How do I install the Es Icr Adjustment skill?

Run npx skillmds@latest add dromlakhani/es-icr-adjustment 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 Icr Adjustment 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 Icr Adjustment?

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 Icr Adjustment free to use?

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

Who published Es Icr Adjustment?

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

Es Icr Adjustment by dromlakhani — Agent Skill

Name: Es Icr Adjustment
Rating: 4.2 (5 reviews)
Author: dromlakhani

Es Icr Adjustment

Adjusts the insulin-to-carbohydrate ratio (ICR) for hospitalized patients with diabetes when illness or treatments alter insulin requirements. Triggered by clinician statements such as "Patient's insulin needs changed due to infection, should we adjust the carb ratio?" or "Glucose-interfering medications necessitate ICR modification."

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Adjust insulin-to-carbohydrate ratio to address impact of illness or treatments on insulin requirements

STEP 1 — Gather Information

Collect current ICR, recent pre‑meal and post‑meal blood glucose trends, carbohydrate intake, illness factors (infection, surgery, glucocorticoids, glucose‑interfering meds), renal function, total daily insulin dose, and hypoglycemia episodes. Document these data to inform adjustment.

STEP 2 — Rule In / Rule Out

Determine whether the patient uses carbohydrate counting for prandial insulin dosing (i.e., has an established ICR). If the patient does not use carbohydrate counting, consider fixed prandial dosing or basal‑bolus regimens and stop this skill.

STEP 3 — Classify or Stratify

Assess the direction and magnitude of insulin requirement change: increased needs (e.g., infection, steroids, insulin resistance) versus decreased needs (e.g., reduced oral intake, NPO status, improved insulin sensitivity). Classify as increased, decreased, or unchanged.

STEP 4 — Decide

If insulin requirements are increased, decrease the ICR value (e.g., from 1:15 to 1:12) to deliver more insulin per gram of carbohydrate; if decreased, increase the ICR value (e.g., from 1:15 to 1:18). Set a monitoring plan with pre‑meal and post‑meal glucose checks for 24 h after adjustment.

Clinical Guardrails / Mimics / Pitfalls

Avoid making large ICR changes without frequent glucose monitoring; do not adjust ICR in patients with highly variable intake or who are NPO; use caution in renal impairment where insulin clearance is altered; never rely on ICR adjustment alone without verifying carbohydrate counting accuracy; do not adjust ICR if the patient cannot reliably count carbs.

Concrete Clinical Example

A patient with type 2 diabetes on an insulin pump has a baseline ICR of 1 unit per 15 g carbohydrate. After developing pneumonia and starting prednisone 40 mg daily, pre‑meal glucose averages 180 mg/dL. The team decreases the ICR to 1 unit per 12 g carbohydrate and checks glucose before and after meals; hyperglycemia resolves within 12 h.

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-icr-adjustment calculator

---name: es-icr-adjustmentdescription: Adjusts the insulin-to-carbohydrate ratio (ICR) for hospitalized patients with diabetes when illness or treatments alter insulin requirements. Triggered by clinician statements such as "Patient's insulin needs changed due to infection, should we adjust the carb ratio?" or "Glucose-interfering medications necessitate ICR modification."---# Adjust insulin-to-carbohydrate ratio to address impact of illness or treatments on insulin requirements## STEP 1 — Gather InformationCollect current ICR, recent pre‑meal and post‑meal blood glucose trends, carbohydrate intake, illness factors (infection, surgery, glucocorticoids, glucose‑interfering meds), renal function, total daily insulin dose, and hypoglycemia episodes. Document these data to inform adjustment.## STEP 2 — Rule In / Rule OutDetermine whether the patient uses carbohydrate counting for prandial insulin dosing (i.e., has an established ICR). If the patient does not use carbohydrate counting, consider fixed prandial dosing or basal‑bolus regimens and stop this skill.## STEP 3 — Classify or StratifyAssess the direction and magnitude of insulin requirement change: increased needs (e.g., infection, steroids, insulin resistance) versus decreased needs (e.g., reduced oral intake, NPO status, improved insulin sensitivity). Classify as increased, decreased, or unchanged.## STEP 4 — DecideIf insulin requirements are increased, decrease the ICR value (e.g., from 1:15 to 1:12) to deliver more insulin per gram of carbohydrate; if decreased, increase the ICR value (e.g., from 1:15 to 1:18). Set a monitoring plan with pre‑meal and post‑meal glucose checks for 24 h after adjustment.## Clinical Guardrails / Mimics / PitfallsAvoid making large ICR changes without frequent glucose monitoring; do not adjust ICR in patients with highly variable intake or who are NPO; use caution in renal impairment where insulin clearance is altered; never rely on ICR adjustment alone without verifying carbohydrate counting accuracy; do not adjust ICR if the patient cannot reliably count carbs.## Concrete Clinical ExampleA patient with type 2 diabetes on an insulin pump has a baseline ICR of 1 unit per 15 g carbohydrate. After developing pneumonia and starting prednisone 40 mg daily, pre‑meal glucose averages 180 mg/dL. The team decreases the ICR to 1 unit per 12 g carbohydrate and checks glucose before and after meals; hyperglycemia resolves within 12 h.**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-icr-adjustment calculator

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