New digital tool to facilitate subcutaneous insulin therapy orders: an inpatient insulin dose calculator

Diabetology & Metabolic Syndrome

Márcia Nery³  Ana Claudia Latronico³  Simão Augusto Lottenberg³  Priscilla Cukier¹  Sharon Nina Admoni³  Alexandre Barbosa Câmara de Souza³  Marcos Tadashi Kakitani Toyoshima² 

[1] 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 CEP: 01255-000, SP, Brazil;Centro de Medicina Preventiva, Hospital Israelita Albert Einstein, Av. Brasil, 953, São Paulo CEP: 01431-000, SP, Brazil;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 CEP: 05403-900, SP, Brazil

关键词: Insulin;    Hospitalization;    Hyperglycemia;    Diabetes mellitus;   

Others  :  1235149
DOI  :  10.1186/s13098-015-0111-7

 received in 2015-08-26, accepted in 2015-12-08,  发布年份 2015

【 摘 要 】

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.

Conclusion

We developed software that can be a useful tool for all public hospitals, where generally human insulin is the only available.

【 授权许可】

   
2015 Toyoshima et al.

【 图 表 】

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