# Endo Annual Reassess Cgm Trend Insulin Adjust

> 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.

- Skill: `dromlakhani/endo-annual-reassess-cgm-trend-insulin-adjust` (Agent Skill)
- Install (CLI): `npx skillmds@latest add dromlakhani/endo-annual-reassess-cgm-trend-insulin-adjust`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/endo-annual-reassess-cgm-trend-insulin-adjust/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: dromlakhani (https://skillmd.com/u/dromlakhani)
- Updated: 2026-09-08
- Page: https://skillmd.com/skills/dromlakhani/endo-annual-reassess-cgm-trend-insulin-adjust

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# Annually reassess ability to make insulin adjustment based on CGM trend information

## STEP 1 — Gather Information
Collect patient logs of trend-based insulin adjustments (e.g., basal/bolus changes in response to rising/falling arrows), SMBG calibration frequency, sensor site condition, and alarm settings; if any data missing, schedule focused education before proceeding.

## STEP 2 — Rule In / Rule Out
Determine whether the patient correctly interprets CGM trend data (direction and rate of change) and makes appropriate insulin dose adjustments; if yes, rule in competence; if no, rule out.

## STEP 3 — Classify or Stratify
Classify competence level: Competent (independent, accurate trend‑based adjustments), Needs Retraining (occasional errors or reliance on caregiver), or Unable (requires caregiver for all trend‑based decisions).

## STEP 4 — Decide
If Competent: continue current CGM‑based insulin regimen with annual reassessment; if Needs Retraining: provide targeted one‑on‑one training on trend interpretation and insulin adjustment; if Unable: involve caregiver in dose decisions or consider a simplified insulin regimen.

## Clinical Guardrails / Mimics / Pitfalls
Do not rely solely on CGM trends without confirming with SMBG; avoid making insulin adjustments based on trend alone during rapid glucose changes; do not ignore alarm fatigue or sensor site irritation; never assume competence without direct observation of trend‑based decision making.

## Concrete Clinical Example
A 48‑year‑year‑old with T1D using RT‑CGM user with T1D reviews logs showing they reduce basal rate by 10% when a downward trend arrow exceeds 2 mg/dL/min and confirm with fingerstick; they calibrate twice daily, rotate sensor sites, and report no severe hypoglycemia; deemed Competent, current plan continued.

**Source:** Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, https://doi.org/10.1210/jc.2016-2534