| name | es-cc-outpatient-preference |
| description | This skill determines whether a patient performs carbohydrate counting in the outpatient setting, including insulin-treated type 2 diabetes, and may prefer to continue this method during hospitalization. Clinical triggers include questions such as "Patient uses carb counting at home, should we allow continuation in hospital?" |
Determine if patient performs carbohydrate counting in outpatient setting and may prefer to continue during hospitalization
STEP 1 — Gather Information
Collect diabetes type (T1D, T2D, noninsulin-treated T2D), outpatient carbohydrate counting use (yes/no), insulin treatment status, and hospital resources (CC policy, expertise, ability to adjust insulin-to-carbohydrate ratio); document findings.
STEP 2 — Rule In / Rule Out
If patient does NOT use carbohydrate counting in outpatient setting → Rule out continuation of CC; select alternative prandial insulin dosing per insulin status (noninsulin-treated T2D: follow Rec 9.1; insulin-treated T2D/T1D: follow Rec 9.2 with fixed dosing). If patient DOES use carbohydrate counting in outpatient setting → Proceed to step 3.
STEP 3 — Classify or Stratify
Classify patient as insulin-treated (T1D or insulin-treated T2D) or noninsulin-treated T2D based on outpatient insulin use.
STEP 4 — Decide
If patient uses CC outpatient AND is insulin-treated → Recommend continuation of CC during hospitalization with individualized ICR adjustments, provided hospital has CC policy and expertise. If patient uses CC outpatient but is noninsulin-treated T2D → Recommend against CC; use fixed prandial insulin dosing. If patient does not use CC outpatient → Follow recommendation per insulin status: noninsulin-treated T2D requiring prandial insulin: suggest not using CC (Rec 9.1); insulin-treated T2D/T1D: suggest either CC or fixed dosing (Rec 9.2).
Clinical Guardrails / Mimics / Pitfalls
Do not assume patient wants to continue CC without confirming outpatient use; do not implement CC without hospital policy and expertise; avoid CC in noninsulin-treated T2D per guideline; adjust ICR for illness-related insulin resistance; avoid CC if patient lacks capacity to self-manage due to cognitive/functional limitations.
Concrete Clinical Example
A 58-year-old with type 1 diabetes uses carbohydrate counting at home, admitted for pneumonia. Patient confirms outpatient CC use, insulin-treated. Hospital has diabetes educator and CC policy. Decision: Continue CC during hospitalization with ICR verification and adjustments for infection-related insulin resistance.
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
