How do I install the Endo Basal Insulin Trial skill?

Run npx skillmds@latest add dromlakhani/endo-basal-insulin-trial in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

Is Endo Basal Insulin Trial safe to use?

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Which AI agents work with Endo Basal Insulin Trial?

This skill is tagged as working with Claude Code, Claude.ai, OpenAI Codex. SKILL.md is an open format, so most agents that read a skills directory can load it too.

Is Endo Basal Insulin Trial free to use?

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Who published Endo Basal Insulin Trial?

dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Endo Basal Insulin Trial by dromlakhani

Name: Endo Basal Insulin Trial
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Basal Insulin Trial

In obese patients with type 2 diabetes mellitus requiring insulin, a preferential trial of basal insulin is recommended before initiating premixed or combination insulin therapy. Consider this approach when clinicians ask, 'Should I try basal insulin alone before moving to premixed insulin in this patient?' or 'Is a basal‑only trial appropriate before initiating combination insulin therapy?'.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Consider basal insulin trial before premixed/combo insulin

STEP 1 — Gather Information

Collect: BMI (≥30 kg/m² or ≥27 kg/m² with comorbidity), confirmed type 2 diabetes, indication for insulin therapy (e.g., A1c >9% despite oral agents), current glucose logs, weight, renal function, hypoglycemia risk, existing medications (metformin, sulfonylureas, etc.), and patient preferences regarding injection frequency.

STEP 2 — Rule In / Rule Out

Is the patient obese with T2DM and requires insulin?

Yes → proceed to STEP 3.
No → basal insulin trial not indicated; reassess alternative glucose‑lowering strategies.

STEP 3 — Classify or Stratify

Assess suitability for basal‑only trial:

Suitable – fasting hyperglycemia predominates, low risk of severe hypoglycemia, no immediate prandial coverage needed.
Not suitable – significant postprandial excursions, history of severe hypoglycemia, or need for rapid mealtime dosing → consider premixed/combo insulin directly.

STEP 4 — Decide

If suitable, initiate basal insulin (e.g., glargine or detemir) at a starting dose of 0.1–0.2 U/kg nightly, continue metformin, and reassess fasting glucose and weight after 4–6 weeks; titrate to target fasting glucose 80–130 mg/dL. If targets not met or weight gain >2 kg, evaluate adding pramlintide, GLP‑1 agonist, or transition to premixed/combo regimen.

Clinical Guardrails / Mimics / Pitfalls

Do not use basal insulin alone in patients with marked postprandial hyperglycemia or frequent hypoglycemia; avoid delaying necessary prandial coverage; always pair basal insulin with weight‑mitigating agents (metformin, pramlintide, GLP‑1 agonist) per guideline; monitor for hypoglycemia and weight changes; do not exceed dose escalation without reviewing tolerability.

Concrete Clinical Example

A 58‑year‑old man with T2DM, BMI 32 kg/m², A1c 9.2% on metformin alone, reports elevated fasting glucose (150–180 mg/dL) but stable postprandial values. He asks whether to start basal insulin before considering premixed insulin. Clinician initiates insulin glargine 10 U nightly, continues metformin, reviews fasting logs in 4 weeks, titrates to 18 U nightly achieving fasting glucose 110 mg/dL with minimal weight gain, and continues basal‑only regimen.

Source: Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2015, DOI:10.1210/jc.2014-3415

---name: endo-basal-insulin-trialdescription: In obese patients with type 2 diabetes mellitus requiring insulin, a preferential trial of basal insulin is recommended before initiating premixed or combination insulin therapy. Consider this approach when clinicians ask, 'Should I try basal insulin alone before moving to premixed insulin in this patient?' or 'Is a basal‑only trial appropriate before initiating combination insulin therapy?'.---# Consider basal insulin trial before premixed/combo insulin## STEP 1 — Gather InformationCollect: BMI (≥30 kg/m² or ≥27 kg/m² with comorbidity), confirmed type 2 diabetes, indication for insulin therapy (e.g., A1c >9% despite oral agents), current glucose logs, weight, renal function, hypoglycemia risk, existing medications (metformin, sulfonylureas, etc.), and patient preferences regarding injection frequency.## STEP 2 — Rule In / Rule OutIs the patient obese with T2DM and requires insulin? - **Yes** → proceed to STEP 3. - **No** → basal insulin trial not indicated; reassess alternative glucose‑lowering strategies.## STEP 3 — Classify or StratifyAssess suitability for basal‑only trial: - **Suitable** – fasting hyperglycemia predominates, low risk of severe hypoglycemia, no immediate prandial coverage needed. - **Not suitable** – significant postprandial excursions, history of severe hypoglycemia, or need for rapid mealtime dosing → consider premixed/combo insulin directly.## STEP 4 — DecideIf suitable, initiate basal insulin (e.g., glargine or detemir) at a starting dose of 0.1–0.2 U/kg nightly, continue metformin, and reassess fasting glucose and weight after 4–6 weeks; titrate to target fasting glucose 80–130 mg/dL. If targets not met or weight gain >2 kg, evaluate adding pramlintide, GLP‑1 agonist, or transition to premixed/combo regimen.## Clinical Guardrails / Mimics / PitfallsDo not use basal insulin alone in patients with marked postprandial hyperglycemia or frequent hypoglycemia; avoid delaying necessary prandial coverage; always pair basal insulin with weight‑mitigating agents (metformin, pramlintide, GLP‑1 agonist) per guideline; monitor for hypoglycemia and weight changes; do not exceed dose escalation without reviewing tolerability.## Concrete Clinical ExampleA 58‑year‑old man with T2DM, BMI 32 kg/m², A1c 9.2% on metformin alone, reports elevated fasting glucose (150–180 mg/dL) but stable postprandial values. He asks whether to start basal insulin before considering premixed insulin. Clinician initiates insulin glargine 10 U nightly, continues metformin, reviews fasting logs in 4 weeks, titrates to 18 U nightly achieving fasting glucose 110 mg/dL with minimal weight gain, and continues basal‑only regimen.**Source:** Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2015, DOI:10.1210/jc.2014-3415

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