How do I install the Es Add Scheduled Insulin Persistent Hyperglycemia skill?

Run npx skillmds@latest add dromlakhani/es-add-scheduled-insulin-persistent-hyperglycemia 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 Es Add Scheduled Insulin Persistent Hyperglycemia safe to use?

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Which AI agents work with Es Add Scheduled Insulin Persistent Hyperglycemia?

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 Es Add Scheduled Insulin Persistent Hyperglycemia?

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

Es Add Scheduled Insulin Persistent Hyperglycemia by dromlakhani

Name: Es Add Scheduled Insulin Persistent Hyperglycemia
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Add Scheduled Insulin Persistent Hyperglycemia

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?"

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Add scheduled insulin therapy if persistent hyperglycemia occurs on correctional insulin alone

STEP 1 — Gather Information

Collect: diabetes history prior to admission (none, diet-treated noninsulin, insulin-treated), current insulin regimen (confirm correctional insulin alone), and point-of-care blood glucose values over the past 24 hours (count of readings ≥180 mg/dL). Action: Document these data.

STEP 2 — Rule In / Rule Out

Is the patient on correctional insulin alone AND have ≥2 POC-BG measurements ≥180 mg/dL in the last 24 hours? If yes, proceed to Step 3; if no, continue correctional insulin alone and re-evaluate BG in 4-6 hours.

STEP 3 — Classify or Stratify

Stratify by prior diabetes status:

No prior diabetes
Diabetes treated with diet or noninsulin medications prior to admission
Insulin-treated diabetes prior to admission Action: Record the determined category to guide decision in Step 4.

STEP 4 — Decide

For no prior diabetes or diet-treated noninsulin: Initiate scheduled insulin therapy (basal ± bolus insulin) while continuing correctional insulin for meals, aiming for glucose targets 100-180 mg/dL.
For insulin-treated prior: Continue the scheduled insulin regimen, adjusting basal and prandial doses based on nutritional status and severity of illness to maintain glucose targets 100-180 mg/dL.

Clinical Guardrails / Mimics / Pitfalls

Do not add scheduled insulin if the patient is experiencing hypoglycemia (<70 mg/dL) or has severe renal impairment (eGFR <30 mL/min) without dose adjustment; avoid inertia by not persisting with correctional insulin alone after meeting hyperglycemia criteria; do not use scheduled insulin in patients who are NPO without holding prandial components; remember that type 1 diabetes patients should already be on scheduled insulin, not correctional alone.

Concrete Clinical Example

A 68-year-old woman with no known diabetes admitted for pneumonia. On admission BG 160 mg/dL, started on correctional insulin sliding scale. Over 24h, she has two POC-BG readings: 190 mg/dL and 205 mg/dL. She meets criteria for persistent hyperglycemia on correctional insulin alone. Per guideline, add basal insulin glargine 0.15 units/kg/day (approx 10 units for 70 kg) and continue correctional insulin before meals.

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

TODO: consider adding scripts/calc.py for the es-add-scheduled-insulin-persistent-hyperglycemia calculator

---name: es-add-scheduled-insulin-persistent-hyperglycemiadescription: 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?"---# Add scheduled insulin therapy if persistent hyperglycemia occurs on correctional insulin alone## STEP 1 — Gather InformationCollect: diabetes history prior to admission (none, diet-treated noninsulin, insulin-treated), current insulin regimen (confirm correctional insulin alone), and point-of-care blood glucose values over the past 24 hours (count of readings ≥180 mg/dL). Action: Document these data.## STEP 2 — Rule In / Rule OutIs the patient on correctional insulin alone AND have ≥2 POC-BG measurements ≥180 mg/dL in the last 24 hours? If yes, proceed to Step 3; if no, continue correctional insulin alone and re-evaluate BG in 4-6 hours.## STEP 3 — Classify or StratifyStratify by prior diabetes status: - No prior diabetes- Diabetes treated with diet or noninsulin medications prior to admission- Insulin-treated diabetes prior to admissionAction: Record the determined category to guide decision in Step 4.## STEP 4 — Decide- For no prior diabetes or diet-treated noninsulin: Initiate scheduled insulin therapy (basal ± bolus insulin) while continuing correctional insulin for meals, aiming for glucose targets 100-180 mg/dL.- For insulin-treated prior: Continue the scheduled insulin regimen, adjusting basal and prandial doses based on nutritional status and severity of illness to maintain glucose targets 100-180 mg/dL.## Clinical Guardrails / Mimics / PitfallsDo not add scheduled insulin if the patient is experiencing hypoglycemia (<70 mg/dL) or has severe renal impairment (eGFR <30 mL/min) without dose adjustment; avoid inertia by not persisting with correctional insulin alone after meeting hyperglycemia criteria; do not use scheduled insulin in patients who are NPO without holding prandial components; remember that type 1 diabetes patients should already be on scheduled insulin, not correctional alone.## Concrete Clinical ExampleA 68-year-old woman with no known diabetes admitted for pneumonia. On admission BG 160 mg/dL, started on correctional insulin sliding scale. Over 24h, she has two POC-BG readings: 190 mg/dL and 205 mg/dL. She meets criteria for persistent hyperglycemia on correctional insulin alone. Per guideline, add basal insulin glargine 0.15 units/kg/day (approx 10 units for 70 kg) and continue correctional insulin before meals.**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, https://doi.org/10.1210/clinem/dgac278> **TODO:** consider adding scripts/calc.py for the es-add-scheduled-insulin-persistent-hyperglycemia calculator

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