Claude Skills by dromlakhani

For hospitalized adults with persistent hyperglycemia defined as ≥2 point-of-care blood glucose measurements ≥180 mg/dL in 24 hours while on correctional insulin alone, the guideline suggests adding scheduled insulin therapy. Trigger phrases include "Patient on correctional insulin has BG ≥180 twice in 24h, should we add scheduled insulin?"

Consider reducing basal insulin dose by 10% to 20% at hospitalization for patients on basal heavy insulin regimens (≥0.6–1.0 units/kg/day) to prevent over‑coverage of meal‑related glucose excursions. Trigger phrases include “Patient on high basal insulin dose, should we reduce it during hospital stay?” and “Basal insulin dose ≥0.6 U/kg/day, consider reduction on admission.”

In hospitals where expertise, resources, and training are available, implement carbohydrate counting or fixed prandial insulin dosing for prandial insulin therapy. Trigger phrase: “We have the expertise and resources, which prandial dosing method should we use?”

For adult patients with type 1 diabetes or insulin-treated type 2 diabetes hospitalized for noncritical illness who require prandial insulin, suggest either carbohydrate counting or fixed prandial insulin dosing. Triggered by clinician queries such as "Patient is T1D or insulin-treated T2D, how should we dose prandial insulin?"

This skill determines whether a patient performs carbohydrate counting in the outpatient setting, including insulin-treated type 2 diabetes, and may prefer to continue this method during hospitalization. Clinical triggers include questions such as "Patient uses carb counting at home, should we allow continuation in hospital?"

This skill ensures the hospital has a policy to guide carbohydrate counting for prandial insulin dosing and confirms availability of healthcare professionals knowledgeable in diabetes management. It is triggered when clinicians ask, "Do we have a hospital policy and expertise for carbohydrate counting?" to standardize insulin dosing and improve glycemic safety.

Recommend continuation of the pre‑admission scheduled insulin regimen, adjusted for nutritional status and severity of illness, to keep glucose between 100‑180 mg/dL in hospitalized adults with insulin‑treated diabetes. Triggered by clinician questions such as “Patient was on insulin before admission, how should we adjust their regimen in hospital?” or similar.

Verify that a diabetes care and education specialist (DCES) involved in inpatient diabetes education holds Certified Diabetes Care and Education Specialist (CDE) or Board Certified-Advanced Diabetes Management (BC-ADM) credentials, or is actively working toward such certification. Triggered by questions like "Does the DCES have required credentials?" to ensure qualified education delivery.

When diabetes care and education specialist (DCES) availability is limited, availability is limited, the DCES serves as a resource to train healthcare providers (e.g., staff nurses, pharmacists, dietitians) to deliver inpatient diabetes education. Trigger phrases include "DCES scarce, how to still provide diabetes education?"

This skill outlines the core components to include in comprehensive diabetes discharge planning for hospitalized adults. It is triggered by questions such as "What should be included in diabetes discharge planning?" and ensures education on survival skills, referral for outpatient DSMES, follow-up scheduling, and medication/supply access.

Discuss cost and overall acceptability of a DPP4 inhibitor with the patient when there are plans to continue the medication after hospital discharge. Trigger phrases include: "Patient wants to continue DPP4i after discharge, should we discuss cost and access?" or "Need to address affordability of sitagliptin/linagliptin before discharge."

This skill determines whether a hospitalized adult with type 2 diabetes is eligible for DPP4i initiation based on recent HbA1c <7.5%, blood glucose <180 mg/dL, and, if insulin‑treated pre‑admission, a total daily insulin dose <0.6 units/kg/day. It is triggered by questions such as "Does this patient meet criteria for DPP4i consideration?"

Determines whether DPP4i therapy is appropriate for hospitalized adults with hyperglycemia. Excludes patients with type 1 diabetes or other insulin-dependent diabetes; triggers include “Patient has T1D, is DPP4i appropriate?” and “Should a DPP4i be started in this patient?”

For select adult patients with mild hyperglycemia and type 2 diabetes, the guideline suggests using either a DPP4 inhibitor with correction insulin or scheduled insulin therapy. Trigger phrase: "Patient has mild hyperglycemia and T2D, could we use a DPP4i?"

When inpatient diabetes education staff are limited, prioritize education for patients at high risk for readmission, admitted for diabetes-related hyperglycemia, or newly diagnosed/starting insulin. Use this skill when clinicians ask, "Which patients should receive diabetes education first given limited staff?"

Recommends implementing EHR-leveraged glycemic surveillance and management programs for hospitalized patients at risk for hypoglycemia to reduce hypoglycemic episodes. Triggered when clinicians ask, "Should I implement EHR-based glycemic surveillance for this inpatient at risk for hypoglycemia?" or "Is system-based glycemic management preferred over standard care?"

Select either neutral protamine Hagedorn (NPH)-based or basal bolus insulin regimens for glycemic management in hospitalized patients receiving enteral nutrition with diabetes-specific or nonspecific formulations. Triggered when clinicians ask, "Patient on enteral nutrition, which insulin regimen should we use?" or encounter hyperglycemia during tube feeding.

In patients already on a basal bolus insulin (BBI) regimen who develop hyperglycemia while receiving glucocorticoids, consider adding neutral protamine Hagedorn (NPH) insulin to the regimen. Trigger phrases include: "Patient is on BBI, should we add NPH for steroid coverage?" or "Glucocorticoid-associated hyperglycemia on BBI, consider NPH addition."

This skill ensures ongoing blood glucose monitoring with adjustment of insulin dosing to manage glucocorticoid-associated hyperglycemia and prevent hypoglycemia during taper or discontinuation. It is triggered when clinicians ask, "Do we need to adjust insulin doses as glucocorticoids change?"

This skill guides clinicians to apply safeguards—including frequent point-of-care glucose monitoring and insulin dose adjustments—to prevent hypoglycemia when tapering or discontinuing glucocorticoids in hospitalized patients. Use when encountering triggers such as "Glucocorticoid being tapered, how to avoid hypoglycemia?" or "Stopping steroids, need to avoid low blood sugar."

Select either NPH-based insulin regimen or basal bolus insulin regimen for glycemic management in patients receiving glucocorticoids. Triggered by clinician questions such as "Which insulin regimen should we use for steroid-induced hyperglycemia?"

Calculates NPH insulin dosing (divided doses) according to the timing, pharmacokinetics, and frequency of the specific glucocorticoid being administered. Triggered by clinician questions such as "How should we dose NPH insulin given the glucocorticoid schedule?"

Assesses whether a hospitalized insulin-treated patient is at high risk for hypoglycemia using age, BMI, insulin dose, comorbidities, and hypoglycemia history. Triggered by clinician questions such as "Should we consider CGM for this patient?" or "Is this patient high risk for hypoglycemia?"

Classifies hypoglycemia severity into Levels 1-3 using glucose thresholds and clinical assessment per Table 2 of the Endocrine Society guideline. Triggered by clinician questions such as "What is the severity of this patient's hypoglycemia?" or "How should I manage this hypoglycemic episode based on level?"

Adjusts the insulin-to-carbohydrate ratio (ICR) for hospitalized patients with diabetes when illness or treatments alter insulin requirements. Triggered by clinician statements such as "Patient's insulin needs changed due to infection, should we adjust the carb ratio?" or "Glucose-interfering medications necessitate ICR modification."

In adults with no prior diabetes hospitalized for noncritical illness and hyperglycemia >140 mg/dL, initiate correctional insulin rather than scheduled insulin to maintain glucose 100-180 mg/dL. Trigger phrase: "New hyperglycemia >140, start with correctional or scheduled insulin?"

In adults with diabetes treated with diet or noninsulin medications before admission, suggest initial therapy with correctional insulin or scheduled insulin to maintain glucose targets of 100–180 mg/dL. Trigger phrase: "Patient on diet or noninsulin meds before admission, start with correctional or scheduled insulin?"

Suggest initiation of scheduled insulin therapy for patients with confirmed admission blood glucose ≥180 mg/dL (≥10.0 mmol/L). Triggered by clinician language such as “Admission BG confirmed ≥180, should we start scheduled insulin?”

Provides inpatient diabetes education integrated into discharge planning for adults with diabetes hospitalized for noncritical illness. Triggered by the question: "Should we provide diabetes education before discharge?"

Suggests long-acting insulin analogs over human NPH insulin for basal insulin therapy in adult and pediatric outpatients at high risk for hypoglycemia. Trigger phrases include “Should I use long-acting analogs or NPH for basal insulin in this high‑risk patient?” or “Is long‑acting analog insulin preferred for this patient?”.

In adult patients with noninsulin-treated type 2 diabetes hospitalized for noncritical illness who require prandial insulin therapy, the guideline suggests avoiding carbohydrate counting for prandial insulin dosing. Consider this approach when clinicians ask, "Patient is noninsulin-treated T2D needing prandial insulin, should we use carb counting?"

Do not administer carbohydrate-containing oral fluids preoperatively to adult patients with diabetes undergoing planned elective surgical procedures. Triggered when clinicians ask, "Should we give this patient a carbohydrate drink before surgery?"

Recommends non-reconstituted glucagon preparations over reconstituted ones for treating outpatients with severe hypoglycemia. Triggered by questions such as "Should I use non-reconstituted or reconstituted glucagon for this patient with severe hypoglycemia?" or "Is ready-to-use glucagon preferred for emergency treatment?"

Assesses outpatient diabetes patients for high hypoglycemia risk using Table 1 criteria including medications, organ function, age, and history. Triggered by questions such as "Is this outpatient diabetic patient at high risk for hypoglycemia?" or "Should I consider preventive hypoglycemia interventions?"

If achieving preoperative HbA1c <8% is not feasible, target preoperative blood glucose concentrations of 100 to 180 mg/dL instead. Trigger phrase: "Cannot meet HbA1c goal, what glucose target should we use preoperatively?"

The clinician verifies that blood glucose concentrations are within the targeted range of 100 to 180 mg/dL during the 1 to 4 hours preceding surgery. A common trigger is the question, "Is the patient's BG in target range shortly before surgery?"

Consider factors that may affect hemoglobin A1c when interpreting preoperative levels for adults with diabetes undergoing elective surgery. Triggered by questions such as "Are there conditions that might make HbA1c unreliable for this patient?" when anemia, hemoglobinopathies, chronic renal failure, alcoholism, drugs, or large blood glucose variations are present.

For adult patients with diabetes undergoing elective surgical procedures, aim for preoperative hemoglobin A1c below 8% and blood glucose concentrations between 100 to 180 mg/dL. Triggered by questions such as "What preoperative glycemic targets should we set for this surgical patient?"

This skill suggests using rapid-acting insulin analogs instead of regular human insulin for prandial bolus dosing in basal-bolus therapy for patients at high risk of hypoglycemia. It is triggered by clinician questions such as "Should I use rapid-acting analogs or regular insulin for prandial therapy in this high-risk patient?" or "Is rapid-acting analog insulin preferred for this patient?"

In most adult patients with hyperglycemia (with or without known type 2 diabetes) hospitalized for noncritical illness, scheduled insulin therapy is preferred over noninsulin agents for glycemic management. Clinicians should consider this when they ask, "Patient has hyperglycemia, should we start insulin or try a noninsulin drug?"

Recommends structured diabetes education with follow-up over unstructured advice for insulin-treated type 1 or type 2 diabetes outpatients at high risk for hypoglycemia. Trigger phrases include "Should I provide structured diabetes education or unstructured advice for this insulin-treated patient at high risk for hypoglycemia?" and "Is formal education indicated for this patient?"

Adjust basal insulin dose day-to-day in a hospitalised patient being managed for glucocorticoid-induced hyperglycemia (GCIH) using the Lakhani protocol. Trigger when a clinician asks "how to titrate basal insulin in steroid patient", "adjust glargine for GCIH", "fasting glucose high on steroid protocol what to do", "increase or decrease basal insulin GCIH", or any day-to-day basal insulin adjustment question in a patient on glucocorticoids.

Select the correct type and dose of "correctional insulin" to co-administer with a glucocorticoid in a hospitalised patient with glucocorticoid-induced hyperglycemia (GCIH). Trigger when a clinician asks "what insulin to give with steroids", "which insulin with prednisolone/dexamethasone/hydrocortisone/methylprednisolone", "how to dose NPH with steroids", "correctional insulin for GCIH", or any question about matching insulin to a glucocorticoid in an inpatient setting.

Classify a hospitalised patient on glucocorticoids as established diabetic (Group 1) or new glucocorticoid-induced hyperglycemia without prior DM (Group 2), then determine whether background basal-bolus insulin is needed and at what starting dose based on HbA1c. Trigger when a clinician asks "does this steroid patient need background insulin", "starting insulin dose for steroid-induced diabetes", "how to manage GCIH in a known diabetic vs new hyperglycemia", "background insulin for prednisolo...

Determine the supplemental premeal short-acting insulin dose for a hospitalised patient on the GCIH protocol, based on premeal capillary blood glucose. Use two separate scales: standard (experimental/Lakhani protocol) and insulin-resistant (control/Endocrine Society). Trigger when a clinician asks "supplemental insulin dose GCIH", "correction dose for steroid patient before meals", "how much lispro to give before meal in GCIH", "sliding scale for steroid hyperglycemia", or needs premeal insul...

This skill recommends against using growth hormone replacement solely to lower LDL‑C to reduce cardiovascular risk in adult patients with growth hormone deficiency. Trigger phrases include: "Considering GH replacement for lipid lowering in GHD", "Assessing inappropriate use of GH therapy", "Evaluating GH treatment indications in growth hormone deficiency".

This skill advises against routine insulin infusion in patients without diabetes who have triglyceride-induced pancreatitis. Trigger phrases include "Patient has triglyceride-induced pancreatitis without diabetes" and "Considering insulin infusion for pancreatitis management".

The guideline recommends against using lipid-lowering therapies to treat hyperandrogenism or infertility in women with polycystic ovary syndrome. Consider this recommendation when encountering a PCOS patient with infertility concerns, when considering lipid drugs for androgen excess, or when assessing inappropriate lipid therapy for reproductive symptoms.

This skill recommends against using acute plasmapheresis as first-line therapy to lower triglycerides in triglyceride-induced pancreatitis. Trigger phrases include "Patient presents with triglyceride-induced pancreatitis" and "Considering plasmapheresis for acute pancreatitis management".

Suggests against treating hyperlipidemia until the patient becomes euthyroid in order to more accurately assess the lipid profile in patients with overt hypothyroidism. Triggers include: "Patient with overt hypothyroidism and hyperlipidemia", "Considering lipid-lowering therapy in untreated hypothyroidism", "Assessing need to treat thyroid first before lipids".