菜单
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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For a person with confirmed islet autoantibodies (early-stage type 1 diabetes), state the numerical progression risk to Stage 3 T1D by stage and age, set the age-stratified monitoring frequency (metabolic and HbA1c), apply the ≥10% longitudinal HbA1c rise → OGTT rule, and give the standard risk-modifier and communication framing. Use when a clinician asks how often should I monitor this Stage 1 child, what's the risk of this teenager progressing to insulin, adult with GAD positive what's the 5-year risk, my patient's HbA1c has risen 12% is that important, single autoantibody how often to retest, or how to counsel a family about progression risk. Grounded in Phillip et al. Diabetologia 2024 international staging and monitoring consensus, cross-referenced with Hussain et al 2026 IDF Europe roadmap.
Order and confirm islet autoantibody screening for early-stage type 1 diabetes — which antibodies to test (GAD65, IAA, IA2, ZnT8), sample types (capillary dried blood spot, venous), the mandatory two-sample two-method confirmation protocol, and how to interpret a positive, negative, or single-antibody result. Use when a clinician asks how to screen for early T1D, which islet autoantibodies to order, how to confirm a positive T1D antibody screen, is one autoantibody enough for T1D diagnosis, GAD antibody positive what next, or is running a general population or family-history T1D screening program. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
Classify a person with a positive islet autoantibody screen into a specific stage of type 1 diabetes (At Risk / Stage 1 / Stage 2a / Stage 2b / Stage 3a / Stage 3b / Stage 4) using the international consensus staging framework based on autoantibody count and glycaemic status. Use when a clinician asks how to stage a positive autoantibody screen, what stage of T1D is this, is this early-stage T1D, does this child need insulin yet, is this presymptomatic T1D, does this qualify for teplizumab, or presents a person with any combination of islet autoantibodies + glucose data. Applies across paediatric and adult populations. Grounded in Hussain et al 2026 (Diabetes, Obesity and Metabolism, IDF Europe consensus, DOI 10.1111/dom.70569).
基于 SOC 职业分类
正在显示 SKILL.md
| name | endo-assess-backup-plan-injected-insulin |
| description | 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'. |
Collect current pump settings (basal rates, bolus insulin-to-carbohydrate ratio, correction factor), total daily dose, carbohydrate counting proficiency, ability to operate pump and troubleshoot alarms, knowledge of sick-day rules, and availability of emergency supplies (syringes/pens, long-acting and rapid-acting insulin, glucose tablets, glucagon).
Does the patient have a documented back-up plan for injected insulin if the pump fails?
Classify the back-up plan as adequate if it includes:
If adequate: Reinforce the plan, review annually or with device changes, and ensure supplies are current.
If inadequate: Collaborate with the patient to develop a written back‑up plan, provide education on basal‑bolus conversion, carbohydrate counting, sick‑day management, and prescribe necessary injection supplies.
Do not assume the patient knows how to convert pump basal to basal insulin without calculation. Avoid giving vague instructions; provide specific doses and ratios. Do not overlook hypoglycemia treatment or DKA prevention in the plan. Never rely solely on memory; ensure the plan is written and accessible.
A 28‑year‑old using a Medtronic 670G pump with basal 1.0 U/hr (total 24 U/day), bolus ratio 1:10 g carb, correction factor 1 U per 50 mg/dL >150 mg/dL. If pump fails, the back‑up plan is insulin glargine 24 U subcut daily at bedtime, insulin aspart 1 U per 10 g carbs plus correction per glucose, with glucose checks every 2‑4 hrs, ketone monitoring if glucose >250 mg/dL, and glucagon kit available.
Source: Diabetes Technology—Continuous Subcutaneous Insulin Infusion Therapy and Continuous Glucose Monitoring in Adults: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2016, DOI:10.1210/jc.2016-2534