Confirms patient understands that continuous glucose monitoring complements but does not replace self-monitoring of blood glucose. Triggers include: 'Clarify CGM role alongside fingersticks', 'Ensure patient knows CGM does not eliminate need for SMBG'.
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Recommends discontinuation of GLP-1RA before conception rather than between start of pregnancy and end of first trimester for individuals with type 2 diabetes who are planning pregnancy. Trigger when clinician considers stopping GLP-1RA therapy in a patient with type 2 diabetes who is planning pregnancy or seeking preconception care.
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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 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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Assesses that CGM low- and high-glucose alarm thresholds are individualized to optimize patient benefit and minimize alarm fatigue. Triggered by clinician prompts to 'Review low-glucose alarm thresholds' or 'Ensure alarms are individualized and not excessive'.
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Reassesses annually the patient’s use of self-monitoring blood glucose to calibrate the CGM system. Triggered by ‘Yearly calibration practice review’ or ‘Annual check of SMBG calibration adherence’.
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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 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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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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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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Recommends early delivery based on individualized risk assessment rather than expectant management for pregnant patients with preexisting diabetes mellitus (PDM). Consider when evaluating delivery timing in the presence of diabetes‑related complications, suboptimal glycemia, abnormal fetal growth, or maternal comorbidities that may increase perinatal risk beyond 38 weeks gestation.
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Evaluates basal insulin rates through basal rate testing across different time periods and adjusts as indicated. Triggered by clinician orders to 'Perform basal rate test to verify pump settings' or 'Check basal rates during periodic pump review'.
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Suggests either continuous glucose monitor (CGM) or self-monitoring of blood glucose (SMBG) for pregnant individuals with type 2 diabetes. Triggers include decisions about glucose monitoring methods for pregnant patients with T2DM needing a monitoring strategy.
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Assesses whether a patient performs self-monitoring blood glucose (SMBG) fingerstick calibrations as required for their real-time CGM system. Triggers include: 'Verify patient performs fingerstick calibrations', 'Ensure calibration schedule is followed'.
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The skill suggests using real-time continuous glucose monitoring (CGM) combined with algorithm-driven insulin pumps (ADIPs) rather than multiple daily injections (MDIs) with self-monitoring of blood glucose (SMBG) three or more times daily for adults and children with type 1 diabetes (T1D) to lower hypoglycemia incidence. Clinical triggers include discussions about insulin pump therapy, CGM use, or reducing hypoglycemia in T1D patients on intensive insulin regimens.
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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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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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Recommends real-time continuous glucose monitoring (RT-CGM) for adult patients with type 1 diabetes mellitus (T1DM) whose hemoglobin A1C is above individualized target. Consider when clinician notes 'T1DM A1C above goal, consider RT-CGM' or 'Patient willing to wear CGM daily, A1C elevated'.
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Suggests initiating inpatient continuous glucose monitoring (CGM) for select hospitalized patients at high risk for hypoglycemia, combined with periodic point-of-care glucose checks for accuracy. Triggers include planning glucose monitoring for inpatients with prior severe hypoglycemia, renal or hepatic dysfunction, or age 65 years or older.
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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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Suggests CSII with good adherence to monitoring and dosing for adults with type 2 diabetes mellitus who have poor glycemic control despite intensive insulin therapy, oral agents, other injectable therapy, and lifestyle modifications. Trigger phrases include 'T2DM on multiple injectables still uncontrolled' and 'Consider pump for insulin-requiring T2DM failing other therapies'.
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This skill guides clinicians to reassess glucose monitoring frequency when discontinuing continuous subcutaneous insulin infusion (CSII) or transitioning to multiple daily injections (MDI). It is triggered by phrases such as 'Plan for glucose monitoring after pump stop' or 'Determine SMBG/CGM frequency post-pump' to ensure individualized glycemic goals are met.
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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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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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