Other skills

Assess whether a hospitalized adult with diabetes on insulin pump therapy remains a candidate for continued inpatient pump use. Consider triggers such as the clinician asking "Is this patient appropriate to continue insulin pump in hospital?" and evaluate for impaired consciousness, inability to adjust pump settings, critical illness, DKA, or hyperosmolar hyperglycemic state.

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This skill determines whether inpatient diabetic patients meet high-risk criteria for CGM initiation using Table 3 factors such as age ≥65 years, BMI ≤27 kg/m², type 1 diabetes, insulin regimen, and specific clinical conditions. It is triggered by clinician questions like "Should I assess this inpatient for CGM initiation based on hypoglycemia risk?" or "Is this patient a candidate for inpatient CGM?"

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Suggests initiating inpatient CGM for select diabetic patients at high risk for hypoglycemia based on Table 3 criteria. Triggers include "Should I initiate CGM for this hospitalized diabetic patient at high risk for hypoglycemia?" or "Is inpatient CGM warranted for this patient?"

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This skill advises against using a single 24-hour CGM target <140 mg/dL when managing glucose in pregnancy for patients with preexisting diabetes. Trigger when a clinician is determining CGM-based glucose targets for pregnant individuals with type 1 or type 2 diabetes.

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Recommends contraception when pregnancy is not desired for individuals with diabetes who could become pregnant. Triggered by discussions about pregnancy planning, contraception needs, or when pregnancy is not desired.

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Suggests continuous subcutaneous insulin infusion (CSII) for adults with type 1 diabetes mellitus who desire increased insulin delivery flexibility or improved treatment satisfaction and are capable of using the device. Clinical triggers include statements such as 'Patient wants more lifestyle flexibility with insulin' or 'Consider pump for improved satisfaction in T1DM'.

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Recommends continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) for adults with type 1 diabetes who have achieved their A1C goal but experience severe hypoglycemia or high glucose variability, provided the patient and caregivers are willing and able to use the device. Consider CSII when clinicians hear 'A1C is at goal but patient has severe lows or glucose swings' or think 'pump for hypoglycemia-prone controlled T1DM'.

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Assesses the patient’s ability to troubleshoot insulin pump malfunctions such as occlusion, battery failure, or error messages. Trigger phrases include “Review pump alarm responses” and “Ensure patient knows steps for pump error”.

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Recommends continuing insulin pump therapy in hospitals with pump expertise; otherwise transitioning to scheduled subcutaneous basal bolus insulin if anticipated length of stay exceeds 1–2 days before pump discontinuation. Consider this when anticipating a hospital stay >2 days, lacking pump expertise, or needing to conserve supplies.

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Evaluates patient-specific factors such as lifestyle, motivation, and barriers that may affect successful CGM use. Triggered when clinicians discuss patient’s readiness for CGM or identify obstacles to consistent sensor wear.

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Assesses patient's ability to identify the receiver, sensor, and transmitter components of a real-time CGM system. Triggered by clinician requests to review CGM parts or verify patient can name sensor, transmitter, and receiver.

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Evaluates the patient’s plan for using injected insulin in case of pump failure, including knowledge of basal-bolus dosing. Triggered by phrases such as 'Discuss sick-day plan for pump failure' or 'Review transition to injections if pump stops'.

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Reassesses annually the patient’s ability to use CGM trend information to adjust insulin doses. Triggered by yearly CGM skills check or annual review of trend-based dosing competence.

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This skill reassesses the insulin plan when discontinuing continuous subcutaneous insulin infusion (CSII) and transitioning to multiple daily injections (MDI). It is triggered by phrases such as 'Review planned basal-bolus regimen after pump' and 'Confirm MDI dose calculations and schedule'.

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Performs a structured pre‑prescription evaluation of mental/psychological status, prior diabetes self‑care adherence, willingness/interest in CSII, and availability for follow‑up visits. Triggers include: 'Evaluating pump candidacy', 'Pre‑pump checklist: psych, adherence, motivation, follow-up'.

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This skill screens for pregnancy intention in individuals with preexisting diabetes at every reproductive, diabetes, primary care, and urgent care/ER visit when clinically appropriate. Trigger phrases include reproductive planning, preconception care, or pregnancy intention discussion.

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Evaluates patient’s selection of sensor insertion sites and site care to prevent irritation or infection. Triggers include: 'Review CGM site rotation', 'Check sensor site hygiene and adhesion'.

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Recommends continuing a patient’s personal continuous glucose monitor (CGM) in the hospital with or without algorithm-driven insulin pump (ADIP) therapy rather than discontinuing it for individuals already using CGM outpatient. Use when deciding whether to maintain personal CGM during admission or when a patient requests to keep their device, particularly in those at high risk for hypoglycemia.

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Recommends postpartum endocrine care (diabetes management) in addition to usual obstetric care for individuals with preexisting diabetes (including those with pregnancy loss or termination). Triggered by postpartum care planning for patients with diabetes after delivery.

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This skill guides clinicians to assess bolus calculator settings when reviewing pump settings or verifying carb ratio and sensitivity factor during clinic visits. It evaluates insulin-to-carbohydrate ratio, insulin sensitivity factor, glucose targets, and active insulin time for embedded bolus calculators in CSII.

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Evaluates patient’s ability to use CGM trend information (arrows, rate of change) to make insulin dose adjustments. Triggers include reviewing patient’s response to CGM trends and checking if patient adjusts bolus based on glucose direction.

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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.

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Recommends use of hybrid closed-loop pump rather than insulin pump with CGM (without algorithm) or multiple daily injections with CGM for pregnant individuals with type 1 diabetes. Triggered when deciding on insulin delivery methods for pregnant patients with type 1 diabetes.

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Assesses the patient’s ability to prevent, detect, and treat hypoglycemia, including recognition of symptoms, appropriate carbohydrate treatment, and use of emergency glucagon. Triggered when clinicians review the hypoglycemia action plan or check whether the patient recognizes low symptoms and treatment steps.

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