How do I install the Endo No Carb Counting Prandial Insulin Noninsulin T2d skill?

Run npx skillmds@latest add dromlakhani/endo-no-carb-counting-prandial-insulin-noninsulin-t2d 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.

Which AI agents work with Endo No Carb Counting Prandial Insulin Noninsulin T2d?

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.

Who published Endo No Carb Counting Prandial Insulin Noninsulin T2d?

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

Endo No Carb Counting Prandial Insulin Noninsulin T2d by dromlakhani

Name: Endo No Carb Counting Prandial Insulin Noninsulin T2d
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo No Carb Counting Prandial Insulin Noninsulin T2d

Recommends avoiding carbohydrate counting for prandial insulin dosing in adults with noninsulin‑treated type 2 diabetes who require mealtime insulin during noncritical illness hospitalization. Trigger phrases include “initiating prandial insulin in a diet‑ or oral‑agent‑managed type 2 diabetic” and “noninsulin‑treated T2D needing mealtime insulin in the ward.”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Do not use carbohydrate counting for prandial insulin dosing in noninsulin‑treated type 2 diabetes requiring prandial insulin

STEP 1 — Gather Information

Confirm adult patient with type 2 diabetes not on home insulin (managed by diet or oral agents), hospitalized for noncritical illness, and requiring prandial insulin therapy (e.g., persistent hyperglycemia ≥180 mg/dL despite basal/correctional insulin). Collect admission BG, HbA1c if available, current meds, renal function, and nutrition plan.

STEP 2 — Rule In / Rule Out

If patient meets all criteria (noninsulin‑treated T2D, noncritical illness, requires prandial insulin), proceed to Step 3; otherwise, use alternative insulin strategy (e.g., continue home insulin, use correctional insulin alone, or follow protocol for insulin‑treated or type 1 diabetes).

STEP 3 — Classify or Stratify

Select fixed‑dose prandial insulin regimen (e.g., same number of units before each meal) rather than carbohydrate counting; adjust dose based on premeal blood glucose trends and nutritional intake consistency.

STEP 4 — Decide

Initiate prandial insulin using the chosen fixed dose (commonly 4–6 units per meal) and adjust every 24 h based on premeal BG and hypoglycemia events; do not calculate doses from carbohydrate intake.

Clinical Guardrails / Mimics / Pitfalls

Do not rely on carbohydrate counting even if patient reports consistent intake; avoid using insulin‑to‑carbohydrate ratios derived from outpatient practice. Monitor for hypoglycemia when illness or intake changes. Remember that fixed dosing may need reduction if NPO or decreased intake; avoid sliding‑scale‑only approaches without basal coverage.

Concrete Clinical Example

A 66‑year‑old woman admitted for community‑acquired pneumonia, HbA1c 7.1%, on metformin only, develops pre‑lunch BG 210 mg/dL. She is started on basal insulin glargine 10 units nightly and prandial insulin lispro 4 units before each meal (fixed dose). Carbohydrate counting is not used; doses are adjusted downward if she eats <50 % of meals.

Source: Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Recommendation 9.1, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278

---name: endo-no-carb-counting-prandial-insulin-noninsulin-t2ddescription: Recommends avoiding carbohydrate counting for prandial insulin dosing in adults with noninsulin‑treated type 2 diabetes who require mealtime insulin during noncritical illness hospitalization. Trigger phrases include “initiating prandial insulin in a diet‑ or oral‑agent‑managed type 2 diabetic” and “noninsulin‑treated T2D needing mealtime insulin in the ward.”---# Do not use carbohydrate counting for prandial insulin dosing in noninsulin‑treated type 2 diabetes requiring prandial insulin## STEP 1 — Gather InformationConfirm adult patient with type 2 diabetes not on home insulin (managed by diet or oral agents), hospitalized for noncritical illness, and requiring prandial insulin therapy (e.g., persistent hyperglycemia ≥180 mg/dL despite basal/correctional insulin). Collect admission BG, HbA1c if available, current meds, renal function, and nutrition plan.## STEP 2 — Rule In / Rule OutIf patient meets all criteria (noninsulin‑treated T2D, noncritical illness, requires prandial insulin), proceed to Step 3; otherwise, use alternative insulin strategy (e.g., continue home insulin, use correctional insulin alone, or follow protocol for insulin‑treated or type 1 diabetes).## STEP 3 — Classify or StratifySelect fixed‑dose prandial insulin regimen (e.g., same number of units before each meal) rather than carbohydrate counting; adjust dose based on premeal blood glucose trends and nutritional intake consistency.## STEP 4 — DecideInitiate prandial insulin using the chosen fixed dose (commonly 4–6 units per meal) and adjust every 24 h based on premeal BG and hypoglycemia events; do not calculate doses from carbohydrate intake.## Clinical Guardrails / Mimics / PitfallsDo not rely on carbohydrate counting even if patient reports consistent intake; avoid using insulin‑to‑carbohydrate ratios derived from outpatient practice. Monitor for hypoglycemia when illness or intake changes. Remember that fixed dosing may need reduction if NPO or decreased intake; avoid sliding‑scale‑only approaches without basal coverage.## Concrete Clinical ExampleA 66‑year‑old woman admitted for community‑acquired pneumonia, HbA1c 7.1%, on metformin only, develops pre‑lunch BG 210 mg/dL. She is started on basal insulin glargine 10 units nightly and prandial insulin lispro 4 units before each meal (fixed dose). Carbohydrate counting is not used; doses are adjusted downward if she eats <50 % of meals.**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Recommendation 9.1, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278

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