How do I install the Es Cc Or Fixed Prandial skill?

Run npx skillmds@latest add dromlakhani/es-cc-or-fixed-prandial 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 Cc Or Fixed Prandial safe to use?

This skill has not completed SkillMD's automated safety review yet. Independent scanners report: SkillSpector: PASS, Skill Scanner: PASS. Capability flags: makes network calls. SkillMD never runs a skill's scripts for you; review the SKILL.md before installing.

Which AI agents work with Es Cc Or Fixed Prandial?

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 Cc Or Fixed Prandial free to use?

Yes. Installing skills from SkillMD is free, and the skill stays under its author's original license.

Who published Es Cc Or Fixed Prandial?

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

Es Cc Or Fixed Prandial by dromlakhani

Name: Es Cc Or Fixed Prandial
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Cc Or Fixed Prandial

For adult patients with type 1 diabetes or insulin-treated type 2 diabetes hospitalized for noncritical illness who require prandial insulin, suggest either carbohydrate counting or fixed prandial insulin dosing. Triggered by clinician queries such as "Patient is T1D or insulin-treated T2D, how should we dose prandial insulin?"

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Suggest either carbohydrate counting or no carbohydrate counting with fixed prandial insulin dosing for type 1 or insulin-treated type 2 diabetes

STEP 1 — Gather Information

Collect diabetes type (T1D or insulin-treated T2D), confirmation of noncritical illness hospitalization, need for prandial insulin therapy, patient's carbohydrate counting proficiency and preference, availability of diabetes expertise/resources for CC, current basal insulin dose, and recent glucose trends. Proceed to determine eligibility for CC vs fixed dosing.

STEP 2 — Rule In / Rule Out

Is the patient diagnosed with type 1 diabetes or insulin-treated type 2 diabetes and hospitalized for noncritical illness? If yes, proceed to Step 3; if no, consider noninsulin-treated T2D pathway (suggest not using carbohydrate counting per Recommendation 9.1) and exit this skill.

STEP 3 — Classify or Stratify

Assess patient's carbohydrate counting ability, preference, and institutional resources (expertise, policies, training). If patient is proficient, prefers CC, and expertise/resources are available, classify as suitable for carbohydrate counting; otherwise classify as suitable for fixed prandial insulin dosing.

STEP 4 — Decide

If classified for carbohydrate counting, implement CC using an individualized insulin-to-carbohydrate ratio (ICR) with adjustments for illness-related insulin resistance; if classified for fixed dosing, administer fixed prandial insulin doses (e.g., weight-based 0.2–0.4 units/kg per meal) plus correctional insulin for premeal hyperglycemia > target.

Clinical Guardrails / Mimics / Pitfalls

CC requires a hospital policy, expertise from a diabetes professional, and adjustments to ICR may be needed due to illness, glucocorticoids, infection, or surgery; avoid CC if resources lacking. Fixed dosing should be weight-based and include correctional insulin; reduce basal insulin by 10–20% in basal-heavy regimens (≥0.6 units/kg/day) to prevent hypoglycemia. Do not use CC without expertise or policy guidance.

Concrete Clinical Example

A 62-year-old woman with T1D admitted for cellulitis reports using CC at home, has access to a diabetes educator, and prefers to continue; her ICR is 1 unit per 10 g CHO, adjusted downward 20% during hospitalization. A 70-year-old man with insulin-treated T2D admitted for COPD exacerbation has difficulty with carb counting; fixed prandial insulin of 4 units per meal plus correctional insulin based on premeal glucose is used.

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

---name: es-cc-or-fixed-prandialdescription: For adult patients with type 1 diabetes or insulin-treated type 2 diabetes hospitalized for noncritical illness who require prandial insulin, suggest either carbohydrate counting or fixed prandial insulin dosing. Triggered by clinician queries such as "Patient is T1D or insulin-treated T2D, how should we dose prandial insulin?"---# Suggest either carbohydrate counting or no carbohydrate counting with fixed prandial insulin dosing for type 1 or insulin-treated type 2 diabetes## STEP 1 — Gather InformationCollect diabetes type (T1D or insulin-treated T2D), confirmation of noncritical illness hospitalization, need for prandial insulin therapy, patient's carbohydrate counting proficiency and preference, availability of diabetes expertise/resources for CC, current basal insulin dose, and recent glucose trends. Proceed to determine eligibility for CC vs fixed dosing.## STEP 2 — Rule In / Rule OutIs the patient diagnosed with type 1 diabetes or insulin-treated type 2 diabetes and hospitalized for noncritical illness? If yes, proceed to Step 3; if no, consider noninsulin-treated T2D pathway (suggest not using carbohydrate counting per Recommendation 9.1) and exit this skill.## STEP 3 — Classify or StratifyAssess patient's carbohydrate counting ability, preference, and institutional resources (expertise, policies, training). If patient is proficient, prefers CC, and expertise/resources are available, classify as suitable for carbohydrate counting; otherwise classify as suitable for fixed prandial insulin dosing.## STEP 4 — DecideIf classified for carbohydrate counting, implement CC using an individualized insulin-to-carbohydrate ratio (ICR) with adjustments for illness-related insulin resistance; if classified for fixed dosing, administer fixed prandial insulin doses (e.g., weight-based 0.2–0.4 units/kg per meal) plus correctional insulin for premeal hyperglycemia > target.## Clinical Guardrails / Mimics / PitfallsCC requires a hospital policy, expertise from a diabetes professional, and adjustments to ICR may be needed due to illness, glucocorticoids, infection, or surgery; avoid CC if resources lacking. Fixed dosing should be weight-based and include correctional insulin; reduce basal insulin by 10–20% in basal-heavy regimens (≥0.6 units/kg/day) to prevent hypoglycemia. Do not use CC without expertise or policy guidance.## Concrete Clinical ExampleA 62-year-old woman with T1D admitted for cellulitis reports using CC at home, has access to a diabetes educator, and prefers to continue; her ICR is 1 unit per 10 g CHO, adjusted downward 20% during hospitalization. A 70-year-old man with insulin-treated T2D admitted for COPD exacerbation has difficulty with carb counting; fixed prandial insulin of 4 units per meal plus correctional insulin based on premeal glucose is used.**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

Frequently asked questions