DE3925940A1 - FABRIC CHANGE CONTROL DEVICE, IN PARTICULAR SUGAR DISEASE - Google Patents

Abstract

A device for the control of metabolism e.g. in diabetes mellitus by automatic measurement of blood sugar at given place on the body consists of a relatively flat housing with central suction cups resilient against the skin, on which the spring pressure for the drive of two suction pumps is produced by a single electric motor connected to gearing, whereby the skin is lifted by influence of at least two pump strokes.

Description

The invention relates to the field of medical technology, more particularly to the field of metabolic diagnosis and injection therapy, in particular for diabetics. The publications WO 86/0 1728 and Euro No 02 21005 as well as the applications Euro No 8 59 04 428.1 from 1986 and Euro No 8 81 03 775.8 from 1988 are consequently continued herewith. Registration No. 88 18 491 in the United Kingdom - as yet unpublished - for which the novelties are additional has been incorporated here. The goal remains: to create a handy device that allows the diabetic to perform automatic blood sugar measurements on themselves without painful puncture into the fingertip; the patient is encouraged to take more frequent blood glucose measurements and, if his illness is insulin-dependent, is also supplied with insulin according to the metabolic values determined. All significant data - including those relating to usage conditions and the effects of the patient on the device function - are usually printed out during daily battery charging to give the doctor and patient a quick overview of the illness and lifestyle.

The present invention is for improvement through Ensuring device skin contact itself for periods in which the vacuum exposure the skin is deliberately or unintentionally interrupted (For example, a seal leak in the area of the suction cup rim due to heavy skin hair). According to the invention, this object is achieved by that by means of negative pressure in the suction bell  lifted skin by lowering a pressure ring within the skin bell the edge area (under supports from an undercut of the skin) from the inside is pressed against the skin of the skin; this Mechanism can be - especially with regard to less elastic skin areas - thereby increasing that around an axis near the inner edge of the suction cup tiltable lever against the fold of the skin are directed and moved so that a return slip the skin out of the suction cup through Rei increase in exercise is prevented. The design of the Levers and their sectoral wing-like extensions can be chosen so that its pressure on the skin surface in the order from the outside the blood inside the skin vessels to the top point, to the puncture site, which shifts the Blood leakage favors there. The levers can by an air cushion can be added, which also yours Lowering causes the inside of this Pillow (or a membrane under solid wall) over a valve is connected to the outside air after which it had previously - during the suction of the skin - with the suction source was connected.

As a source of suction, the simple cylinder Piston pump used, which via a (train) - Spring is operated, which serves as an energy store (to save space and more even effect division from a by means of gears and chain with consisting of interconnected spiral spring rows, after the operation of a slide drive, for example with a mechanical typewriter). The Spring tension is via a small electric motor achieved, whose revs via a gearbox ver slowly on a spindle for driving the suction piston is transmitted. The air in the pump cylinder is released outside via a valve, while when retracting the piston via spring action only air filtered against sand from the suction cup  will let. Before triggering the suction piston via grid opening when reversing the movement of the electric motors is used to feed the spindle Lock nut opened by putting it together pushing wedge pins from the edge area of the Lock nut to be withdrawn. But before that Suction cup in gas exchange with the low pressure pump stands inside, wanders on an axis spindle drive wheel driven by the electric motor by it after changing direction out of contact with the drive wheel of the piston spindle loosened and over a butt-to-butt connection on a barrel spindle changed (by light spring thread coupling was made possible) and drives a gear on this, which over a gear cross connection the pump spindle one second cylinder piston pump against corresponding Tension springs, these exciting, moving. So it will be one second suction pump is ready so that the first skin suction fractionated in two "bumps" can be done. But the vacuum can also be internal half of the suction cup especially if the skin is inside the suction cup repeated pressure changes for blood movement should be set. In a variation, it can also only a single pump can be provided, which always ready to function again is reset while a valve closure for the inclusion of the negative pressure in the suction cup worries. Even the combination of one or two suction pump with a vacuum storage inside of the (then of course to be sealed) device housing this could be considered.

For the further function circuits for conveying the puncture stylus, a second electric motor is used ( FIG. 2) and a gearbox that switches itself into functions inevitably is introduced and combined with the mechanism of the function change, which is controlled by reversing the direction of rotation of the motor. For this purpose, an axis is driven by the electric motor, on which a switching pinion is securely slidably ver and successively comes into contact with various gears, the rotation of which is transmitted via flexible shafts to drive wheels and disks in the area above the suction bell for transporting the stylus. Bendable shafts or cardan shafts must be chosen because the suction bell is slidable vertically in the central opening of the housing and is approximated by means of predetermined spring pressure on the skin surface. The shifting pinion is shifted in the selected example in that it is mounted on the end of the pump spindle, which is driven by the motor and is moved past the drive wheels for the transmission of the various functions one after the other. The gaps between the drive wheels are selected so that the shift pinion has left the last driven drive wheel before it comes into contact with the closest one. This contact is made possible by the fact that the shift pinion is divided into two halves that are sprung against each other. If one half hits the left with the left, the right with the right, even rotating on the stationary toothing of the next drive wheel, it is moved against the suspension described and approached to the other half of the pinion. In doing so, it loses its rotationally secured axle seat and its movement is slowed down by friction on that drive wheel. The latter, on the other hand, is rotated slightly until the teeth of the pinion enter the tooth gaps of the leaning drive wheel. Under spring action, the pinion halves come apart again and now have both axially secured axles. (The anti-rotation device is guaranteed by a cross pin on an axle sleeve, each of which lies against a radial edge strip of the pinion half). However, if the work wheel is stopped suddenly on a stop bar, one of the cross pins on the outside inside the corresponding ring throat of the drive wheel passes over the radial edge strip or stop bridge and the worm spindle can make almost a whole additional turn before attacking the web edge radial edge strip again exerts a torque on the pinion. The pinion has now lost tooth contact with the drive wheel. because it was moved laterally. The use of ratchet gears can cause some drive wheels to be driven only in the direction of movement. Instead of le of the shift spindle thrust, the shift of the shift pinion can also be effected via wedge guides on its outer sides in cooperation with disk segments originating from the drive wheels; the aids can, of course, be interchanged for a pinion transverse displacement. For example, the drive wheels can each be split into two halves that are sprung against each other with an undivided pinion. Basically, there is the possibility of tapping the rotational movement of the drive wheel at each of its ends (for operating two different functions, for example). To save space, the axis sleeve can also rotate around the worm spindle if a different ratio by an additional wheel as the drive wheel is expedient. The change from a forced self-switching device of the transmission to an externally controlled and thus variable control is expediently carried out immediately before the backward movement of the worm spindle in the direction of the starting position. A thread-free end piece can be used to allow pinion rotation without spindle feed. It can now allow the highest worm thread shift reached to actuate any of the last work function. With the reversal of movement by reversing the polarity of the electric motor, a slight spring-back of the worm spindle takes effect and brings it back into the thread engagement, which is now maintained up to its starting position ( FIG. 2). A variant of this mechanism is given when the device is supplemented with an injection device ( 138 , FIG. 9). In the purely diagnostic version, the repetition option of the spindle end stand function was used to be able to lower the lancet by means of three puncture stages suddenly designed via spring pressure accumulation in order to guarantee a minimal injury for blood collection. The expansion stage for the sensor-controlled injector dispenses with such a variation option for the puncture (to simplify the presentation). After reaching the thread-free end position of the transport spindle in its thread guide, the drive wheel of the pump for one type of insulin is rotated in a dose-dependent frequency, after changing the direction of rotation of the spindle, the pinion becomes a little bit (using a stop pin and a radial edge strip, for example) delayed locking of the drive wheel for the opposite direction to the dosing movement prevented from rotating and the transport spindle rotation continues in the unscrewing of a separately screwed or screwed-in axle piece with the end permanent switching pinion, it finally in the end position of the axle piece thread for taking the drive wheel for the pump for the second type of insulin comes. The latched preload of a return spring for the worm thread becomes effective after the renewed change of direction of rotation has resulted in the screwing back of the axle piece under the pinion (due to blocking the reverse rotation of the second pump drive as well) by triggering this locking block. Thus, when the direction of rotation is changed again, the worm spindle is brought back into engagement with the thread guiding it, and the shift pinion is then pushed back into the starting position by further worm thread rotation. The dosing pumps are based on those already available from Euro-Pat. 1 02 21 005 known solution of a "hose-integrated", better "dosing chamber closing the medicament supply line" from which a membrane-bound compressed gas supply is replaced by medicinal liquid filled under pressure and then ejected through the neighboring cannula under the action of the gas pressure cushion. The alternating valve actuation for supplying liquid to the metering chamber and its outlet was disclosed in the Euro-Pat. 03 01 165 has already switched to rotary operation. The spherical gas cushion was replaced by a diaphragm because it made model building easier.

Should the injury-free glucose measurement be carried out using Laser light reflection is making progress they easily follow the device concept presented incorporate; then it should be the combination with a cannula-free pressure jet injection in Be considered.

As long as blood flows into a capillary gap must (expediently horizontally in the amount of puncture injury from escaping blood drop), the necessary injury will be greater as such through a fine cannula for the drug injection. The more expensive cannula can be  replace the capillary on the rail a central lancet furrow or hollow gutter the lancet are pushed under the skin can, if an injection by the measurement result appears desirable. Thanks to the lifting of the skin fall te of the support (bones, fascia etc) can Lancet lengthened and become more acute what their penetration into the skin easier. A cannula, especially a rotating one, could, of course, be used to collect blood in this device be used; the optical reflex could also be Metabolism determination by an electrical inner replace half of the capillary measuring gap if the Principles of WO 86/01 728 (Euro Pat. Disclosure font 02 21 005 to be followed up accordingly. However, the optical equipment is certain The greatest advantage: thanks to reflex photometry Diseased skin areas recognized as such and by the puncture can be excluded. The same or a similar measuring arrangement can also be used on the top of the skin was a prerequisite for measurement or injection check. The measuring chamber filling can also be best to check visually, for example by breaking the measurement down into several: the measurement results differ from a specified one Limit, the measuring chamber is not yet sufficient appropriately filled (the lancet cut must be deepened or the measurement result can be rejected), indifferent whether it is blood that has entered the measuring gap or after filtering out corpuscles around plas ma is what is measured. Color change or change in brightness of an indicator layer must also not be too far for grid measurement apart to be as valid measurements to be registered and processed. Has one Puncture pen a guide surface for the Lan tine on or in the stylus body and a caps sleeve to move the lancet against the handle  rock body, so you can also a film strip, which is the upper limit of the measuring gap above the Indicator layer forms under the (preferably centrally in the stylus body in a bore of the same introduced) measuring or radiation pen by means of the motion of that sleeve go by; windowed Openings for measuring beams can be left open or with a wipe "pillow" the indica Gate area of blood before blood metabolism measurement get bert. Finally, the chamber floor can the measuring layer also from a second film batch fen are formed, the time difference to the first strip and sliding with it sticks under the ray pen is moved so that the indicator layer only then under densel ben comes to rest if the skin control beforehand made by the same ray pen has been. An additional fold when fastening those (e.g. transparent) foils rubbing against the sleeve or body secures the process this relative strip shift against each other. Ultimately, an innovation should be emphasized that the puncture stylus in line at least an adhesive tape, from which they are attached the guide into the suction cup. Also, the uncapping of the stylus above and down at the same time by a cross slide, which is also the exact height of the sleeve opposite the stylus body (the one in the suction cup is held in place by a kind of clip) serves. The space-saving eccentric guide via one Cross slot on a slide in which the eccentric pin of a disk protrudes still mentioned.

As far as the advantages of the invention are not already are highlighted or still from the figure spelling out, they are in simpler  and safe handling using only one (namely the electrical) energy source and further Zen Functionalization without poisoning drive through indicator substances.

The task is also solved by that in a facility with a suction cup the emergency agile negative air pressure before skin contact the facility by means of many pump strokes is manufactured. The vacuum storage volume will thereby maintaining the pocket format of the one direction increased that a kind of bellows pulled apart before use and by wall support is prevented from collapsing. It With this solution, a single electric motor is sufficient, which both the vacuum pump and the rest Device functions drives or effects.

The gearbox required for this is so attached specifies that the pole or direction change in certain Switch positions causes a function switchover. In addition to a forced shift, with a pinion on a kind of screw driving on different radio tion gears is passed, these in succession Driving others becomes the drives for the front drive the pump tappet and the cone drive for the operation of the lock nut on the pump tappet as well as the pinion for driving two dosing units pumps are only temporarily connected to the motor. The Change of direction or change of pole or the duration an inverse drive type are used to close or close switch any repeatable functions - like Suction pump strokes or metering pump actuations - be uses. The pinion shift from the toothing in the work cycle he is through a short pole change relieved. When the gear pinion approaches Drive wheel is the first against a suspension shifted and loses its fixed Axle seat. Free spinning and by pressing up  The teeth can slow down almost to a standstill of the shift pinion now between the teeth of the operator insert drive wheel. The Fe just described which also causes the shift pinion to return to the middle position in a fixed axle seat.

Further improvements concern a spring roller conveyor for even skin pressure on the suction cup regardless of their height, the metering pump by means of a gas pressure cushion near the cannula (which is made of an elastic stretched over the dosing chamber Membrane) and the puncture stylus and transport. The style is now in the right gel from a single injection molded part, which one Guide gap for the lancet stored in it points.

In one example, the measuring chamber for the recording me of the blood formed below by the membrane cover, through its thin-walled gap the lancet tip passes. In addition to the well-worn lancet shaft is the specially coated indicator or measuring zone. Be above the membrane cover there is the window of a film strip, the absorbent wiping pad over a kind of lower Rolling surface of the stylus body on the blood coat traced indicator zone. This can happen for example by the fact that those foils strip with its upper loop-like end into a notch in the lancet shaft, for example with a slit, is hooked (which is preferred wise already at the beginning of the lifting movement of the lancet This reduces the stylus height helps). Can in a slot of the film strip also the tip of the end olive of a push pin advocate the stylus lowering and Anhe Exercise pull up the film strip. The lanzet can also be rectangular at the top  be kinked with a hole to put one together let through resilient end olive.

Finally, the measuring zone can also be on the LAN Zettenschaft be applied and its side surface with the guide surface (central bore) in the stylus body by forming the measuring chamber. The indicator layer will then when lifting the lancet on a handle wiping pad fixed on the body of the blade. In this case, the measurement is not carried out radiation from above but from the side Lich by flattening the outer stylus surface, which also radiate the stylus position Source and recipient allowed to be determined. A seal of the puncture mechanism in the suction Bell roof can be avoided if you tion in the stylus body against its guide tube or push pin. The union of Stylus depression and puncture procedure into one Stages continued lowering movement of the leadership tubes offers a significant advantage. For diagnostic use it can be simplified also on an automatic stylus change to be dispensed with. The suction cup comes with a correspondingly adapted usual pocket reflex photometer connected via at least one connector and is surrounded by a cylinder, which encloses a compression spring system. A floating inner part becomes manual Pressure from the photometer downwards pushed out the suction cup area so that the used stylus removed and replaced by a new one can be replaced.

The push pin for lancet transport is from a compression spring surrounded by a lock first grid from below then through another enclosed from above in a tense position  becomes. When putting the device on the skin the inner part is first pushed upwards. From the outside, there are two opposing ones Push buttons against the movement of the outer jacket released the suction cup and thereby folding Enlarge bellows over suction cup and pressure spring system eats under suction. This movement is after inhibited again by grid at the top. The Ent Removal of the spring-loaded plunger from the inner part causes this by special compression springs is raised. The raised under suction Skin lifts a gearshift sleeve, which the lower Locking grid for the push pin releases; the lan The tip of the tine is lowered into the skin and lastly briefly via a lever guide on the side ever tipped. The repeated actuation of the two push buttons - the device can already be removed from the skin - according to the device tone for the blood exposure time causes another out stretching the bellows and taking the Push pin up, taking the lancets shaft raised and back into the stylus body is pulled. After another warning tone, you can use the button provided on the photometer or automatically the measuring process can be triggered.

An even simpler diagnostic facility works when the inside of the outer jacket is pressed spring-loaded ring jacket - which later also as Suction cup can serve - an upset skin. When you squeeze this additional The direction is under the photometer pen lowered and thus the lancet; the end movement causes the Lan to move briefly sideways Zettenspitze, in the example given over a movable section of the otherwise rigid sliding pin, initially in a hole of the medium  part was "splinted".

The holder for the stylus is with a tension spring connected to the lower jacket opening. The one when released the relaxation of the spring system in the bellows suction can cause blood leakage from the skin into the measurement favor chamber, but need not necessarily exist be that. The shaft is raised again by hand button movement when the pressure spring system relaxes. The return of the lancet tip to the vertical after their sideways movement is done manually after a small one generated overstroke, or by the described small increase the distance between the jacket and the photometer de Relaxation movement of the compression spring system. Even with such diagnostic facilities, the measurement radiate the photometer through at least one optical one Cable fed. Suitability is appropriate the skin for the puncture and the filling of the measuring chamber if checked by measuring beam by comparison absorbance measurements with the environment or in comparison with previous measured values saved. The reflex photo meter should be adapted to the additional device, so that an acoustic prompt is given when the Skin is suitable for puncture at the selected site. A warning tone should also sound when the chamber is filled not sufficient after the puncture.

A major improvement in the puncturing process is the blunting of the cut surface of the lancet above its tip area, as well as the lowering of the pivot point for its sideways movement. The lancet no longer needs to be inserted as deeply, since the incision is expanded in depth - where the larger skin vessels are located. This is now done without widening the outer skin incision.

Detailed description of the exemplary embodiments:

Fig. 1 shows a top view on the left in the middle, and the rest in cross-section a device for diagnostic use. The suction piston ( 1 ) with the pump spins del ( 3 ) rotatable in its bore and secured by means of the fastening ring ( 2 ) can be seen inside the suction cylinder ( 4 ). Within the fixed transverse wall ( 5 ), two of the four projections connected to the movable disc ( 6 ) can be seen in the bores, the wedge guide of which is made up of two halves of the lock nut ( 7 ) in a larger bore in the transverse wall so that they approach one another Thread with the pump spindle is coherent. The latter ends with the drive wheel ( 8 ), which is firmly connected to the pump spindle and secured against rotation and meshes with the sliding pinion ( 9 ). This is constantly maintained by the fact that the guide plates ( 10 ), which include the rotationally secured sliding pinion on the sliding axis ( 11 ), hold both toothed wheels on the two guide plates common axle bushings in connection. The sliding axis is driven via the large gear wheel ( 12 ) firmly connected to it through the small ring gear of the wheel ( 13 ). The large sprocket of the wheel ( 13 ) in turn is driven by a side cam ( 14 ) of the ratchet wheel ( 15 ), the latter approaching the large wheel ( 13 ) on the axle spindle ( 16 ) which is firmly connected to this, until a lateral edge notch of that Provides cam resistance.

When the ratchet wheel ( 15 ) rotates in the opposite direction, this removes it from the large wheel ( 13 ) and leaves that axle spindle ( 16 ) by pushing the running spindle ( 17 ) against its suspension until its thread matches the internal thread of the ratchet wheel engages. The ratchet finally moves with the side cam ( 14 ) in the side notch of the up to the counter bearing ( 19 ) displaceable gear ( 18 ) (middle part figure), so that it is taken along and the rotation via the left-hand rotating spindle ( 17 ) onto the cup-shaped wheel with front toothing ( 20 ) and from there via the gear wheels ( 21 ) of the transverse axis ( 22 ) - see upper part figure - via a cup-shaped wheel ( 20 ) with front toothing in the opposite direction onto the sliding axis ( 24 ) is transmitted. The drive wheel ( 8 a ) - lower right part figure - for the second pump spindle ( 25 ) is driven via the slide pinion ( 9 a ) (upper part figure). The pump spindle ( 25 ) is shown in an end position in which the pull cable ( 26 ) on the roller ( 27 ) - shown above the other pump cylinder - and a second (not shown) deeper roller with a coil in connection with the relatively relaxed coil spring packages, which are interconnected via gear and chain ( 28 ). This pull cable is used to return the suction piston from the position as with the suction piston ( 1 ) while exerting suction on the suction bell chamber ( Fig. 10). The lock nut ( 7 a ) is open around the pump spindle ( 25 ). Extension springs here are not shown, but the release of the gap for the lock nut halves through the four extensions connected to the washer ( 29 ). The fork guide ( 30 ) which actuates the two disks ( 6 , 29 ) in the opposite function of approach and distance to the lock nut under movement tapping from the switching wheel ( 15 ) is only indicated schematically as a dash-dotted line with the associated linkage. On the middle part of the figure you can see the locking mechanism or locking grid for the suction piston return movement under the action of springs. This consists of an eccentric disc ( 31 ) - see also the lower left part of the figure - which is rotated via the switching axis ( 32 ) by a gear ( 33 ), which, however, only allows movement via a coupling mechanism if the return movement of the drive wheel ( 8 ) - before breaking contact with the toothless wheel ( 18 ), the sprockets ( 145 , 146 ) and the toothed chain ( 147 ) rotate and, via a special ring gear of the chain wheel ( 145 ), the right half of the two-part gear ( 33 ) with the mutual wedge flanks which are pushed apart and the left half, via a pin now hitting a stop, the disc of the chain wheel ( 33 ) connected to the transverse axis ( 22 ). The sector movement of the transverse axis releases the pump piston ( 1 ). For the previous locking of the pump piston ( 1 ), the eccentric disc ( 31 ) is rotated via a rocker ( 34 ) after overhaul by the drive wheel ( 8 ) behind it into a locking position (lower left part figure).

As a variant of this locking mechanism around the axis of the eccentric disc ( 31 ) is placed a spiral spring acting on the latter, which is overhauled with a downward-pointing and rearward wedge-shaped end claw from the sprocket of the drive wheel ( 8 ) and stretched out a little ; the shift axis is rotated and the eccentric disc comes behind the drive wheel to lie and is pressed there under spring action. For locking and releasing the movement of the second pump piston there is an analog locking mechanism ( 146 a ) for blocking and triggering the second pump piston, the trigger only when the ratchet wheel ( 15 ) overtakes the ratchet gear ( 158 ) and thereby rotates the chain wheels .

The driving force for the two pumps is derived from a single electric motor ( 35 ) and transmitted from there via the small gear ( 36 ), which can be moved on the motor axis, to gear engagement ( 15 ) secured by means of the guide lugs ( 37 ).

In the opposite direction of motor rotation, ie if the cup-shaped wheel with front toothing ( 23 ), reversing the direction of rotation again, drives the sliding axis ( 24 ) via the transverse axis ( 38 ), then the rotation via the small gear ( 39 ) on the large gear ( 37 ) transferred, which drives the drive wheel ( 42 ) for the pump spindle via the sliding pinion ( 41 ), in tab connection with this (lower right part of the figure). The engine position at the rear is still clear from Fig. 2 (dash-dotted).

Figs. 2 are in the scale of 2: 1 at the top in a cross section, the bottom a side view from the left, the gearbox again, its representation in the left central part of the diagnostic device in Figure 1 was omitted.. The functions that are driven by the electric motor ( 43 ) (somewhat withdrawn in favor of the representation of the gears in the size representation) were designated by Roman numerals (I-IV) for a better understanding of the assignment to the executing parts ( FIG. 3 ) for the puncture stylus transport. Via the large gearwheel ( 44 ) fixed on the motor axis, the rotation is transmitted to the large gearwheel ( 47 ), which rotates about the axle bushing ( 48 ), by means of the small gearwheel ( 45 ) which can be rotated about an axis ( 46 ). This axle bushing is held by the strut ( 49 ) in such a way that the trans port spindle ( 50 ) for the rotatable bushing ( 51 ) is guided through it without friction. The gearwheel ( 54 ) is moved with an internal thread acting on the transport spindle via the gearwheel pair ( 53 ) rotating independently around the axle beech ( 53 ) and the counter gears interacting with them on the axle ( 46 ). The gear wheel ( 54 ) has grooves with ball bearings on the housing wall and the holding arm ( 56 ) extending from the housing. Regardless of their position, the drive wheels (as well as the motor) are shown in dash-dotted lines to clarify their functional relationship. The two-part shift pinion ( 55 ), consisting of its two halves, drives the other drive wheels one after the other, which are firmly seated on their axles rigidly connected with flexible shafts (the axle holders are not all shown), where several axles with flexible shafts are not provided via a pinion Additional pinions (Ia, IIIa, IVa) are driven; The transport spindle ( 50 ) is shifted with the two-part shift pinion up to the thread-free axis distance up to IV moving past all drive wheels. The drive gear IV, which rotates about the axis ( 46 ), transmits the rotation via the drive pinion (IV, IVa) with its own axle bearings. For taking the two halves of the two-part shift pinion with them, the bushing ( 51 ) has a coarse edge toothing or a pin which engages in the rough internal toothing or stop-interrupted ring groove; in the middle, however, they include an annular zone without this toothing, around which the pressure spring is arranged, which urges the two halves of the two-part shift pinion into the tooth engagement or groove engagement against an axle stop.

The detailed view to the right of the side view in Fig. 2, a side view of the left half of the two-part shift pinion, shows the radial edge strip ( 60 ) on which the transverse pin ( 59 ) emanating from the transport spindle for transmitting its torque to the two-part pinion attacks when it turns to the left and allows one-turn freewheeling when the pin turns to the right.

The semicircle at the top right denotes the free space for the suction cup and its functional structures, while the puncture stylus chain for clarity and their transport wheels and curved transport skids were omitted.

Figs. 3 shows in the scale of 2: 1 is a plan view of the function structures of the suction cup, which serve the stylus transport. The deeply indented transport disc ( 63 ) is attached to the suction bell roof at its height directly above the seal ( 62 , Fig. 5) with its turning axis and is attached to the spur gear by an overlying ratchet wheel by a pinion only during the left shift of the Shift pinion ( Fig. 2) actuated by function I from the manual transmission. The puncture stylus chain is moved by one stylus to the right in cooperation with the indented counter disc ( 63 ) - supported by a transport wheel drive (not shown) via Ia. The adhesive band ( 65 ) for the introduction of the puncture stylus as a chain lies above the plane of the transport disks ( 61 , 63 ) on the edge of the curved manhole incision ( 64 ) for the puncture stylus guide. The drive mentioned can be transmitted to the transport wheels for the puncture stylus via the two hubs of a separately driven drive gear (IVa, FIG. 2 below). On the fixed column arm ( 70 ) on the suction cup roof there is a vertical rail guide ( 71 ) in which the two slides ( 72 , 9 ) are raised and lowered.

For the slide ( 72 ), which is connected to the tube segment ( 76 ) for the puncturing mechanism via the bridge arm ( 74 ), the latter guided through the elongated axis of the disc ( 63 ), a transverse slot serves to raise and lower, in which the eccentric Pin ( 68 ) engages a disc driven by the flexible shaft (III) (also Fig. 4). The slide ( 79 ) for the vertical movement of the optical measuring pen is moved through its transverse slot by the eccentric pin of the disc ( 69 ), the axis of which is fixed in the frame ( 78 ), which in turn is firmly connected to the slide ( 72 ). The gallows for the compression spring acting against the slide ( 79 ) extend from the frame ( 78 ). From the puncture mechanism can be seen in plan view (with the cover screw removed) the spoke cross ( 75 ), which surrounds the central screw bolt fixed in the pipe segment, like a collar, resting on the fixed pipe segment ( 76 ). The rod ( 66 ) behind a spoke extends from the cover nut ( Fig. 5).

The sliding cylinder surrounding the spoke cross carries the cross slide with the sliding fork ( 85 ).

Fig. 4 shows a side view of the mechanism for the stylus countersink. In addition to the slider for raising and lowering the bridge arm ( 74 ) via the drive of the flexible shaft (III), the drive IIIa for the optical stylus via the disk ( 69 ) is explained. The axis senhalterung this disc ( 69 ) with in the slot of the slide ( 79 ) effective eccentric pin is on a cross strut on a starting from the slide ( 72 ) fork. About slide rotation by means of the flexible shaft (IIIa) against the pressure spring on the gallows ( 80 ), the slide ( 79 ) is raised, while its lowering is favored by the compression spring. On the slide ( 79 ) there is still the crossbar ( 80 ) for attaching the optical stylus.

Figs. 5 shows a scale of 2: 1 in a longitudinal section, details from the cross section of Figure 3 to illustrate the puncturing mechanism..

It can again be seen the spoke cross ( 75 ), which surrounds the screw bolt fixed in the tubular segment in a sleeve-like manner, the fixed tubular segment ( 76 ), which has step-shaped recesses, lying on top. The ends of the spokes chenkreuz transmit its abrupt lowering under the influence of the vacuum under the cover sleeve and the compression spring under the cover nut ( 81 ). The rod ( 66 ) extends from the latter to behind the vertical extension of one of the three spokes. The spoke cross is turned over the toothed ring of the cover nut over the flexible shaft (IV). After the turnstile has dropped behind one of the three stages that are regularly distributed over the circumference of the pipe segment, the rod and thus the cover nut can be actuated by almost one turn before it strikes that extension again. The ends of the storage cross transfer its abrupt lowering via an internal groove to the segment cylinder ( 77 ), which is connected to the slide mechanism ( Fig. 6).

Below, the suction cup roof with the sealing ring ( 62 ) can be seen in a partial view when the puncture handle body ( 90 ) is lowered into the elastic retaining bracket ( 88 ). The measuring stylus is inserted into its central bore ( 91 ) from above. The Griffelkör is held by an engagement of the bracket ( 88 ) in an annular groove ( 86 ). Between the bracket and the stylus body there is room for the lowering of the cap sleeve ( 87 ), between the upper ring ring of which the slide fork ( 85 ) of the cross slide is inserted, with which the puncture stylus can be moved in the vertical direction. The lancet shaft (shown in black), still lying inside the puncture stylus body, is attached to the top of the cap sleeve ( 87 ). The foil strip ( 87 ) above the base plate with the indicator layer under the central bore with the wiping pad ( 98 ) at the end in a bottom recess of the stylus base is not shown, but can be understood from the further development of the stylus in FIG. 7.

Fig. 6 shows the slide mechanism (II) above in cross-section in front of a puncture stylus in the war position, below in transverse section after advancement of the cross slide, the slider fork via a telescopic rod (only indicated as a dashed line) the upper and lower protective cover of the puncture stylus, by knobs favored, deported. (The lids remain connected by threads to lid caps or stylus bodies). Above you can see the generation of the eccentric movement via a disc with an eccentric pin in a slider slot and an additional hole for light transmission through the cross slide.

FIG. 7 shows a puncture stylus without a separate base plate at the top in longitudinal section and at the bottom in cross section on a scale of about 3: 1. The stylus body ( 90 ) is rounded at the bottom and flattened on two sides with marginal ridges, which on the left encompass the lancet shaft in the upper part (away from the bevel). Between the lancet shaft and the left flattening of the stylus body, portions of two foil strips are initially stored, which are stretched over the central bore ( 91 ) and extend in the right stylus flattening to the roof of the cap sleeve ( 87 ), where they are attached (the upper one directly , the lower one in sliding adhesive connection with the upper one or with a removable adhesive fold). The upper strip ( 97 ) det det left and there carries a wiping pad ( 98 ) with a lower cross bar (to prevent the influx of blood) and ends attached to the right of the cap sleeve. The lower film strip carries the indicator layer on the left in the stylus flattening below the wiping pad and ends after a reserve fold ( 96 ) on the stylus body. The stylus body has knobs at the bottom to make it difficult to lower the cap sleeve and above it a caliber jump ( 99 ) into which an inner edge of the cap sleeve engages to prevent it from being pulled off the stylus body. On the right, two edge bends of the film strip ( 95 ) in the area of the indicator layer are shown as a detail in the transverse section, which delimit a capillary gap with the film strip ( 97 ) lying above it.

Fig. 8 shows three coil spring packages ( 28 ) in longitudinal section on a scale of 2: 1, each with a spring end connected axis gears ( 100 ), and from whose toothed chain ( 147 ) all three spiral spring packages are included, here only two, wäh rend the third is coupled via the switching pinion ( 102 ) with the coil spring winding reversed. By pulling the switching pinion ( 102 ) out transversely, the chain-connected spiral spring assemblies, the receiving cylinder surrounding the elastic medicament supply balls, can be temporarily generated as pressure chambers via the suction piston movement (FIGS . 11, 12). The power transmission to the pump spindle via train cable ( 26 ) and roller ( 27 ) is indicated.

Fig. 9 shows on a scale of 2: 1 in longitudinal section and below in cross section a suction cup without roof structures.

An undercut ( 114 ) of the suction cup edge in the case of non-sliding surface properties in this inner ring zone is essential, and the hammers shown in the side joints ( 115 ) downward fall with the air cushion ring ( 117 ) above it, which is connected via a hose ( 118 ) the valve ( Fig. 11) is connected. In the cross-section below, the distribution of the radial hammers can be seen, lateral (but also unnecessary) wing plates ( 116 ) which in reality overlap slightly are shown. The holding clamps with the stylus body project down into the suction cup. The Luftab line over the skin takes place for example via a fine channel in the stylus.

The details on the left show (curved) variants above the hammer shape below an elastic membrane, below is a clamp as a hammer with a side ab bend the ends as joints.

Fig. 10 shows in longitudinal section schematically another solution of the lateral pinching of the skin crest by a slightly at first when the skin is sucked in with raised elastic edge ring ( 119 ) when pinching the skin fold behind it by the inflated tube ring ( 118 ) with the edge ring lowered ( 119 ). The skin elevation is demonstrated on the left side and the skin clamping on the right side.

Another hose ring is said to be the possibility the wavy skin pressure caused by pressure when inflating the rings in the order of show outside inside.

Fig. 11 can be understood as a longitudinal or cross-section in natural size and shows a valve device whose inlet hose (solid arrow) is connected to the suction nozzle ( 120 ) of the suction pump via a segmental rotor cavity; the air from the air cushion ring ( 117 , Fig. 9) is now sucked in; If the hammers on their underside (e.g. by elastic threads) are attached, they are now raised. The valve rotation can be coupled to function IV - also modified by a slowdown in rotation by a drive pinion - so that after a certain rotation the connection to the suction pump is interrupted and later the air cushion ring (or hose rings one after the other as in Fig. 10) through duct opening to the outside air (dashed arrow) can be inflated again. There is also a return check valve ( 121 ) to the air outlet during the suction piston return, and the check valve ( 122 ) to prevent air from entering the suction bell during the same phase of the pump function.

Fig. 12 shows a similar rotor-driven valve, but which would have to be driven by an additional drive wheel (VII), for deriving compressed air from the pump cylinder into the receiving cylinder ( 123 ). Two spherical medication bubbles with elastic walls ( 124 ) with medication outlet cones for the hose attachment in the direction of the metering pumps are stored twice within the same. On the left side, the first medication bladder is almost used up and its inner cannula ( 125 ) penetrates the attached replacement bladder in order to discharge medication from there to the dosing pump V after the destruction of a sealing membrane against the opening cone; on the right, the medication still flows from the filled first medication bladder to the dosing pump VI.

. Figure 13, above, in partial side view of the bottom of the cross-sections along section lines AB and CD, a variant of a lancet on a scale of about 4: 1. A cutting surface of the lancet is fitted (without exclusive need) with edge teeth (133). At different heights there is a gently increasing profile from the side ( 134 ) as a strip-like increase in thickness to spread the puncture wound for a better blood outlet. A capillary for drug injection can be pushed under the skin through the central groove, even after the puncture.

Fig. 14 shows a metering pump in longitudinal section on a scale of 2: 1 again, which is actuated by rotating the valve ring ( 126 ) with the bridge trough ( 127 ). This valve ring seals the half cylinder with the cup-shaped metering chamber ( 128 ) of the central and transverse bore for periodic connection to the discharge channel ( 130 ) through the center between the valve rings and the supply channel, which is in the second half cylinder ( 132 ) - in the wall the same - continues on the other. An initiated Druckgasvor advice inside the half cylinder ( 132 ) causes the filling of the dosing chamber through the elastic membrane between the two half cylinders and there with the liquid discharge. In the case of liquid flow under excess pressure, this membrane is pressed onto a solid grid while filling the metering chamber. The grid can also be replaced by a central hole in an end wall. One turn of the valve cylinder corresponds to the delivery of one metering chamber filling.

Fig. 15 shows on a scale of 2: 1 in cross-section of the detail of an expanded control mechanism according to FIG. 2 for the possibility of situation-adapted th dosing by means of two rotary pumps ( Fig. 14, Fig. 9 dashed lines).

The gear wheel ( 54 ) has conveyed the transport spindle ( 50 ) so far that its thread-free end sleeve ( 152 ) permits the rotation of the gear wheel ( 54 ) to continue without such a movement of the transport spindle. In this case, a threaded rod ( 103 ) is unscrewed from a threaded hole in the transport spindle after an empty revolution - because of the return of the transverse pins ( 59 ) until the opposite side of the radial edge strip ( 60 , Fig. 2) and an analog device on the side of the raster wheel ( 104 ) - which the transport wheel ( 105 ) is only transferred to the pump V in the now continued clockwise rotation. After the end of the desired dosing movement of the motor takes place and there with counterclockwise rotation of the gear ( 54 ). Since after appropriate idling (because of the return of the cross pins ( 59 )) until reaching the opposite side of the radial edge strip ( 60 , Fig. 2) and an ana logic device on the side of the raster wheel ( 104 ) with the rotation inhibition of the rod on the thread terminal shift pinion, the threaded rod is extended further when turning to the left and the shift pinion comes into the engagement area of the steroid wheel ( 106 ). After (similarly controlled idling same) is driven by the same drive wheel and the pump VI. When the direction of rotation is changed again, the pinion is moved back by screwing the threaded rod into the internal thread of the transport spindle. The return movement of the shift pinion past the transport wheel ( 105 ) is favored by a return spring ( 108 ), which also allows the direction of movement to be reversed to the left by pushing against the transport spindle. The return spring was tensioned during the extension of the threaded rod and fixed by raster ( 109 ) and released by rotation of the release pinion ( 110 ), which was only released in the direction of action - analogous to the processes in the pump piston lock ( Fig. 1). "Only in the direction of action" means: that over a ratchet toothing the entrainment of the effective axis ( 111 ) is prevented by the release pinion. The rotation of the eccentric ratchet wheel ( 112 ) to the left in the blocking position relative to the guide slide of the compression spring ( 108 ) takes place via lateral friction on a disk ( 113 ) rotating with the axis at the end of the two-part shift pinion ( 55 ). Due to the special wedge-shaped mounting of the side of the housing of the raster wheel, this moves away from that disk ( 113 ) as the rotation continues, so that the friction that is created is lifted again. The distances between the trans port wheels ( 104 , 105 ) are designed so that the rotation inhibition of the shift pinion by contact with a rod locked to the direction of rotation of the threaded transport wheels whose axes allow displacement.

Fig. 16 shows a schematic longitudinal section through a switching device with self-displacement of the sliding pinion ( 114 ) along its axis ( 115 ) parallel to the axis ( 116 ) of the drive wheels. In phase A , the sliding pinion meshes with the left drive wheel and is prevented from moving sideways by the disks ( 140 ), which have larger diameters than the drive wheel flanked by them. However, the wedge wing ( 141 ) is already approaching the pinion and the right disk then has a gap for its passage. In stage B this has happened and you can see a wedge wing ( 142 ) on the flank of the pinion, which meets the wedge wing ( 141 ) in a nutshell. In stage C , during this encounter, the pinion was shifted further to the right by a gap in the left disk ( 143 ) of the second drive wheel and is now half meshed with this right drive wheel while it left the tooth mesh with the left. A wedge wing ( 121 ) on the right disk of the right drive wheel completes the right shift of the pinion, which is completed in stage D , due to the gap in the left disk of the right drive wheel that is still open at this stage of the rotation. In principle, a pinion can be moved further to the right by calculating the encounter of repelling wedges by means of further drive wheels, but also to the left again by means of reciprocally acting wedges.

The diagnostic device described (also expandable for injection purposes) still contains batteries and electronic control unit, which are not shown. The space for this is kept free in the central area ( FIG. 1 above) and can be accessed from below through flaps. The control contacts and subsequent lines between the control unit and mechanical parts have also been omitted.

These control contacts are once along the pump spindles, on this route even adjustable in part and in part; for example, actuated when touched by the respective drive wheel of the pump spindle. The time period from the triggering of a suction pump movement to the reaching of a control contact can serve as an indication of the tightness of the skin at the suction bell edge and can be further processed, for example, as a signal to prevent a puncture. In the other case, it can also serve as a signal for triggering the second suction pump. Before using the device - at the end of a previous use or actuated by a hand contact on the housing and confirmed by a control lamp - the electric motor ( 43 ) runs clockwise with the tendency of the drive wheel ( 8 ) to move to the left until the pump spindle is in the locked position (also possible according to the method of FIG. 15). After feedback of this locking position, the electric motor is reversed and the indexing wheel is shifted to the right by turning it to the right first on the axle spindle ( 16 ), then on the running spindle ( 17 ) - which could initially deflect to the right against its return spring until thread engagement with the indexing wheel - up to the stop on the tooth-free ratchet wheel ( 15 ) rotating the spindle, which is flank-secured against shifting to the right. The further left rotation leads via the cup-shaped wheels with spur toothing ( 20 , 23 ) to drive the pump spindle ( 25 ) up to its locked end position. The switching wheel ( 15 ) is brought to the right again after reversing the polarity of the electric motor. However, this only happens when the edge of the suction cup has skin contact and the suction cup has been raised against its springback. Before the drive wheel ( 8 ) loosens again to the right after idling from the ratchet wheel ( 15 ) by shifting to the left, the right-hand rotation of the gear ( 145 ) via the chain ( 146 ) running to the gear ( 147 ) runs over its spindle rotation transfer the second ring gear of the latter and drives because of its ratchet gear portion in the opposite direction be motion-locked gear ( 33 ). The latter causes the trigger movement of the eccentric disc ( 31 ) for the suction piston ( 1 ), which is driven by the tension spring assemblies, via the switching axis ( 32 ) in a sector rotation to the left. About the check valve ( 122 ) and its connecting hose ( 132 , Fig. 10) creates negative pressure in the suction bell and in the air cushion ring ( 117 ), which pulls the skin up. After a short delay - which may be linked to the speed of the movement of the pump spindle ( 3 ) - the motor, which has meanwhile been stopped, is operated again in the same direction of movement. The drive wheel ( 8 ) moves to the left past the gear ( 137 ), the rotation of which acts only in this direction of rotation (due to the design as a ratchet wheel) via the gear chain ( 138 ) of a gear that is rigidly in waves near the housing wall is connected to the gear ( 137 ) is transmitted to a gear with shaft connection to the eccentric ( 31 a ). To distribute the force, this takes place before the wedges are pressed, which press the lock nut ( 7 ) together. As a result, the second suction pump is now actuated and its suction takes effect via a corresponding valve arrangement ( FIG. 11) in the suction bell. The further motor drive causes the suction piston ( 1 ) to be returned to the left under spring tension and the check valve ( 121 ) to open for the air outlet. Motor reversal causes displacement of the drive wheel ( 8 ) when it rotates left to the right. Even before the second pump piston is recirculated, the suction piston ( 1 ) is triggered by briefly turning the pole. Then, while continuing to rotate the drive wheel ( 8 ) to the left - that is, after changing the poles again - the second suction piston is returned to the voltage lock. The pump pulses can now be prepared and triggered again until the energy is exhausted. At the same time or alternately with the described function of the electric motor ( 35 ) for the suction pump drive, the manual transmission can also be actuated via the electric motor ( 43 ) up to switching stage IV. If the energy supply is weaker, the functions for lowering the puncture stylus are put in front of the processes just described (alternating intermediate orders can also be useful). The transport of a stylus (function I), but at the latest the un-capping of it (function II), is only economically and hygienically justifiable if the skin puncture is immediately connected. However, this is not done if difficulties arise during skin suction. With function Ia, power transmission via a single movement hub is also an option, namely to the left and right over the suction cup to the more horizontal transport wheel for the puncture grip row. For functional level II (the split pinion is shown in this functional position in Fig. 2), the feed of the slide fork ( 85 , Fig. 6) takes place simultaneously with the uncapping, which from now on leads to the stylus in the vertical. If no other gear ratio is selected, then function II is only designed for half a circle rotation (and therefore only drawn half as wide). However, the lead up to the stop on the drive plate ( 135 ) in axial engagement must still be added. In function III, the optical stylus is also sealed in the central bore, the latter for closing the suction cup roof inside the seal ( 62 ).

The connection of the facility with one in Schie Guide or snap fastener from above her connected optical measuring device was not depicted, just as little as the numerous purposes necessary adjustments - e.g. B. the lighting - since they are also state of the art without special ren inventive effort.

Be it through the transparent film strip ( 97 ) or through a hole in it, the light beam can now be directed against the skin. The comparison of the measurement results with previous measurement values or with those obtained from another skin area by at least one reference beam, for example, via a fiberglass bundle through the suction cup roof, permits the exclusion of grossly abnormal skin changes from the puncture, which is done with the issuing of warning signs. The device can then be put into operation again in another area of the skin.

Before the lowering of the cap for the lancet puncture takes place (when using a puncture stylus varies according to FIG. 7), the cap sleeve is raised in short current surges after motor reversal until the optical measuring stylus reports the light reflection on the indicator layer. Instead of wrinkling, the right end of the film strip ( 95 ) was connected to the film strip ( 97 ) attached to the cover in a gluable glue and after a fold on the left the film strip ( 95 ) is attached to the stylus body, but the film strip ( 97 ) ends free in the wiping pad. Now, after renewed motor reversal, the full rotations of function IV for a sudden drop in lancet into the skin begin (with or without specifying a rotation via corresponding driving disks) with a delay to actuate the ventilation valve ( Fig. 11) for the air cushion rings ( 117 ) with a blocking effect on the skin inside the suction bell ( Fig. 9, Fig. 10) and blood-squeezing effect until feedback of the capillary gap filling by the sensor (whose timing can be supported by rotation counter contacts). As soon as the blood collection has been optically confirmed (possibly even distribution of blood by means of a grid-distributed multiple measurement), the electric motor ( 43 ) is reversed and the cover cap is lifted in an abrupt segmental backward movement monitored by the optical stylus, while the stylus body is removed from the retaining bracket ( 86 , Fig. 5) is held. This action continues after the preprogrammed blood or plasma exposure time to the indicator layer and optical measurement there (although a "blank value measurement" may also have been carried out before or during the puncture). If the transverse lower edge of the wiping pad initially pushed the indicator layer between the mask and the stylus body in front of you, supported by pulling from the right through the film strip ( 97 ), the indicator zone under the central hole remains fixed to the left of the stylus body due to film strip attachment, while the right end of the Strip ( 95 ) glides along the strip ( 97 ), while the wiping pad is pulled past the indicator layer before the metabolism measurement. From the time of confirmed blood coating of the indicator layer, the skin barrier can be released by re-venting the air cushion and the device can be released from the skin in response to a signal. After the measurement has been completed, the measured value is displayed on the photometer while the signal is being emitted, and the starting position is restored by shifting the two-part shift pinion to the right, the optical measuring stylus being withdrawn, the puncture handle pulled out of the retaining bracket ( 88 ) and finally also transported horizontally can be (function I).

The expansion of the diagnostic device to a diagnosing injector was only shown through detailed additions so as not to overload the registration (WO 86/01 728 as well as the subsequent registration offers a wide range of possible combinations). For injection purposes, a capillary or fine cannula with the puncture shaft can be inserted under the skin or inserted afterwards ( 137 , Fig. 7). Lateral capillary openings in the upper section and lateral outlet channels in the puncture stylus can allow medication to be loaded even if the metering pumps ( 138 ) are arranged on the side. These can also be spring-loaded from the outside in to facilitate the sealing of the channels. The overpressure for expelling medication from the storage containers ( 124 , FIG. 12) can be generated by gas-forming chemicals stored in their surrounding receiving cylinders; Gas overpressure can also be pre-produced. Via a separate function VII, however, a valve can be controlled when the suction piston is returned, possibly with spring relief ( FIG. 8) and exclusively for this pressure generation. The level of the gas pressure could be assessed by the decrease in the pump spindle movement after a certain distance; anyway, it is limited by the power of the electric motor. Of course, the movement of the membrane in the metering pumps for function control of the metering could be optically monitored via fiberglass bundles.

Fig. 17 shows a cross section along the section line CD of the longitudinal section of Fig. 2 by a device with automatic stylus change with the possibility of injection.

The device consists of the housing ( 165 ), the wall thickness of which is not shown. Shown is the axis of the transport spindle ( 50 ) with a central square, which is displaceable within the socket ( 51 ) with an external thread and is driven by the pinion ( 162 ) firmly connected to the square as soon as the latter engages in the large gear ( 47 ) . The bushing ( 51 ) is moved sideways over the threaded bore of the strut ( 49 ) and carries at its ends the two shifting pinions ( 167 , 168 ), which always drive the drive wheels (I-VI) alternately one after the other for various working functions, such as stylus transport, valve and switching functions mostly driven by flexible shafts. The angular axis with the pinion ( 164 ) fixed on it for driving by the large gear ( 47 ) can be moved between two retaining bushes ( 169 , 170 ) on the housing wall. A pinion is freely displaceable on this axis, which is clamped via a fork between a tension spring attached to the strut ( 49 ) and a string ( 172 ) to the periphery of the switching gear ( 177 ) and depending on the position of the switching gear - and thus the one rotatable roller effective length of the string - with one of the two drive wheels ( 173 , 174 ) in one handle and via flexible shafts one of which drives the metering pumps. The motion is transmitted to the drive wheels by a smaller disc, not shown, with axle contact via locking teeth only when turning to the right on the drive wheels ( 173 , 174 ). A corresponding locking tooth device is now rotated to the left in three equal sector movements when the gear wheel ( 177 ) is turned to the left. The string or the cable pull ( 172 ) on the gear wheel causes during the third sector movement - which is immediately returned to the 0 position for cable tension relaxation - via which on the cross plate ( 184 ) a left shift of the axis with the pinion ( 164 ) enables and thus a power circuit of the motor drive with the metering pumps. About the spindle ( 182 ) with the pressure acting against this or the rocker ( 181 ) attached to the transport spindle - the extension of which is guided via a leaf spring arch - the axis shift to the end position is toggle switch-like continued even when the axis rotation over the pinion came to a standstill. The spring of Überholklinke (186) is overtaken by a fixed to the En de of the bushing (51) disc with extreme right shift and during a brief shift to the left of the bush (51) in the zero position the pinion gear (161) back into engagement with the large gear rad ( 47 ) brought. The closed chain of the Griffelkör by ( 90 ), which are held together by the adhesive tape ( 65 ), is only shown in sections without the elastic U-rail, the latter is attached to the roof of the suction bell. Only one of the transport wheels ( 254 ) is shown, which moves the puncture pen past the center of the suction cup ( 626 ). The suction cup edges are held evenly downwards by means of the band ( 199 ) over the two spring rollers ( 190 ). The rechargeable battery ( 193 ) is below. One of the two receiving cylinders ( 590 ) for each two elastic liquid containers ( 701 ) lie within the piston-like caps ( 595 ) with the central pipe socket ( 191 ), which carry a sealing ring ( 192 ) against the screw cap ( 728 ) and an adhesive ring ( 596 ) at the other end for sticking to the adjacent liquid container. In the pipe socket, which is passed through the screw cap in a sealed manner, in its insertion funnel, which is carried out sealed by the screw cap, is in the insertion funnel ( 596 ) with its cone, the hose for the medication discharge to the dosing device ( Fig. 17) in Puncture stylus inserted.

From the space in front of the suction piston, the (dashed) compressed air line leads via a check valve - to prevent air intake during suction generation in the pump - through the slide valve ( 194 ) through another check valve - to maintain the excess pressure in the container cylinder - into the same. The tappet of the slide valve (a 3/2-way valve) is operated via a bellows, the interior of which is connected to the receiving cylinder. If there is sufficient pressure, the slide valve is switched so that the suction piston cylinder is connected to the outside air via the compressed air line.

.. Figure 18 shows a partial longitudinal section along the section line AB of the section of Figure 17. It is the suction cylinder (4) recognizable and in the same of the suction piston (1) and on that - at seal for the Saugzylinderhälften - rotate the pump shaft (3 ) and the tension spring ( 160 ) between the suction piston and the transverse wall ( 5 ). The pump spindle is enclosed behind the transverse wall by the halves of the lock nut ( 7 ). Two pins - connected to each other via the cross plate ( 184 ) - are guided in bores in the transverse wall ( 5 ) and can press the lock nut halves together by means of their conical caliber jump so that their threads come into engagement with those of the pump spindle. For this purpose, a pin with a sliding pinion ( 161 ) is rotated ben to the left in gear connection with the large gear ( 47 ) - with the help of the counter pinion ( 261 ) when reversing movement - with its left-hand thread within the fixed threaded bushing ( 195 ). The pinion ( 161 ) and ( 162 ) are partially coupled via the sliding linkage ( 198 ) ( Fig. 27). Screw couplings ( 196 , 197 ) - that is, the axle connection by means of an internal and external threaded part with an anti-rotation device against separation of the two parts combined with an anti-friction end at the end of the motor remote from the motor - cause the axles to rotate clockwise with the pinion ( 162 ), which means that the axles are extended, in the Motor direction a return to the original axis length. After the lock nut closes, the pinion ( 161 ) loses contact with the large gear ( 47 ), while the clockwise rotation of the pinion ( 162 ) via the drive of the pump spindle initially serves to generate compressed air, but ultimately only the tension of the tension spring ( 160 ) for the suction piston. Due to self-locking between the pump spindle ( 3 ) and lock nut ( 7 ), the suction piston initially remains in the waiting position when the tension spring ( 160 ) is tensioned. Right rotation, ie reversal of movement, of the pinion ( 161 ) causes the opening of the lock spindle and thus suction, whereby air is drawn from the space between the bellows ( 205 ) via the hose ( 202 ) inserted into the cover plate ( 204 , FIG. 17) ) is suctioned off. The tension spring returns the piston to the starting position. This has the prerequisite that in the piston via the slide valve ( 199 ) when actuated while sliding past the drive wheel ( 8 ) on the associated overhaul pawl ( 201 ) releases the air inflow into the (left) displacement, while a check valve before Opening the slide valve also in the open position prevents the occurrence of compressed air.

Fig. 19 shows a vertical section along the section line EF of the longitudinal section of Fig. 18. The housing ( 165 ) is by means of several a latching brackets ( 203 ), the cover plate ( 204 ) is set up, which has a kind of lateral bellows ( 205 ) is tightly connected to the end plate ( 206 ). The telescopic support ( 207 ) made of pipe socket segments with vertical slot guides with end bending for each rivet is pushed together, the locking locking handle ( 209 ) of which is folded up on the pivot pin sealed in the end plate.

From the bottom, the longitudinal trough can be seen for better skin contact with rounded parts of the body with the cut of the suction cup ( 626 ) above. On the left side is the battery ( 193 ), above it one of the two holding cylinders ( 590 ) for the medicine. On the right side he knows the arrangement of the pinion around the large gear wheel ( 47 ), which is driven by the large gear wheel of the electric motor ( 35 ) via the small gear wheel ( 45 ). The large gear ( 47 ) successively drives the pinions ( 261 ), ( 162 ), ( 163 ) and ( 164 ), the pinion ( 161 ) being driven via the intermediate pinion ( 261 ).

Fig. 20 shows a longitudinal section above and a cross section below at the level of the transport disc ( 61 ) through the suction cup with the puncturing mechanism.

The transport disk ( 61 ) and counter disk ( 63 ) are each rotated to the left by one segment via flexible shafts to the drive wheel (I) while being carried along by the passing pinion ( 663 ); the rightward movement is blocked by locking teeth on the drive wheel (I), not shown. The edge of the suction cup has a beveled edge on the inside, against which the transport screw ( 665 ) sealed to the suction cup roof is rotated by the transport wheel (II) against a skin that is lifted up by suction and pinches, lowering the shell ( 211 ). The guide tube ( 210 ) for the puncture stylus penetrates into its body ( 90 ) from above, piercing or pushing the cover membrane in front of itself ( FIG. 5). The slider ( 72 ) is used to lower the guide tube, to which it is attached i 36254 00070 552 001000280000000200012000285913614300040 0002003925940 00004 36135st and which is moved by means of an eccentric pin in a wide slot in the disc ( 68 ) over the drive wheel (III). The notches and resilient pins ( 212 ) directed against them indicate a principle applied to all motions transmitted via the drive wheels of determining the end position after each operation by means of idler pulleys with notches. The unevenly long engagement ( Fig. 25) between pinion and large gear ( 47 ) requires an early or late drive standstill, while the spring pin ( 212 ) causes the movement to level off in the desired end position. The excess width of the transverse slot in the slides ( 72 , 79 ) allows the eccentric pin to return to a position determined by the spring pin ( 211 ).

The column arm ( 70 ) is fixed on the suction cup roof. From it, the (shown) axis of rotation of the disk ( 68 ) extends to the rear with drive through the flexible shaft (II). The eccentric pin of the disk ( 68 ) moves the frame ( 78 ) vertically in its transverse slot, to which the guide tube ( 210 ) is attached. The flexible shaft (IV) for the lancet in a further reduction Sektorbewe supply of the disc (68) acts via a second gear (213) also on the disc (68) a. A steep flank of the notch for the spring pin ( 212 ) can, after tightening a torsion spring around the disc axis (not shown), make the puncture jerky. Within the frame ( 78 ), the disc ( 69 ) is attached to an axis, the eccentric pin of which moves the slide ( 79 ) in the transverse slot. Via a connecting bridge between the disc ( 69 ) and the pin ( 214 ), which is actuated by a vertical slot in the guide tube, the pin ( 214 ) - with a seal in the guide tube towards the suction bell - acts on the upper right notch of the lancet shaft and thereby causes the lancet tip to move laterally under the skin. Expediently eccentric pin and transverse slot (unlike in the figure) are below the axis of the disc ( 69 ) to create a kind of "negative overstroke". If the lancet tip is deflected via a special shaft guide within the handle body, the disk ( 69 ) and slide ( 79 ) and their drive can be omitted ( FIG. 22).

Fig. 21 shows up in the longitudinal section with a left side view of the lancet right ge rotates by 90 degrees in view of the lancet blade a puncture stylus. Below are cross sections. It can be seen on the latter that the shaft of the lancet ( 84 ) is guided within a gap in the handle body ( 90 ), a capillary ( 185 ) lying opposite each other in the furrows formed, which has a funnel-like mouth since are welded from the cannula body after they form a reserve sheet in the free upper stylus space. The bottom membrane has a central thinner for the passage of the lancet tip. The measuring zones ( 5 ) with the indicator layer are found on the side on the top of the bottom membrane in the shape of a half moon. The guide tube ( 210 ) carries laterally from the end claw ( 215 ) for the lancet guide, the two light fiber bundles for determining the blood filling (shown in dashed lines) over the two indicator zones, which can be provided for different substance concentration levels. The time-controlled reading, after the time-controlled passing of the wiping pad ( 98 ) also takes place via the two optical fiber bundles. A central bundle of light fibers (also dashed) within the end claw projects light past the lancet shaft onto the skin and allows the skin to be checked for suitability for puncture by means of measured value comparisons, ie the exclusion of skin diseases at the puncture site. The film strip ( 97 ) is transparent or windowed over the central measuring beam. The end of the film strip is placed as a loop around the lantern shaft. The capillaries ( 185 ) for the injection are glued in the longitudinal furrows of the shaft at their end near the tip and sealed in the end in the funnel openings in the stylus body ( 90 ). The lancet shaft is guided in a vertical right gap of the stylus body. The pin ( 214 ) for deflecting the lowered lancet tip to the side has been described in relation to FIG. 20.

Fig. 22 shows a 2: 1 scale in longitudinal section above another puncture stylus, left before and right during the puncture. Cross sections are shown below.

The stylus body ( 90 ) near its lower opening in the elongated guide gap for the lancet has a transverse hinge axis ( 226 ) into which a notch which is open at the bottom is engaged. The part of the lancet penetrating the skin is covered over its entire length by the cover sleeve with edge ( 224 ) in an adhesive but easily detachable connection to the stylus body. The latter is flattened to the rear for fixing the position and hangs there on the transport or adhesive belt ( 65 ). Above an annularly closed section for sealing against the suction bell there is a side slot. The protruding over the body sleeve at the upper end rounded shaft part - with at least one bent frame ( 227 ) there - is enclosed together with the slot ( 225 ) by a thin zugelasti rule or stretchable membrane ( 228 ). The guide tube ( 210 ) overtakes with its end claw called frame and presses the lancet in a fork laterally away (right figure) when lowering over the locking of the stylus body, which causes the cutting movement. In this example, the measuring zone ( 5 ) lies on the lancet shaft, which forms the chamber for the blood absorption via a shaft groove from below with the inner wall of the stylus body. If the shaft is pulled up, the measuring zone is moved past the wiping pad ( 98 ). This is firmly on the inside of the stylus body and close to the lancet. The cover sleeve ( 224 ) is removed before use when manually changing the stylus - as in the case of devices according to FIGS . 31 and 32. For the automatic change, a second adhesive conveyor belt ( 229 ) with its own transport discs can be provided, twice the length of the adhesive belt ( 65 ) for changing the handle. In this case, the stylus body is first lifted out of the cover sleeve in a central position with respect to the suction bell - by means of a special outer clamp on the guide tube -, the adhesive conveyor belt ( 229 ) is approached via a pressure roller and the Dec sleeve is laterally transported away before the stylus body is lowered.

For the device according to FIGS. 17-19, a stylus combination between FIGS . 21 and 22 can be used. The transverse hinge axis is then just below the cover membrane, and the associated notch is only approached to the latter when the shaft is lowered. The lateral slot ( 225 ) in turn allows the lateral cutting movement.

Fig. 23 shows in longitudinal section on a scale of 2: 1 a seat valve for discharging the air inside the suction bell schematically again. The valve stamp ( 216 ) above the valve cone has a screw thread to the roof of the valve socket ( 217 ), a sealing ring above. The valve plunger is driven by the flexible shaft (III), whereby the valve cone is first lifted out of its seat. The air from the suction bell is discharged through the suction hose after passing a sand filter in the direction of the arrow through the valve into the low-pressure space between the bellows ( 205 ). During the return phase of the pinion ( 163 ), the seat valve is screwed on again.

Fig. 24 shows a longitudinal section above along the line AB of the bottom plan view of a feed fork ( 218 ) for liquid to the puncture stylus body. The two legs of the fork intersect like scissors in a joint and are approached when lowering the lowering cone ( 219 ) via its thread rotation via the biegsa me shaft (VI) so that the stylus body that tapered ends of the feed fork in the two funnels to penetrate the capillaries ( 185 ).

As an example of the fact that the device can also be operated with at their metering devices, a step syringe with refill from a medicament container is described, which does not have to be under compressed air. Concentrated medication is used when using insulin. The lowering cone ( 219 ) closes the seat valve ( 230 ) during the fork closure and thus the medication flow from the front near the fork opening into the small dosing cylinder. The dosing piston ( 231 ) is driven in phase via the drive wheel ( 173 ) and advanced by a precision thread depending on the dose level. When the pinion ( 264 ) returns, the metering piston moves backwards past the drive wheel ( 173 ). The dosing device is double available for two different types of medication.

Fig. 25 shows on a scale of 2: 1 in a longitudinal section, below in vertical section along the section line AB of the longitudinal section, a switching pinion, which is held by two pressure rings ( 221 , 222 ) based on clamping rings on the axis that the axis next to grooves Bo gene profile ( 223 ) of the pinion from the driving pin ( 220 ) is reached in the transverse bore of the axis. When the pinion gear is turned to the right, the frictional connection to the axle is retained, while when it is turned to the left, the drive pin, which is displaceable in the transverse bore, is pushed back by the arc profile without frictional connection.

The vertical section on the right shows an edge profile in within the shift pinion, which is a movement coupling in relation to the axis in every direction of movement Driving pin that is firmly seated in the cross hole can, guaranteed.

Fig. 26 shows a side view against the telescope support between the cover plate ( 204 ) and the end plate ( 206 ), on the (not shown) rail guide is pushed from the right, the photometer. The light cable ( 231 ) and the optical sliding coupling ( 232 ) in proximity to the light cable ( 231 ) can be seen. The telescopic sleeves have the vertical slots ( 233 ). The rivets ( 234 ) are located on the folding bracket ( 208 ) within the right-angled slot bends and prevent the telescopic support from being pushed together.

Fig. 27 shows on a scale of 3: 1 in a cross section the screw coupling ( 196 ) in the axis of the pinion ( 162 ) and its function. Above, in stage A , the pinion ( 161 ) - together with the pinion (not shown) coupled between the pinions ( 261 ) - is in engagement with the large gear ( 47 ), held by the linkage ( 197 ) above axis of the pinion (162), while is driven downwards in stage B, the pinion (162) from the motor after (161) to the left via the linkage (237), the pinion (162) also on the displacement of the axis of the pinion by left has been moved. Thereafter, when the pinion ( 162 ) was driven via the motor to the right in the screw coupling ( 196 ), an axis extension was effected by displacing the pinion ( 161 ) via the linkage ( 197 ) to the right.

Fig. 28 shows schematically stages in the AF switching the pinion drives via pole change of the electric motor. The vertical dashed line shows the position of the large gear ( 47 ) as a source of power. The pinion ( 161 ) was designated by 1 , the pinion ( 162 ) by 2 , etc., and the axis rotation direction was indicated by arrows.

A) Pinions ( 261 , 161 ) are engaged when the motor rotates clockwise: the axis of the pinion ( 161 ) is screwed to the left into its threaded bushing, while the latter is held in position by the linkage ( 197 ) above the large gear ( 47 ) and their con nicity presses the lock nut ( 7 , Fig. 18) around the pump penspindel ( 3 ). It is approached via the linkage ( 197 ), the pinion ( 162 ) of the large gear, shortly afterwards via the screw coupling ( 196 ) the pinion ( 261 ) is separated from the large gear by the pinion shifting to the right.

B) With further motor clockwise rotation via the Rit zel ( 162 ) and the sliding pinion ( 9 ) the drive wheel ( 8 ) of the pump spindle is actuated until the suction piston ( 1 ) is completely moved to the left.

The air displaced by the suction piston to the left in the suction cylinder passes via the slide valve ( 194 ) into the receiving cylinder ( 590 , Fig. 17) and puts the liquid container ( 701 ) under positive pressure, so that the medication is inserted via the insertion cone on the right, which is in the Drug tube continues into the assigned metering pump ( Fig. 24) and from there into the capillary ( 185 , Fig. 21) can be pressed (in stage E).

If the necessary overpressure in the intake cylinders (one for each medication) is reached, the slide valve is actuated and the force of the air compression in the first phase of the suction piston displacement is avoided. The overrunning pawl ( 201 ) actuates the slide valve ( 199 ) to prevent the otherwise strong air compression during the increasing engine work for the tension spring tension. (During the suction piston return to the right, this slide valve, which is preceded by a check valve to prevent air entry, is closed again).

B) Switching the motor to the left rotation causes an axis extension via the screw couplings with return of the pinion ( 261 , 161 ) in the frictional connection: the lock spindle is opened by the right axis shift and the suction piston under the action of the tension spring ( 160 ) moved to the right again.

In this case, the air from the storage space between the cover plate ( 204 ) and the end plate ( 206 ) is derived from a suction hose from the left end of the suction cylinder while opening the Rückschlagven tiles, and a vacuum reservoir is created there. Here, too, the inhibition of the piston movement by the negative air pressure is finally eliminated by the slide valve ( 199 ) for venting the suction cylinder by slight "overstroke" when the pinion ( 161 ) is turned to the left via the rod ( 235 ). The tension spring ( 160 ) then brings the Saugkol ben right back into the basic position, so that the lock spindle can close again. These suction pump movements are repeated with reversal of the motor direction until a stronger inhibition of the suction piston by the stored negative pressure via measuring contacts along the drive wheel ( 8 ) of the electronic control system, in short: "Computer" ( 236 ), is reported by evaluating the increase in the time intervals.

C) Switching the motor to a stronger counterclockwise rotation causes with the axis shift of the pinion ( 162 ), which is then completed by the pressure pin effect on the spindle ( 182 ), that this is shifted from the engagement with the large gear ( 47 ) to the right. At the same time, the pinion ( 263 ) is brought into engagement with the large toothed wheel ( 47 ) via the bracket ( 238 , FIG. 27).

D) Clockwise rotation of the motor moves the bushing ( 51 , Fig. 17) of the transport spindle to the left via the pinion ( 163 ) and the drive wheels (I-VI) one after the other via its switching pinion ( 167 , 168 ).

First, the switching pinion ( 167 ) passes to the drive wheel (I), which is narrower, and thus moves the transport discs for changing the stylus ( 61 , 63 , Fig. 4) by a stylus width.

The new stylus is lowered over the shift pinion ( 168 ) and the work wheel (II) by means of the guide tube on the slide ( 79 ) until the stylus body closes the central opening to the suction bell. (Previously, the guide tube had penetrated the stylus - sealing it.)

With the switching pinion ( 167 ) and the work wheel (III) the seat valve between the vacuum accumulator and the suction bell is opened ( Fig. 23); however, the electric motor is only activated when there is contact with the skin on three points of the suction cup rim (not shown).

Working wheel (IV) causes rotation of the trans port screw ( 665 ) - but in front of a not shown compression spring, which in turn acts on the bowl inside the suction cup - the clamping pressure of the edge of the skin bell generated by suction.

With the rotation of the working wheel (V), the slide ( 69 ) or again the slide ( 79 ) and thus the lancet lowers into the skin ( FIG. 4).

When the work wheel (VI) rotates, the medicinal fork closes around the stylus body ( Fig. 24). Without injection, the skin can be removed by reversing the movement, the fork around the cannula can be opened and, in addition, a ventilation valve for the suction cup (not shown) can be opened.

E) For injection, the bushing is turned further to the left above the transport spindle and actuates the resilient toggle switch ( 239 ) which switches the transport spindle and the axis connected to it for the pinion ( 163 ) and the cross-connected axis to the pinion ( 164 ). moves to the right, the last res assuming the drive function by engaging the large gear ( 47 ). The drive wheel ( 173 ) only actuates the assigned metering pump per revolution for one metering unit when turning to the right. Turning the pinion ( 164 ) to the left and the ratchet of the ( 177 ), which is carried along by the gear wheel ( 176 ) only when turning to the left, shortens the string deflected via the reel. The fork attached to it is pulled to the left and the pinion ( 178 ) is brought into engagement with the drive wheel ( 174 ) for the second metering pump. The latter is operated by turning to the right as required.

F) The further left turn of the ratchet wheel ( 177 ) shortens the string even further and pulls - by knocking its knot against the bore of the linkage ( 240 ) - the latter and thus the axle with the pinion ( 163 ) again to the left, so that the latter comes into operation. By turning to the left, the drive wheels (VI-I) are then rotated one after the other and the intended functions are performed. During an extreme rightward shift of the shift pinion ( 167 ) with the bushing ( 51 ), the overrunning pawl ( 186 ) is pased and in the first return phase to the left with pole change, the pinion ( 161 ) is brought into engagement with the large gear ( 47 ). The starting position is reached again.

To start up the device, after loosening the brackets ( 203 ), the vacuum accumulator and therefore also the cover plate ( 204 ) are removed. The chain of the puncture stylus can now be inserted from above and a used one can be lifted out beforehand. The holding cylinders ( 560 ) for the medicine containers can also be removed from their (not shown) holding clips after removing the guide rail for the puncture stylus from the suction cup roof and, if one of the containers is empty, added (see Euro. Pat. Appl. No 0 31 165). The consumption of medication and pills can be monitored by counting from the "computer": an alarm device provides information on necessary additions (Euro Pat. Appl. Publ. No 02 21 005, Fig. 59, 62, 63). The wiring and the large number of control contacts have been omitted. Such may consist, for example, that functional disks (I-VI) are stripped with a notches on their edge and only at the low point of the notch a bare spot remains for contact with the electrically conductive spring pin. The control unit ("computer") can then report that the correct functional position has been reached. The processing of the measurement data, their representation on the display device and the printing of all essential data via a printer in conjunction with a recharging device for the battery correspond to the known technology, which every person skilled in the art can master. The same applies to the programming of the metering pumps, which can correspond to the one described in the last cited Euro Pat. Registration after redesigning the control panel while adapting to the wide device shape.

Fig. 29 shows on a scale of almost 1: 2 a view of the bottom plate of the housing with the control panel from below and a vertical section through it below. The base plate has a slightly gable shape that rises towards the center and shows slotted vertical rails ( 241 ) - for simplicity only five - in each of which a flexible slide bar ( 242 ) can be moved. The latter are downward with a Wel lenleiste ( 243 ), which one after the other in sequence determined by the direction of movement and because of the ball catch ( 243 ) also in time interval groups - operate two adjacent contacts, which is sent to the computer. There, a counter is programmed up and down so that the value set on the switch at the middle vertex is recognized. The "gable bar", as a line read across all bars, shows the set program (degrees of freedom for device operation, such as selectable warning times, supplementary doses or daily programs), sensitivity of the drug correction dose correction factors - and their adjustment in automatic program - in flat numbers and letters. Adjacent raised characters in mirror writing allow the space-saving imprint of the set program on carbon paper in the patient file. Similar to the ring arrangement in Euro Pat. Appl. Publ. No 02 21 005 ( Fig. 57) it is desirable to query actual values by means of the keys for programming the setpoints by actuating the sensor contact or by pressing a key or slight lateral contact shift. Lateral extensions of the slide bars can restrict the degree of freedom of mutual displacement.

Figs. 30 shows in the scale of nearly 1: 2 a different solution to the panel with simultaneous views. A slide ( 242 ) with a position-marking transverse marking bar is moved over a vertical row of individual contacts. Carbon markings of the marking strips can follow on pre-printed circuit cards. The possibility of variation of the facility is high: the number of work wheels can be reduced to who, since several functions can be driven via the same wheel; the clamping device can be omitted especially for devices for diagnostic use alone. Photometer and puncture device can be connected spatially separately via cable or wirelessly. A device without an injection device is useful.

Fig. 31 shows a device especially for diagnostic use with a reflex photometer without automatic stylus change in longitudinal section on a scale of 2: 1. Below (slightly shifted to the left) a partial cross-section through the lower grid for the puncture device again given, a partial view on the right on the push button grid for the upward movement of the outer pot for cleaning the measuring zone. In the wall of the outer pot ( 245 ) there are two spring-loaded snap fasteners ( 246 ) with lower and upper locking positions (on the right side in a partial view from the side). Inside the outer pot, the perforated bottom shell ( 247 ) is slidably arranged, which surrounds the suction bell. Around the latter, the bellows ( 248 ) and the strong compression spring ( 249 ) extend up to the outer pot lid. The floating cylinder ( 250 ) is vertically displaceable in the suction cup roof. By means of the compression springs ( 251 ), the latter can be lowered with the action of the pins ( 252 ) from the outer pot lid. In the center of the floating cylinder there is the receiving hole for the puncture pen (not shown). Above that, the end claw ( 215 ) of the guide tube can be seen with its edge ( 253 ) for locking in the lower grid ( 255 ). The latter can be seen in cross section as a partial view. From the release sleeve ( 256 ) inside the suction bell go in opposite bores of the suction bell roof two pins up with lateral rectified notches ( 257 ) in which the cross slide ( 258 ) is located with a central passage for the edge of the guide tube, the edge of which three points of this cross slide rests. The compression spring ( 258 ) lies at the bottom of the edge of the guide tube, at the top it is supported against spreading levers ( 260 ), the hinges of which lie in the sleeve ( 275 ) above the sliding tube. The guide tube continues upward in a push rod, which is covered by the outgoing from the suction cup roof guide cylinder ( 261 ). The stroke of the sliding cylinder is limited by the ge spring-loaded rod ( 262 ). The two sticks ( 263 ) from the outer pot cover act on the pins of the release sleeve ( 256 ) when the latter is lowered, which is pressed downwards before the edge of the guide tube passes the cross slide.

For use, the outer pot is pressed against this on a solid base so far that under tension all the compression springs the floating cylinder is lowered until it locks into the lower grid. If the device is now rotated by 180 degrees, the compression springs ( 251 ) cause the lower end of the floating cylinder to protrude through the suction bell. A puncture stylus (for example according to FIG. 5 or a combination between FIGS. 4 and 5) can now be pulled out of the receptacle provided for this purpose and a new one inserted. The lowering of the outer pot also had the consequence that the compression spring ( 249 ) was tensioned because the edge of the guide tube is held by the cross slide ( 258 ); After the two spreading levers ( 260 ) have been spread as far as possible, the compression spring ( 249 ) cannot deflect upwards either (cf. 330, Fig. 37, 38 Euro Pat. App. Publ. No. 02 21 005). If the suction cup is pressed against the skin and the button grid ( 246 ) is released, the outer pot moves upwards under the action of the strong pressure spring ( 249 ). Suction is created in the bellows ( 248 ), which lifts the skin in the suction cup and thus the release sleeve ( 256 ). The notches ( 257 ) raised with the pins allow the cross slide to move to the left so that the edge of the guide tube can pass over, which causes the lancet to lower into the skin. If the pushbutton raster is pressed again in the upper locking position after the blood exposure time in the stylus (and after the device has been lifted off the skin), the cross plate of the rod of the guide tube is carried along by the lower constriction of the guide cylinder ( 264 ) and raised, what to wipe the measuring zone from the wiping pad in the stylus floating cylinder.

Fig. 32 shows in longitudinal section a Punktionsein direction in which suction at most after the puncture is applied. The cutting movement of the lancet is also demonstrated in detail on the left in longitudinal section. On the far left, another preferred variant for the stylus tipping is shown in longitudinal section. Between the lower and upper edge ring of the outer cylinder ( 265 ) with its lower edge there is a gripping outer pot ( 245 ). Two tilting grids ( 266 ) are held in between in an upper and a lower ring notch, the lower ( 267 ) being wider. The bellows ( 248 ) is attached to the top of the outer pot lid and to the bottom of the fixed piston ( 269 ) and reinforced on the inside by the strong compression spring ( 249 ). The guide pin, which is displaceable centrally in the fixed piston, has a flexible portion ( 268 ) and is connected at the top by a band to the outer pot lid. The light cables ( 231 ) running down next to the guide pin run in loops at the top. The fixed piston ( 269 ) continues at the bottom into a central guide cap ( 270 ), within which the receiving sleeve ( 271 ) for the puncture stylus can be displaced in height and tilted sideways in one plane. The lancet shaft shows a right-angled bend with a hole ( 273 ) through which the resilient end olive ( 273 ) of the guide pin can pass. To the suction cup edge extends, interrupted by the opening of the receiving sleeve for the puncture stylus, the Zugfe derband ( 274 ).

After use, the "suction bell" is pressed against the skin after the stylus has been inserted. The tension spring band is slightly raised due to the jammed skin. When the strong compression spring ( 249 ) is tightened, the bellows is reduced in size if air leaks through the flap valve ( 275 ). The outer pot lid finally hits the guide tube and lowers the end olive through the lancet shaft and the lancet into the skin. Within the "overstroke" of the annular furrow ( 267 ), the lateral shaft deflection takes place through the flexible part ( 268 ) emerging from its piston guide, as can be seen from the detail illustration since. The suction that arises during the expansion of the bellows (if one is used at all) becomes effective via the central guide hole in the piston above the puncture pen and promotes blood leakage. The stylus detail of Fig. 32 left with the cross section below shows a stylus body which has opposite grooves ( 278 ) with which it can be inserted into the fork ( 277 ); their bent ends advise in the deeper pits ( 279 ), which form the hinge axis. The fork sprung slightly upwards over the springs ( 281 ) in the suction cup roof (or support frame) is held together by the telescopic support ( 280 ), which includes the cannula in the semicircular arch. It occurs when the stylus is lowered by pressure from the side of the guide tube due to the type of fork guide in the suction cup roof, the fork moving away from the grooves. now the stylus can be tipped sideways. The bevel ( 282 ) on the lower surface of the stylus body prevents the lancet tip from being pulled out of the skin when the handle is inclined.

The tension spring band ( 274 ) can also be replaced by an elastic septum and the suction can be centered in the stylus. Also for diagnostic use, a capillary can lead in a groove of the lancet shaft from the measuring zone in the direction of the tip of the lancet in order to drain blood directly from the cut area under the skin.

Active and passive electrical sensors (Euro Pat. Note published no. 02 21 005) can also be inserted into the stylus body for metabolic measurement; the measuring zone can also be cleared of blood by drafts (Euro Pat. Publ. No. 03 01 165 ( Fig. 7); the device - or parts of it - can be removed using tapes or adhesive devices (02 21 005, Fig. 1, Fig be. 103) attached to the body. in use of the lancet this is after passing the sharp tip region usually blunt narrow sides in the actual Hautschich th, so that it debewegung at a lateral tilting or tailoring is no skin-sectional widening. the cutting motion of a lancet or needle tip can of course also be accomplished by the fact that a spindle guide with a worm thread segment on the guide tube engages in the last section of its lowering and causes rotation. The depth of the recess and the extent of the cutting movement can also after the con The density of the vessels can be modified using light measurement ner injection device - which can also be operated via a torsion spring - be permitted.

In the following claims, the components mentioned should also stand for similar ones: guide tube also applies synonymously to guide pin, lancet for cannula, membrane also for cover or wall, sleeve occasionally for fork ( Fig. 32, 275 ), receiving cylinder for pressure vessel, film strip for thread, bellows for roller diaphragm or cylinder-piston pump, suction bell for the frame lying on the skin around the puncture stylus, measuring zone for the indicator layer, etc. It should be shown the variety of possible combinations without impairing the spirit of the invention should: their protection should also extend to combinations.

Claims (65)

1. A facility for metabolism control especially with diabetes, consisting of a puncture device, which connected with a measuring device - if possible after optical exclusion of an unsuitable skin area - with a gradual lowering movement of the Guide tube for a stylus and an in this stored lancet, its deflection movement in the tip area for the necessary vessel opening caused by a special device with the pivot point for the Deflection movement, after which blood enters the measuring zone inside the stylus enclosing the lancet guided and after the necessary exposure time the metabolism measurement is carried out there, when expanding to an injection device by means of at least one dosing pump with at least one liquid container preferably with at least one device for skin contact of the facility for the time required to complete injection, in addition to the switching devices, in order to largely function automatically do.   2. Device according to claim 1, that one generated by means of at least one pump Vacuum to lift the skin within one Suction cup is used and a clamping device is present to raise a dome inside the top of the skin by pressing on it Outskirts against the inner edge of the suction cup maintain. 3. Device according to claim 1, wherein at least one valve device is present is to by several pumping movements, which can also be carried out by more than one pump can, generated negative air pressure during a single use in the suction cup effective to be let. 4. Device according to claim 1, wherein there is a manual transmission to the Tensioning the springs for more than one pump successively by one and the same electric motor to effect.   5. Device according to claim 1 and 4, wherein the power transmission from the electric motor via a Spindle with lock nut and a mechanism mus exists, the latter to release the Pump movement under the action of the tension spring open after the spring action on the pump was blocked by a raster mechanism. 6. Device according to claim 1 and 2, wherein the mechanism for skin tightening in Inside the suction cup from at least one body exists after lifting the skin in the suction Bell against the skin by means of negative air pressure is lowered and thereby pressure on the outside edge, so that this on the inner edge of the Suction cup is held as long as this Pressure is exerted while lowering. 7. Device according to claim 1 and 6, in which that body consists of several radially arranged Lever exists, whose axis of rotation over the edge area of the suction bell within the same is ordered that the pressure against the Skin down also has an external effect de component receives. 8. Device according to claim 1 and 7, wherein the lever elements are plate-like widenings have conditions that sometimes put pressure on the skin can exercise surface. 9. Device according to claim 1 and 6, in which that body consists of a ring body.   10. Device according to claim 1 and 2, wherein at least one inside the suction cup Membrane is arranged, which under connection temporarily raised with a pump, for air introduction into a space enclosed by her with the intermediation of a valve device against the skin that has penetrated into the suction cup is lowered to put pressure on it also using at least one additional one Body. 11. The device according to claim 1 and 10, in which the membrane encloses a kind of ring cushion. 12. Device according to claim 1 and 10, wherein at least two concentrically arranged Hoses over a valve device with a Pump device can be connected, little at least one of them but not at the same time as the other same internal pressure. 13. Device according to claim 1, wherein at least one manual transmission for the There is movement of the puncture stylus, wel ches is driven by an electric motor, the driving force not only to drive on drive wheels for different functions but also for shifting at least one switching step zels is used, with means available this shift pinion after a defined shift distance to move so that it successively with the ver different drive wheels are in mesh. 14. Device according to claim 1 and 13, wherein the means for shifting the switching step zels is a transport spindle whose drive at the same time the shift pinion shifts and on drives.   15. Device according to claim 1 and 14, the shift pinion consists of two gears, which are mutually suspended from an axle seat ver in a center position rotatable about the axis can be pushed. 16. Device according to claim 1 and 13, being on the shift pinion and on disk segments of larger diameter discs the gears partially flanking, if with the same ach seat, also wedge-shaped on the side of the counter wheel Sliders are present, which according to predetermined tem angle of rotation by mutual repulsion Cause shift pinion axis shift. 17. Device according to claim 1 and 13, whereby the axis spindle moves without further displacement can rotate around a thread-free axis distance of them under pressure, which preferably is exercised by a spring, according to Drehrich reversal in the thread guide brought. 18. Device according to claim 1 and 13, being between a gear with free rotation around its axis and one with the axis itself in Engaging or guiding disc there is a stop on the one hand, on wel Chen a kind of stop pin on the other hand after a defined turning sector for axis attack comes, also a springy overhaul the stop when stopping the axis or of the gear can be provided. 19. Device according to claim 1, in a manual transmission, the ratchet from an axle spindle on a separate spindle can change, with the spindles on mean  samer axis plane and at least one of is suspended in the axial direction. 20. Device according to claim 1, wherein there is a switching mechanism, wherein during the overhaul and rotation by a a shifting gear moved past a shifting pinion Trigger mechanism operated during a lock mechanism a sprocket rotation when overhauled in Opposite direction prevented. 21. Device according to claim 1, the spring drive for at least one pump consists of at least one spiral spring, which their power over a pull cable from a spool transmits from here. 22. Device according to claim 1 and 21, where several coil spring packages in series over a kind of gear connection, including a chain can be used are connected. 23. Device according to claim 1 and 21, being between at least two coil spring packages a gear forms the connection, which to Uncoupling a part of the power drive who pulled out the mutual tooth mesh that can. 24. Device according to claim 1, being used to lower the puncture stylus horizontal and thus perpendicular to the lowering direction tion acting slider in guide profiles of the Puncture pen engages which slider also to push away at least one protection cover can be used.   25. Device according to claim 1, with stylus movements across one across the movement direction slotted slider take place in which the eccentric pin of a disc engages which is driven by a manual transmission. 26. Device according to claim 1 and 25, being with a slider to lower the punk tion pen connected another slider is that by the slider for the puncture handle the lancet, with the other ren only the latter can be lowered. 27. Device according to claim 1, where a kind of cross spoke on one Pipe segment with abrupt cuts across a rod connected with a screw underneath Tension a compression spring between that screw and that cross of spokes can be turned so that a jerky lowering of the spoke cross and related to it Slider for the transport of the puncture pen he follows. 28. Device according to claim 1, a puncture stylus has a body, at least through its hole for the stylus a film strip is stretched, which with the cap sleeve partially surrounding the stylus body is connected so that the film strip on the bore - preferably a central bore - can be moved past. 29. Device according to claim 1 and 28, the measuring chamber through a capillary gap space is formed between two film strips.   30. Device according to claim 1 and 28, a film strip at the end of a kind Wiping pad that is intended to the past the blood-coated indicator layer leads is used, if necessary before cleaning the indicator layer pushing the carrying film strip in front of it, with or without additional foil cross rib Separation of the blood in the measuring gap from the wiping pad. 31. Device according to claim 1 and 28, a film strip on a movement fold points and is thus connected to the stylus body, that with direct or indirect attachment at the other end of the cap sleeve limited distance when lifting the same on the Hole can be pulled past. 32. Device according to claim 1 and 28, the position of at least one film strip for drilling in the stylus stylus body through a Kind of masking directed against the latter is sighted. 33. Device according to claim 1 and 28, being a film strip in the area of the indicator layer a pile of material on its edges which determines the height of the blood layer. 34. Device according to claim 1, being one on the lid cap of a puncture handle a hollow channel attached to the rock has, in which a kind of capillary for Ein injection can be inserted.   35. Device according to claim 1 and 28, at least in at least one film strip there is a hole formation which is unimpeded Permission of measuring beams or blood allowed. 36. Device according to claim 1, the lancet shaft of a puncture stylus gradually rising from its tip area, abruptly interrupted sidebars, at least one and then not necessarily with sub refraction, to prevent blood leakage from the To facilitate the puncture channel on the skin. 37. Device according to claim 1, taking a visual check of uniformity the measuring chamber filling in the area of a puncture griffels by dividing the measuring surface on several measuring points. 38. Device according to claim 1, wherein at least one metering device is used which is hollowed out from a capsule-like Cylinder with compressed gas inside and one in the axis connection with this connected second (Half) cylinder, both separated by an elastic cal membrane, which is within a limit area of the two cylinders lying centrally Dosing well can move, taking liquid run across an at least partially de bore of the dosing and fed from this through another hole or its other end can be derived, one around at least one sleeve rotating the cylinder with valve function alternately the inflow and Releases outflow into and out of the dosing well, where the membrane movement by means of light beam could be monitored.   39. Device according to claim 1, which with a device for visualization significant data is linked, primarily in Connection with charging the electrical Energy source and primarily using a Printer. 40. Device according to claim 1, laser radiation for metabolism measurement Is used. 41. Device according to claim 1, with the injection under the skin Overpressure jet through at least one nozzle he follows. 42. Device according to claim 1, wherein there is at least one valve device which is the compressed air filling from a Pump into a pressure vessel with elastic medic new storage containers allowed. 43. Device according to claim 1, wherein there is a pressure vessel in which elastic storage container with a kind of inside cannula are present, at least two which be emptied by adding an inner cannula a valve to the neighboring supply is used container open as soon as it is in stock has almost exhausted. 44. Device according to claim 1, where visual control of uniformity the skin texture in the puncture area instead has, especially by means of the optical measuring stylus.   45. Device according to claim 1, characterized, that a bottom membrane of the stylus to the bottom of the Stylus body contributes at least one measuring zone in within at least one measuring chamber, which is filled with blood after the lancet fills the bottom membrane has permeated. 46. Device according to claim 1, characterized, that a wiping pad near the bottom membrane is stored, which is on a film strip on the Lancet attached to the when lifting the same Measuring zone is passed. 47. Device according to claim 1, characterized, that the lancet shaft on its upper part Has notch in which a pin penetrate and the lateral deflection of the lancet tip can effect. 48. Device according to claim 1, characterized, that the lancet shaft on the lower part is an Notch shows for a kind of rotary axis in the stylus body per, with the upper end of the lancet shaft on the lower end of the guide tube is adapted that lowering the latter the lateral out steering of the lancet tip. 49. Device according to claim 1, characterized, that the lancet shaft itself carries the measuring zone and during its lifting on one in the stylus body attached wiping pad is passed.   50. Device according to claim 1, that the stylus body has a slot on the side, which is covered by a film before use and in which during the lateral deflection of the Lancet shaft this can dodge. 51. Device according to claim 1, characterized, that the guide tube for the stylus is flexible Part that has the lateral deflection of the Lancet shaft enables. 52. Device according to claim 1, characterized, that the end claw of the guide tube is a kind of olive has, which in an opening within the winkle penetrate the bent upper end of the lancet can to move this. 53. Device according to claim 1, characterized, that a height-adjustable receiving sleeve for the Stylus can also be tipped sideways for the side deflection movement of the lancet tip. 54. Device according to claim 1, characterized, that the receptacle for the stylus resiliently over a Device on the side with the border of the top of the skin connected is. 55. Device according to claim 1, characterized, that at least one capillary within a furrow of the lancet shaft with its free end in the Near the tip of the lancet while the other end of the capillary sealed with the cannula body connected is.   56. Device according to claim 1, characterized, that a fork-shaped supply line for liquid through Approaching their ends in funnel-like outlets Capillaries penetrate the cannula body sealingly. 57. Device according to claim 1, characterized, that the vacuum storage space before use bellows can be enlarged, one Support device whose reduction by sub pressure effect prevented. 58. Device according to claim 1, characterized, that as a metering device a step syringe Dosage for partial emptying, which is used in whose dosing room into a liquid supply opening which ver during dosing is closed. 59. Device according to claim 1, characterized, that the cap with the liquid container in a zen tral tube ends, which is the connection with the Plug-in cone of the liquid line and to the approaching a shrinking neighboring Liquid container is used. 60. Device according to claim 1, characterized, that in a manual transmission at least one screw clutch is used, which with the axis rotation their length change used for switching purposes.   61. Device according to claim 1, characterized, that shift pinion by springs on an axis in Middle position in the area of their from the circle shape different profile change in the projection on a corresponding change in the area of Axis surface is held as long as not due to lateral pinion displacement due to impact a lateral shift on drive wheels of the shift pinion. 62. Device according to claim 1, characterized, that at least one fiber optic bundle for the skin control separated from at least one light bundle of conductors for measurements in the measuring chamber area is available. 63. Device according to claim 1, characterized, that the stylus for insertion into a holding device within the puncture site surrounding frame at least two longitudinal has grooves. 64. Device according to claim 1, characterized, that the stylus body facing his skin th end has at least one bevel, in the direction of the pivotal movement of the cutting Part. 65. Device according to claim 1, characterized, that the stylus body pits for snapping has a holding device.