# Es Cc Policy Expertise

> This skill ensures the hospital has a policy to guide carbohydrate counting for prandial insulin dosing and confirms availability of healthcare professionals knowledgeable in diabetes management. It is triggered when clinicians ask, "Do we have a hospital policy and expertise for carbohydrate counting?" to standardize insulin dosing and improve glycemic safety.

- Skill: `dromlakhani/es-cc-policy-expertise` (Agent Skill)
- Install (CLI): `npx skillmds@latest add dromlakhani/es-cc-policy-expertise`
- Raw SKILL.md: https://api.skillmd.com/api/skills/dromlakhani/es-cc-policy-expertise/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: dromlakhani (https://skillmd.com/u/dromlakhani)
- Updated: 2026-09-08
- Page: https://skillmd.com/skills/dromlakhani/es-cc-policy-expertise

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# Ensure hospital has a policy to guide carbohydrate counting and expertise in diabetes management

## STEP 1 — Gather Information
Collect patient diabetes type (type 1 vs type 2), insulin treatment status (insulin-treated vs noninsulin-treated), and requirement for prandial insulin therapy.

## STEP 2 — Rule In / Rule Out
Determine if the patient is noninsulin-treated type 2 diabetes requiring prandial insulin. If yes, rule out carbohydrate counting; proceed to fixed dosing. If no (i.e., type 1 diabetes or insulin-treated type 2 diabetes), proceed to consider carbohydrate counting.

## STEP 3 — Classify or Stratify
For patients where carbohydrate counting is an option, assess hospital readiness: presence of a carbohydrate counting policy and availability of a healthcare professional expert in diabetes management. If both are present, classify as eligible for carbohydrate counting; otherwise, classify as requiring fixed prandial insulin dosing.

## STEP 4 — Decide
If eligible for carbohydrate counting, implement carbohydrate counting using an individualized insulin-to-carbohydrate ratio; if not eligible, use fixed prandial insulin dosing based on weight or standard meal plan.

## Clinical Guardrails / Mimics / Pitfalls
Do not apply carbohydrate counting in noninsulin-treated type 2 diabetes patients requiring prandial insulin; avoid carbohydrate counting when hospital lacks policy or trained expertise; adjust insulin-to-carbohydrate ratios for illness-related insulin resistance; never use carbohydrate counting without verifying meal carbohydrate content and timing.

## Concrete Clinical Example
A 62-year-old woman with type 1 diabetes admitted for cellulitis requires prandial insulin. The hospital has a carbohydrate counting policy and a diabetes care and education specialist. She uses an insulin-to-carbohydrate ratio of 1 unit per 15 grams of carbohydrate. For a lunch containing 60 grams of carbohydrate, she receives 4 units of prandial insulin.

**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