title: New digital tool to facilitate subcutaneous insulin therapy orders: an inpatient insulin dose calculator.
abstract: BACKGROUND
  Inpatient hyperglycemia is associated with adverse outcomes in hospitalized patients, with or without known diabetes. The adherence to American College of Endocrinology and American Diabetes Association guidelines recommendations for inpatient glycemic control is still poor, probably because of their complexity and fear of hypoglycemia.
  
  
  OBJECTIVE
  To create software system that can assist health care providers and hospitalists to manage the insulin therapy orders and turn them into a less complicated issue.
  
  
  METHODS
  A software system was idealized and developed, according to recommendations of major consensus and medical literature.
  
  
  RESULTS
  HTML software was developed to be readily accessed from a workstation, tablet or smartphone. Standard initial daily total dose of insulin was 0.4 units/kg and could be modified by distinct factors, such as chronological age, renal and liver function, and high dose corticosteroids use. Insulin therapy consisted of basal, prandial and correction insulin according to nutritional support, glycemic control and outpatient treatment for diabetes. Human insulin or insulin analogues could be options for insulin therapy. Sensitivity factor was based on 1800 Rule for rapid-acting insulin and the 1500 Rule for short-acting insulin. Insulin-naïve patients with initial BG level less than 250 mg/dL were considered to have an initial step-wise approach with prandial and correction insulin. The calculator system has allowed insulin dose readjustments periodically, according to daily average blood glucose measurements.
  
  
  CONCLUSIONS
  We developed software that can be a useful tool for all public hospitals, where generally human insulin is the only available.
authors.affiliation: Serviço de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-7º andar, Sala 7037, São Paulo, SP CEP: 05403-900 Brazil ; Unidade de Oncologia Endócrina do Instituto do Câncer do Estado de São Paulo-Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Arnaldo, 251-5º andar, São Paulo, SP CEP: 01255-000 Brazil ; Centro de Medicina Preventiva, Hospital Israelita Albert Einstein, Av. Brasil, 953, São Paulo, SP CEP: 01431-000 Brazil.
authors.forename: Marcos Tadashi Kakitani
authors.identifier: 0000-0002-9146-4606
authors.initials: MT
authors.lastname: Toyoshima
authors.affiliation: Serviço de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-7º andar, Sala 7037, São Paulo, SP CEP: 05403-900 Brazil.
authors.forename: Alexandre Barbosa Câmara
authors.initials: AB
authors.lastname: de Souza
authors.affiliation: Serviço de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-7º andar, Sala 7037, São Paulo, SP CEP: 05403-900 Brazil.
authors.forename: Sharon Nina
authors.initials: SN
authors.lastname: Admoni
authors.affiliation: Serviço de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-7º andar, Sala 7037, São Paulo, SP CEP: 05403-900 Brazil ; Unidade de Oncologia Endócrina do Instituto do Câncer do Estado de São Paulo-Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Arnaldo, 251-5º andar, São Paulo, SP CEP: 01255-000 Brazil.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Cukier
authors.affiliation: Serviço de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-7º andar, Sala 7037, São Paulo, SP CEP: 05403-900 Brazil.
authors.forename: Simão Augusto
authors.initials: SA
authors.lastname: Lottenberg
authors.affiliation: Serviço de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-7º andar, Sala 7037, São Paulo, SP CEP: 05403-900 Brazil.
authors.forename: Ana Claudia
authors.initials: AC
authors.lastname: Latronico
authors.affiliation: Serviço de Endocrinologia e Metabologia do Hospital das Clínicas da Faculdade de Medicina da, Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 255-7º andar, Sala 7037, São Paulo, SP CEP: 05403-900 Brazil.
authors.forename: Márcia
authors.initials: M
authors.lastname: Nery
keywords: Diabetes mellitus; Hospitalization; Hyperglycemia; Insulin