How do I install the Es Cgm Vs Smbg T1d Mdi skill?

Run npx skillmds@latest add dromlakhani/es-cgm-vs-smbg-t1d-mdi 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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Who published Es Cgm Vs Smbg T1d Mdi?

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

Es Cgm Vs Smbg T1d Mdi by dromlakhani

Name: Es Cgm Vs Smbg T1d Mdi
Rating: 4.5 (4 reviews)
Author: dromlakhani

Es Cgm Vs Smbg T1d Mdi

Recommends CGM over SMBG for type 1 diabetes patients on multiple daily injections to reduce hypoglycemia risk. Triggered by clinician questions such as "Should I use CGM or SMBG for this T1D patient on MDI?" or "Is CGM preferred for glucose monitoring in this patient?"

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

CGM vs SMBG for Type 1 Diabetes on MDI

STEP 1 — Gather Information

Confirm type 1 diabetes diagnosis and current multiple daily injection (MDI) regimen; assess hypoglycemia history (frequency, severity, nocturnal events), hypoglycemia awareness, patient’s ability/willingness to use CGM (dexterity, visual/hearing for alerts), insurance coverage/access, and need for structured education on device use and data interpretation.

STEP 2 — Rule In / Rule Out

Rule out CGM if the patient cannot safely operate the device (e.g., severe dexterity impairment, uncontrolled dermatitis, lack of training resources, or explicit refusal); otherwise rule in for CGM consideration.

STEP 3 — Classify or Stratify

Stratify by hypoglycemia risk: high (history of severe hypoglycemia requiring assistance, hypoglycemia unawareness, frequent nocturnal events) versus moderate (no severe events but suboptimal glycemic control); prioritize CGM for high‑risk patients.

STEP 4 — Decide

Recommend initiating real‑time CGM (or intermittently scanned CGM with predictive alerts) rather than SMBG alone; provide structured education on device use, troubleshooting, and data interpretation; retain access to SMBG for calibration/validation and sensor warm‑up periods.

Clinical Guardrails / Mimics / Pitfalls

Do not rely solely on CGM values for insulin dosing without confirmatory SMBG during sensor warm‑up, when symptoms mismatch sensor readings, or if sensor malfunctions; do not omit structured education; do not use CGM in patients with substances that interfere with sensor accuracy (e.g., high‑dose vitamin C, hydroxyurea) without verification; do not assume CGM eliminates the need for SMBG entirely.

Concrete Clinical Example

A 22‑year‑old college student with T1D on MDI (glargine basal, lispro bolus) reports two nocturnal hypoglycemia episodes requiring assistance in the past month and fears hypoglycemia disrupting sleep; after confirming MDI regimen and hypoglycemia risk, CGM is initiated with education, and SMBG is retained for calibration and symptom‑sensor mismatches.

Source: Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, https://doi.org/10.1210/clinem/dgac596

---name: es-cgm-vs-smbg-t1d-mdidescription: Recommends CGM over SMBG for type 1 diabetes patients on multiple daily injections to reduce hypoglycemia risk. Triggered by clinician questions such as "Should I use CGM or SMBG for this T1D patient on MDI?" or "Is CGM preferred for glucose monitoring in this patient?"---# CGM vs SMBG for Type 1 Diabetes on MDI## STEP 1 — Gather InformationConfirm type 1 diabetes diagnosis and current multiple daily injection (MDI) regimen; assess hypoglycemia history (frequency, severity, nocturnal events), hypoglycemia awareness, patient’s ability/willingness to use CGM (dexterity, visual/hearing for alerts), insurance coverage/access, and need for structured education on device use and data interpretation.## STEP 2 — Rule In / Rule OutRule out CGM if the patient cannot safely operate the device (e.g., severe dexterity impairment, uncontrolled dermatitis, lack of training resources, or explicit refusal); otherwise rule in for CGM consideration.## STEP 3 — Classify or StratifyStratify by hypoglycemia risk: high (history of severe hypoglycemia requiring assistance, hypoglycemia unawareness, frequent nocturnal events) versus moderate (no severe events but suboptimal glycemic control); prioritize CGM for high‑risk patients.## STEP 4 — DecideRecommend initiating real‑time CGM (or intermittently scanned CGM with predictive alerts) rather than SMBG alone; provide structured education on device use, troubleshooting, and data interpretation; retain access to SMBG for calibration/validation and sensor warm‑up periods.## Clinical Guardrails / Mimics / PitfallsDo not rely solely on CGM values for insulin dosing without confirmatory SMBG during sensor warm‑up, when symptoms mismatch sensor readings, or if sensor malfunctions; do not omit structured education; do not use CGM in patients with substances that interfere with sensor accuracy (e.g., high‑dose vitamin C, hydroxyurea) without verification; do not assume CGM eliminates the need for SMBG entirely.## Concrete Clinical ExampleA 22‑year‑old college student with T1D on MDI (glargine basal, lispro bolus) reports two nocturnal hypoglycemia episodes requiring assistance in the past month and fears hypoglycemia disrupting sleep; after confirming MDI regimen and hypoglycemia risk, CGM is initiated with education, and SMBG is retained for calibration and symptom‑sensor mismatches.**Source:** Management of Individuals With Diabetes at High Risk for Hypoglycemia: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2023, https://doi.org/10.1210/clinem/dgac596

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