How do I install the Es Basal Insulin Dose Reduction skill?

Run npx skillmds@latest add dromlakhani/es-basal-insulin-dose-reduction 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.

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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 Es Basal Insulin Dose Reduction free to use?

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Who published Es Basal Insulin Dose Reduction?

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

Es Basal Insulin Dose Reduction by dromlakhani

Name: Es Basal Insulin Dose Reduction
Rating: 4.5 (4 reviews)
Author: dromlakhani

Es Basal Insulin Dose Reduction

Consider reducing basal insulin dose by 10% to 20% at hospitalization for patients on basal heavy insulin regimens (≥0.6–1.0 units/kg/day) to prevent over‑coverage of meal‑related glucose excursions. Trigger phrases include “Patient on high basal insulin dose, should we reduce it during hospital stay?” and “Basal insulin dose ≥0.6 U/kg/day, consider reduction on admission.”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Consider reducing basal insulin dose by 10% to 20% at hospitalization for patients on basal heavy insulin regimens

STEP 1 — Gather Information

Collect patient weight, current basal insulin dose (units/day), calculate basal dose per kg, assess if basal heavy (≥0.6 U/kg/day), note recent inpatient glucose trends, nutritional status (NPO vs eating), and any planned changes in caloric intake or glucocorticoids. If basal dose ≥0.6 U/kg/day proceed to Step 2; otherwise maintain current basal dose.

STEP 2 — Rule In / Rule Out

Determine if the patient is NPO or has significantly reduced carbohydrate intake compared to home. If yes (reduced intake), rule in for dose reduction; if no (normal or increased intake), rule out reduction and maintain basal dose.

STEP 3 — Classify or Stratify

For patients ruled in, stratify reduction magnitude: 10% if mild reduction in intake or short stay, 20% if marked reduction (e.g., NPO, nil per os, or anticipated low oral intake) or expected prolonged hospitalization. Select the appropriate percentage reduction.

STEP 4 — Decide

Calculate new basal dose = current basal dose × (1 – reduction fraction). Write order for reduced basal insulin at admission, monitor glucose q4‑6h and adjust as needed. Implement the reduced basal dose and set glucose monitoring plan.

Clinical Guardrails / Mimics / Pitfalls

Do not reduce basal insulin in patients with persistent hyperglycemia (>180 mg/dL) or those on glucocorticoids that increase insulin needs; avoid reducing basal in patients with type 1 diabetes or those on glucocorticoids that increase insulin needs; avoid reducing basal in patients with type 1 diabetes or hypoglycemia unawareness; do not apply reduction if receiving enteral/parenteral nutrition with substantial carbohydrates; monitor for hypoglycemia and be prepared to increase dose if glucose falls <70 mg/dL.

Concrete Clinical Example

78‑year‑old woman with T2D weighing 70 kg takes glargine 45 U daily (0.64 U/kg/day). Admitted for hip surgery, expected NPO for 24 h then clear liquids. Basal heavy → rule in. Marked intake reduction → 20% reduction. New dose = 45 U × 0.8 = 36 U glargine daily. Order written, glucose checked q6h; after first day glucose 110‑150 mg/dL, dose maintained.

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-basal-insulin-dose-reduction calculator

---name: es-basal-insulin-dose-reductiondescription: Consider reducing basal insulin dose by 10% to 20% at hospitalization for patients on basal heavy insulin regimens (≥0.6–1.0 units/kg/day) to prevent over‑coverage of meal‑related glucose excursions. Trigger phrases include “Patient on high basal insulin dose, should we reduce it during hospital stay?” and “Basal insulin dose ≥0.6 U/kg/day, consider reduction on admission.”---# Consider reducing basal insulin dose by 10% to 20% at hospitalization for patients on basal heavy insulin regimens## STEP 1 — Gather InformationCollect patient weight, current basal insulin dose (units/day), calculate basal dose per kg, assess if basal heavy (≥0.6 U/kg/day), note recent inpatient glucose trends, nutritional status (NPO vs eating), and any planned changes in caloric intake or glucocorticoids. If basal dose ≥0.6 U/kg/day proceed to Step 2; otherwise maintain current basal dose.## STEP 2 — Rule In / Rule OutDetermine if the patient is NPO or has significantly reduced carbohydrate intake compared to home. If yes (reduced intake), rule in for dose reduction; if no (normal or increased intake), rule out reduction and maintain basal dose.## STEP 3 — Classify or StratifyFor patients ruled in, stratify reduction magnitude: 10% if mild reduction in intake or short stay, 20% if marked reduction (e.g., NPO, nil per os, or anticipated low oral intake) or expected prolonged hospitalization. Select the appropriate percentage reduction.## STEP 4 — DecideCalculate new basal dose = current basal dose × (1 – reduction fraction). Write order for reduced basal insulin at admission, monitor glucose q4‑6h and adjust as needed. Implement the reduced basal dose and set glucose monitoring plan.## Clinical Guardrails / Mimics / PitfallsDo not reduce basal insulin in patients with persistent hyperglycemia (>180 mg/dL) or those on glucocorticoids that increase insulin needs; avoid reducing basal in patients with type 1 diabetes or those on glucocorticoids that increase insulin needs; avoid reducing basal in patients with type 1 diabetes or hypoglycemia unawareness; do not apply reduction if receiving enteral/parenteral nutrition with substantial carbohydrates; monitor for hypoglycemia and be prepared to increase dose if glucose falls <70 mg/dL.## Concrete Clinical Example78‑year‑old woman with T2D weighing 70 kg takes glargine 45 U daily (0.64 U/kg/day). Admitted for hip surgery, expected NPO for 24 h then clear liquids. Basal heavy → rule in. Marked intake reduction → 20% reduction. New dose = 45 U × 0.8 = 36 U glargine daily. Order written, glucose checked q6h; after first day glucose 110‑150 mg/dL, dose maintained.**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-basal-insulin-dose-reduction calculator

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