cleansing matter and sd thinning fluid, and including sup-ply leads for the filling of the chamber between said intermediate piston and the nozzle with drug and even-tually with thinning fluid and the space behind the inter-mediate piston with thinning fluid, and containing valve means working on the intermediate piston which opens,

3. A device according to claim 1 , ? after the drug injection.
wherein drug and cleansing or thinning fluid are metered filled into two separated injection cylinders and expelled one after the other under the control of the mechanical or electronic programme control.

4. A device according to claim 1 , wherein said injection cylinder is a thin tube which is filled before the apply of pressure by the pressure donator without an intermediate piston with drug and cleansing and thinning fluid before the injection.

5. A device according to claim 1 , wherein water or other cleansing fluid is stored in a container as means for cleansing the nozzle and a tube connection lead to each injection cylinder and a filling up cycle is provided by the programme control with an ejection through the nozzle between each drug injection operation.

6. A device according to claim 1 , wherein a kind of blind or lid is provided before the nozzle with mechanical means as a portion of said mechanical programme control to push away said blind or lid, at least one of perhaps two, before an ejection or injection procedure.

7. A device according to claim 1 , wherein water and the cleansing or thinner fluid are combined to a single package unit, whereby the valve inlets are provided, which are protected by protective foils before the installation into the device, on the opposite ends of said package unit to performe the coupling with the supply hoses during the closing up of the package unit inside of the device.

8. A system for diagnosis and therapy of a living being on condition of metabolism alterations c o n s i s t i n g of a housing with a portion adapted to be set on the skin of a living being and means to receive sensor means in a sterile condition and pushes said sensor means through the skin without of an introduction of a cannula surrounding that sensor means, and to retract and to bring into contact with chemical substances for a metabolism measurement, and comprising a mechanical and eventually electronic programme control and power source, consisting further of signal producing and transferring means for a measuring device, which transmits the measured signals to a display and a recording device and over means of programme control, which can also be positioned outside of said housing, preferably to an injector with nozzle and at least one pressure donator.

9. A devise according to claim 1 and 8 , wherein a elastic hose end serves to support a sensor tread or bristle, which is able to take up tissue fluid under the skin, and is temporary compressed to guarantee a conduction of the just mentioned sensor means against the skin and said hose end preferably fitted inside with electrically conductive layers temporary in contact with wires toward the measuring device and said conductive layers then in contact with adjacent chemical substances which react with an interesting metabolic substance.

10. A device according to claims 1 and 8 , wherein a sensor thread or bristle as sensor means are temporary embraced by stacking sheets in a row with cur-rent conducting portions in contact with the wires toward the measuring device while the sensor means are situated outside of its protective sleeve or a hose end.

11. A device according to the claims 1 and 8 , wherein a cylinder with chemicals, which alter their colour by influence of an interesting metabolism substance, is put into the end of a carrier thread, preferably in-serted and fixed a short distance in a bore of said car-rier thread.

12. A device according to the claims 1 and 8 , wherein a sensor thread or bristle as sensor means is injected through the skin by a pressurized gas stroke.

13. A device according to the claims 1 and 8 , wherein the puncture of the skin is performed in a suction cup as means for the production of a skin fold, near the suction cup edge in a direction which deviate from the the suction cup axis.

14. A device according to the claims 1 and 8 , wherein a single cartridge is used for the expulsion of drug with a special own nozzle, which is inserted into said cartridge.

15. A device according to the claims 1 and 8 , wherein suction as means for the production of a skin fold develops by the enlargement of a bag, which is stretched between a fixed housing sheet and a movable lid and widespread fastened on the and operated by pressure springs between the housing and the lid, which are tensioned by manual pressure and temporary fixed inside of an locking device.

16. A device according to the claims 1 and 8 , wherein as means for an optical skin control a kind blind or visor with a hole is proviced near the base of the skin fold, whereby the skin can be approached to the sensor means before its use nearer as the adjacent skin, which leans on the blind, and which hole marks the puncture area, and whereby light is tangentially projected through the small bubble in said hole against a photo receiver in connection with a measuring device and the electronic programme control.

17. A device according to the claims 1 and 8 , wherein as means for an optical skin control a kind of window on the edge of a suction cup, as means for the pro-duction of a skin fold, has a window wich projects light against the skin and reflects it against a photo receiver, preferably connected with said means for the programme con-trol, which checks the condition of the skin in the puncture area by calculation.

18. A device according to the claims 1 and 8 , wherein a control panel exists on which a diabetic inputs the planned time points of meals with the planned contents of and load with carbohydrate as well as the period and heighth of planned bodily work capacity and might correct later correct the mentioned inputs according to the reality, whereby a computer as means of programme control compares the inputs belonging to the life style with programmed data relating to the individual sensitivity for insulin sorts, preferably with different working profile, and calculates the optimum dosage and further advice.

19. A device according to claim 1 , wherein a kind of spectacles for diagnosis are provided with motor driven adjusting wheels which adjust photo emitters and photo receiver tangentially to the cornea for a laser measuring of atleast one metabolic substance.

20. A system for diagnosis and therapy of a living being on condition of metabolic alterations c o n s i s t i n g of a sac, preferably with a tennis-racket formed frame, which can be used over the toilet, and a lace which can be fastened or. a balance, further a test strip projecting with its metabolic measuring layer into the sac, and with an end which can be pulled away from the sac for the evaluation of the test strip.