How do I install the Es Ghc Bg Monitoring skill?

Run npx skillmds@latest add dromlakhani/es-ghc-bg-monitoring 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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Which AI agents work with Es Ghc Bg Monitoring?

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Is Es Ghc Bg Monitoring free to use?

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Who published Es Ghc Bg Monitoring?

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

Es Ghc Bg Monitoring by dromlakhani

Name: Es Ghc Bg Monitoring
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Ghc Bg Monitoring

This skill ensures ongoing blood glucose monitoring with adjustment of insulin dosing to manage glucocorticoid-associated hyperglycemia and prevent hypoglycemia during taper or discontinuation. It is triggered when clinicians ask, "Do we need to adjust insulin doses as glucocorticoids change?"

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Implement ongoing blood glucose monitoring and insulin dose adjustment

STEP 1 — Gather Information

Collect current glucocorticoid type, dose, and schedule; recent point-of-care blood glucose (POC-BG) values (fasting, pre-meal, random, and bedtime); existing insulin regimen (type, dose, timing); renal function; hypoglycemia risk factors (age, BMI, total daily insulin dose, CKD, history of hypoglycemia); and nutritional status.

STEP 2 — Rule In / Rule Out

Determine if glucocorticoid dose is being changed (tapered, held, or increased) versus stable. If glucocorticoid dose is changing, proceed to adjust insulin; if dose is stable, maintain current insulin regimen and continue routine monitoring.

STEP 3 — Classify or Stratify

Stratify glucocorticoid change magnitude: low (≤25% dose change), moderate (25‑50%), or high (>50%). Also classify insulin regimen as NPH‑based or basal‑bolus (BBI) to guide adjustment magnitude.

STEP 4 — Decide

For NPH‑based regimens, adjust the total daily NPH dose by approximately 10‑20% per 25% glucocorticoid change (increase for rising GC, decrease for taper); for BBI, adjust basal and prandial components proportionally. Set monitoring frequency to POC‑BG every 4‑6 hours (or more often if hypoglycemia suspected) and reassess after each glucocorticoid dose change.

Clinical Guardrails / Mimics / Pitfalls

Avoid making insulin adjustments based on a single BG value; never use sliding‑scale insulin alone for GC‑associated hyperglycemia; do not discontinue insulin abruptly during glucocorticoid taper; safeguard against hypoglycemia by checking for risk factors and holding or reducing insulin if BG <70 mg/dL; confirm CGM trends with POC‑BG before dosing changes.

Concrete Clinical Example

A patient on prednisone 40 mg daily develops hyperglycemia (BG 180‑250 mg/dL) and is started on NPH 10 U each morning. When prednisone is tapered to 20 mg daily, the NPH dose is reduced to 8 U each morning. POC‑BG is checked q6h; if BG falls below 70 mg/dL, the NPH dose is held and reassessed.

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

---name: es-ghc-bg-monitoringdescription: This skill ensures ongoing blood glucose monitoring with adjustment of insulin dosing to manage glucocorticoid-associated hyperglycemia and prevent hypoglycemia during taper or discontinuation. It is triggered when clinicians ask, "Do we need to adjust insulin doses as glucocorticoids change?"---# Implement ongoing blood glucose monitoring and insulin dose adjustment## STEP 1 — Gather InformationCollect current glucocorticoid type, dose, and schedule; recent point-of-care blood glucose (POC-BG) values (fasting, pre-meal, random, and bedtime); existing insulin regimen (type, dose, timing); renal function; hypoglycemia risk factors (age, BMI, total daily insulin dose, CKD, history of hypoglycemia); and nutritional status.## STEP 2 — Rule In / Rule OutDetermine if glucocorticoid dose is being changed (tapered, held, or increased) versus stable. If glucocorticoid dose is changing, proceed to adjust insulin; if dose is stable, maintain current insulin regimen and continue routine monitoring.## STEP 3 — Classify or StratifyStratify glucocorticoid change magnitude: low (≤25% dose change), moderate (25‑50%), or high (>50%). Also classify insulin regimen as NPH‑based or basal‑bolus (BBI) to guide adjustment magnitude.## STEP 4 — DecideFor NPH‑based regimens, adjust the total daily NPH dose by approximately 10‑20% per 25% glucocorticoid change (increase for rising GC, decrease for taper); for BBI, adjust basal and prandial components proportionally. Set monitoring frequency to POC‑BG every 4‑6 hours (or more often if hypoglycemia suspected) and reassess after each glucocorticoid dose change.## Clinical Guardrails / Mimics / PitfallsAvoid making insulin adjustments based on a single BG value; never use sliding‑scale insulin alone for GC‑associated hyperglycemia; do not discontinue insulin abruptly during glucocorticoid taper; safeguard against hypoglycemia by checking for risk factors and holding or reducing insulin if BG <70 mg/dL; confirm CGM trends with POC‑BG before dosing changes.## Concrete Clinical ExampleA patient on prednisone 40 mg daily develops hyperglycemia (BG 180‑250 mg/dL) and is started on NPH 10 U each morning. When prednisone is tapered to 20 mg daily, the NPH dose is reduced to 8 U each morning. POC‑BG is checked q6h; if BG falls below 70 mg/dL, the NPH dose is held and reassessed.**Source:** Management of Hyperglycemia in Hospitalized Adult Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2022, DOI: 10.1210/clinem/dgac278

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