Claude Skills by dromlakhani

Reassesses annually the patient’s ability to use CGM trend information to adjust insulin doses. Triggered by yearly CGM skills check or annual review of trend-based dosing competence.

Evaluates the patient’s plan for using injected insulin in case of pump failure, including knowledge of basal-bolus dosing. Triggered by phrases such as 'Discuss sick-day plan for pump failure' or 'Review transition to injections if pump stops'.

Evaluates basal insulin rates through basal rate testing across different time periods and adjusts as indicated. Triggered by clinician orders to 'Perform basal rate test to verify pump settings' or 'Check basal rates during periodic pump review'.

This skill guides clinicians to assess bolus calculator settings when reviewing pump settings or verifying carb ratio and sensitivity factor during clinic visits. It evaluates insulin-to-carbohydrate ratio, insulin sensitivity factor, glucose targets, and active insulin time for embedded bolus calculators in CSII.

Assesses that CGM low- and high-glucose alarm thresholds are individualized to optimize patient benefit and minimize alarm fatigue. Triggered by clinician prompts to 'Review low-glucose alarm thresholds' or 'Ensure alarms are individualized and not excessive'.

Assesses patient's ability to identify the receiver, sensor, and transmitter components of a real-time CGM system. Triggered by clinician requests to review CGM parts or verify patient can name sensor, transmitter, and receiver.

Assesses patient’s understanding of how CGM data (trends, rates of change) differ from discrete SMBG fingerstick values. Triggered when clinicians hear requests to explain lag and trend arrows on CGM or teach the difference between CGM glucose and fingerstick glucose.

Evaluates patient-specific factors such as lifestyle, motivation, and barriers that may affect successful CGM use. Triggered when clinicians discuss patient’s readiness for CGM or identify obstacles to consistent sensor wear.

Evaluates patient’s selection of sensor insertion sites and site care to prevent irritation or infection. Triggers include: 'Review CGM site rotation', 'Check sensor site hygiene and adhesion'.

Assesses whether a patient performs self-monitoring blood glucose (SMBG) fingerstick calibrations as required for their real-time CGM system. Triggers include: 'Verify patient performs fingerstick calibrations', 'Ensure calibration schedule is followed'.

Evaluates patient’s ability to use CGM trend information (arrows, rate of change) to make insulin dose adjustments. Triggers include reviewing patient’s response to CGM trends and checking if patient adjusts bolus based on glucose direction.

Confirms patient understands that continuous glucose monitoring complements but does not replace self-monitoring of blood glucose. Triggers include: 'Clarify CGM role alongside fingersticks', 'Ensure patient knows CGM does not eliminate need for SMBG'.

Assesses a patient’s ability to operate an insulin pump and make setting changes, evaluating dexterity, vision, mental health, and cognition for independent or assisted use. Triggered by phrases such as 'Check patient can manipulate pump controls' and 'Evaluate dexterity and vision for pump use'.

Assesses patient’s knowledge of diabetic ketoacidosis prevention, recognition, and treatment. Triggered by clinician prompts such as 'Review sick-day rules and DKA signs' or 'Ensure patient knows when to seek help for hyperglycemia'.

Assesses whether the patient has emergency supplies such as glucagon, ketone strips, and backup insulin readily available. Triggered when clinicians verify the patient carries a glucagon kit or ensure backup insulin and supplies are accessible.

Assesses the patient’s ability to prevent, detect, and treat hypoglycemia, including recognition of symptoms, appropriate carbohydrate treatment, and use of emergency glucagon. Triggered when clinicians review the hypoglycemia action plan or check whether the patient recognizes low symptoms and treatment steps.

This skill evaluates infusion site health and rotates sites appropriately to prevent lipohypertrophy or infection. It is triggered when clinicians inspect pump sites for irritation or lumps or review site rotation practice at visit.

Assesses the patient’s ability to troubleshoot insulin pump malfunctions such as occlusion, battery failure, or error messages. Trigger phrases include “Review pump alarm responses” and “Ensure patient knows steps for pump error”.

Suggests encouraging patients to use appropriately adjusted embedded bolus calculators in CSII and to provide education regarding their use and limitations. Triggers include: 'Patient starting pump, discuss bolus calculator', 'Review bolus calculator education at pump initiation'.

Recommends real-time CGM with confirmatory bedside POC-BG monitoring for insulin dosing adjustments rather than POC-BG testing alone in adults with insulin-treated diabetes at high risk of hypoglycemia. Consider this approach for patients aged ≥65 years, BMI ≤27 kg/m², total daily insulin dose ≥0.6 units/kg, CKD stage ≥3, or recent hypoglycemia.

Recommends using continuous glucose monitoring instead of fingerstick self-monitoring for type 1 diabetes patients on multiple daily injections to reduce hypoglycemia risk. Use when a clinician evaluates glucose monitoring options for T1D on MDIs or manages hypoglycemia-prone T1D patients.

Suggests that adults with type 1 or type 2 diabetes using continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) receive education, training, and ongoing support to achieve and maintain individualized glycemic goals. Trigger phrases include: 'Patient on pump plus CGM, arrange education' and 'Ensure CSII+CGM users get training and support'.

Suggests that clinicians continue CSII in hospitalized patients with type 1 or type 2 diabetes when the institution has clear protocols for evaluating pump candidates and appropriate monitoring and safety procedures. Trigger phrases include: 'Admitted patient on pump, check hospital pump policy' and 'Inpatient with diabetes using pump, verify institutional guidelines'.

Recommends continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) for adults with type 1 diabetes who have achieved their A1C goal but experience severe hypoglycemia or high glucose variability, provided the patient and caregivers are willing and able to use the device. Consider CSII when clinicians hear 'A1C is at goal but patient has severe lows or glucose swings' or think 'pump for hypoglycemia-prone controlled T1DM'.

Recommends CSII over analog-based basal-bolus MDI for adults with T1DM who have not achieved their A1C goal, provided patient and caregivers are willing and able to use the device. Trigger phrases include 'Patient’s A1C is above target despite MDI' and 'Consider pump for uncontrolled T1DM'.

Performs a structured pre‑prescription evaluation of mental/psychological status, prior diabetes self‑care adherence, willingness/interest in CSII, and availability for follow‑up visits. Triggers include: 'Evaluating pump candidacy', 'Pre‑pump checklist: psych, adherence, motivation, follow-up'.

Suggests continuous subcutaneous insulin infusion (CSII) for adults with type 1 diabetes mellitus who desire increased insulin delivery flexibility or improved treatment satisfaction and are capable of using the device. Clinical triggers include statements such as 'Patient wants more lifestyle flexibility with insulin' or 'Consider pump for improved satisfaction in T1DM'.

Suggests CSII with good adherence to monitoring and dosing for adults with type 2 diabetes mellitus who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. Trigger phrases include 'T2DM on multiple injectables still uncontrolled' and 'Consider pump for insulin-requiring T2DM failing other therapies'.

This skill reassesses the insulin plan when discontinuing continuous subcutaneous insulin infusion (CSII) and transitioning to multiple daily injections (MDI). It is triggered by phrases such as 'Review planned basal-bolus regimen after pump' and 'Confirm MDI dose calculations and schedule'.

This skill guides clinicians to reassess glucose monitoring frequency when discontinuing continuous subcutaneous insulin infusion (CSII) or transitioning to multiple daily injections (MDI). It is triggered by phrases such as 'Plan for glucose monitoring after pump stop' or 'Determine SMBG/CGM frequency post-pump' to ensure individualized glycemic goals are met.

Recommends continuing a patient’s personal continuous glucose monitor (CGM) in the hospital with or without algorithm-driven insulin pump (ADIP) therapy rather than discontinuing it for individuals already using CGM outpatient. Use when deciding whether to maintain personal CGM during admission or when a patient requests to keep their device, particularly in those at high risk for hypoglycemia.

Suggests initiating inpatient continuous glucose monitoring (CGM) for select hospitalized patients at high risk for hypoglycemia, combined with periodic point-of-care glucose checks for accuracy. Triggers include planning glucose monitoring for inpatients with prior severe hypoglycemia, renal or hepatic dysfunction, or age 65 years or older.

Recommends continuing insulin pump therapy in hospitals with pump expertise; otherwise transitioning to scheduled subcutaneous basal bolus insulin if anticipated length of stay exceeds 1–2 days before pump discontinuation. Consider this when anticipating a hospital stay >2 days, lacking pump expertise, or needing to conserve supplies.

The skill suggests using real-time continuous glucose monitoring (CGM) combined with algorithm-driven insulin pumps (ADIPs) rather than multiple daily injections (MDIs) with self-monitoring of blood glucose (SMBG) three or more times daily for adults and children with type 1 diabetes (T1D) to lower hypoglycemia incidence. Clinical triggers include discussions about insulin pump therapy, CGM use, or reducing hypoglycemia in T1D patients on intensive insulin regimens.

Recommends real-time continuous glucose monitoring (RT-CGM) for adult patients with type 1 diabetes mellitus (T1DM) whose hemoglobin A1C is above individualized target. Consider when clinician notes 'T1DM A1C above goal, consider RT-CGM' or 'Patient willing to wear CGM daily, A1C elevated'.

Recommends RT-CGM devices for adult patients with well-controlled type 1 diabetes who are willing and able to use the devices on a nearly daily basis. Trigger phrases include 'Controlled T1DM patient interested in CGM' and 'Consider RT-CGM for glycemic stability in well-controlled T1DM'.

Suggests short-term, intermittent real-time CGM use in adult patients with type 2 diabetes not on prandial insulin who have A1C ≥7% and are willing and able to use the device. Triggered by phrases such as “T2DM basal-only, A1C ≥7%, consider intermittent CGM” or “Short-term CGM for non-prandial T2DM with elevated A1C”.

Suggests real-time CGM over no CGM for outpatients with type 2 diabetes who use insulin and/or sulfonylureas and are at high risk for hypoglycemia to detect and prevent low glucose events. Consider when initiating CGM in T2D patients on insulin/SU with a history of severe hypoglycemia or impaired awareness of hypoglycemia (IAH).

This skill checks for contraindications or sources of inaccuracy that may affect continuous glucose monitoring (CGM) reliability in hospitalized adults. It is triggered when clinicians ask, “Are there factors that could make CGM unreliable?” or when assessing for skin infection, hypoperfusion, hypovolemia, vasoactive/pressor therapy, or medications such as acetaminophen >4 g/day, dopamine, vitamin C, or hydroxyurea.

If CGM is not available, continue monitoring blood glucose with point-of-care testing as an alternative option. Trigger phrases include: "CGM is not available, what should we use for glucose monitoring?"

Recommends real-time CGM with confirmatory POC-BG for insulin dosing adjustments in insulin-treated hospitalized adults at high risk of hypoglycemia when resources and training are available. Triggers include: "Should we use CGM for insulin adjustments?" or "Is CGM appropriate for this patient?"

This skill suggests using real-time continuous glucose monitoring (CGM) rather than no CGM for outpatients with type 2 diabetes (T2D) who take insulin and/or sulfonylureas and are at high risk for hypoglycemia. It is triggered by clinician questions such as "Should I use CGM for this T2D patient on insulin or sulfonylureas with high hypoglycemia risk?" or "Is CGM indicated for this patient?"

Recommends CGM over SMBG for type 1 diabetes patients on multiple daily injections to reduce hypoglycemia risk. Triggered by clinician questions such as "Should I use CGM or SMBG for this T1D patient on MDI?" or "Is CGM preferred for glucose monitoring in this patient?"

This skill suggests continuing personal CGM with or without ADIP rather than discontinuation for inpatients already using it who are at high risk for hypoglycemia. Trigger phrases include "Should I continue or discontinue personal CGM for this inpatient who is already using it?" and "Is it appropriate to maintain personal CGM during hospitalization?"

Suggests initiating inpatient CGM for select diabetic patients at high risk for hypoglycemia based on Table 3 criteria. Triggers include "Should I initiate CGM for this hospitalized diabetic patient at high risk for hypoglycemia?" or "Is inpatient CGM warranted for this patient?"

This skill determines whether inpatient diabetic patients meet high-risk criteria for CGM initiation using Table 3 factors such as age ≥65 years, BMI ≤27 kg/m², type 1 diabetes, insulin regimen, and specific clinical conditions. It is triggered by clinician questions like "Should I assess this inpatient for CGM initiation based on hypoglycemia risk?" or "Is this patient a candidate for inpatient CGM?"

Considers adapting the basal insulin rate at hospital admission for patients using insulin pump therapy. Triggered by clinician questions such as "Should we adjust the basal rate upon admission for pump therapy?" or when evaluating pump continuation versus transition to scheduled subcutaneous insulin.

Assess whether a hospitalized adult with diabetes on insulin pump therapy remains a candidate for continued inpatient pump use. Consider triggers such as the clinician asking "Is this patient appropriate to continue insulin pump in hospital?" and evaluate for impaired consciousness, inability to adjust pump settings, critical illness, DKA, or hyperosmolar hyperglycemic state.

This skill confirms whether a hospital has the necessary policies and expertise to support inpatient insulin pump therapy, including informed consent, standardized order sets, and device management guidance for imaging and surgical procedures. Triggered by questions such as "Are hospital policies and expertise in place for insulin pump use?" to ensure safe continuation of pump therapy in noncritical illness.

This skill determines whether a patient using a hybrid closed-loop insulin pump can continue this therapy upon hospital admission. It is triggered by questions such as "Can hybrid closed-loop pump be continued given hospital constraints?"