How do I install the Pdm Metformin Insulin Avoid skill?

Run npx skillmds@latest add dromlakhani/pdm-metformin-insulin-avoid 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 Pdm Metformin Insulin Avoid?

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

Pdm Metformin Insulin Avoid by dromlakhani

Name: Pdm Metformin Insulin Avoid
Rating: 4.2 (5 reviews)
Author: dromlakhani

Pdm Metformin Insulin Avoid

Recommends against routine addition of metformin to insulin for pregnant individuals with type 2 diabetes already on insulin. Triggered when considering adding metformin to an insulin regimen in pregnancy for patients with type 2 diabetes.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Avoid routine addition of metformin to insulin in pregnancy with type 2 diabetes

STEP 1 — Gather Information

Confirm pregnancy diagnosis, type 2 diabetes mellitus, current insulin therapy, and evaluate glycemic control and maternal weight; assess for any contraindications to metformin (e.g., renal impairment, GI intolerance).

STEP 2 — Rule In / Rule Out

Is the patient pregnant with preexisting type 2 diabetes and currently on insulin? If yes, proceed to Step 3; if no, this guideline does not apply.

STEP 3 — Classify or Stratify

Assess whether there is a specific, evidence-based indication for metformin beyond routine glycemic control (e.g., severe insulin resistance requiring dose reduction) versus routine consideration; if no specific indication, classify as routine addition scenario.

STEP 4 — Decide

Do not routinely add metformin to insulin; continue insulin monotherapy and optimize insulin dosing based on glucose monitoring; consider metformin only in exceptional cases after shared decision-making discussing potential risks (e.g., increased SGA, adverse childhood outcomes).

Clinical Guardrails / Mimics / Pitfalls

Avoid adding metformin solely to reduce insulin dose or gestational weight gain without weighing potential fetal harms; do not overlook placental transfer of metformin and associated risks of fetal growth restriction and long-term metabolic effects; do not use metformin as a substitute for insulin in type 2 diabetes pregnancy.

Concrete Clinical Example

A 32-year-old pregnant woman with type 2 diabetes on basal-bolus insulin reports persistent hyperglycemia despite dose titration; clinician considers adding metformin but, after discussing lack of benefit for LGA reduction versus potential SGA increase, decides against routine metformin addition and intensifies insulin regimen instead.

Source: Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline, Endocrine Society and European Society of Endocrinology, 2025, DOI: 10.1210/clinem/dgaf288

---name: pdm-metformin-insulin-avoiddescription: Recommends against routine addition of metformin to insulin for pregnant individuals with type 2 diabetes already on insulin. Triggered when considering adding metformin to an insulin regimen in pregnancy for patients with type 2 diabetes.---# Avoid routine addition of metformin to insulin in pregnancy with type 2 diabetes## STEP 1 — Gather InformationConfirm pregnancy diagnosis, type 2 diabetes mellitus, current insulin therapy, and evaluate glycemic control and maternal weight; assess for any contraindications to metformin (e.g., renal impairment, GI intolerance).## STEP 2 — Rule In / Rule OutIs the patient pregnant with preexisting type 2 diabetes and currently on insulin? If yes, proceed to Step 3; if no, this guideline does not apply.## STEP 3 — Classify or StratifyAssess whether there is a specific, evidence-based indication for metformin beyond routine glycemic control (e.g., severe insulin resistance requiring dose reduction) versus routine consideration; if no specific indication, classify as routine addition scenario.## STEP 4 — DecideDo not routinely add metformin to insulin; continue insulin monotherapy and optimize insulin dosing based on glucose monitoring; consider metformin only in exceptional cases after shared decision-making discussing potential risks (e.g., increased SGA, adverse childhood outcomes).## Clinical Guardrails / Mimics / PitfallsAvoid adding metformin solely to reduce insulin dose or gestational weight gain without weighing potential fetal harms; do not overlook placental transfer of metformin and associated risks of fetal growth restriction and long-term metabolic effects; do not use metformin as a substitute for insulin in type 2 diabetes pregnancy.## Concrete Clinical ExampleA 32-year-old pregnant woman with type 2 diabetes on basal-bolus insulin reports persistent hyperglycemia despite dose titration; clinician considers adding metformin but, after discussing lack of benefit for LGA reduction versus potential SGA increase, decides against routine metformin addition and intensifies insulin regimen instead.**Source:** Preexisting Diabetes and Pregnancy: An Endocrine Society and European Society of Endocrinology Joint Clinical Practice Guideline, Endocrine Society and European Society of Endocrinology, 2025, DOI: 10.1210/clinem/dgaf288

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