---
name: diabetes
description: Manage diabetes-specific health context and tracking using a focused `diabetes.md` file plus synchronized updates to `health.md`. Use when a user has diabetes (type 1, type 2, gestational, or unspecified), may have diabetes, is discussing blood glucose, HbA1c, hypoglycemia/hyperglycemia symptoms, diabetes medications, glucose monitoring, diabetes self-management questions, or when an agent needs to record diabetes follow-up questions while keeping the master health record updated.
---

# Diabetes

## Overview

Use this skill for diabetes as a condition-specific grounding and tracking layer. Maintain detailed diabetes information in `diabetes.md`, while keeping `health.md` updated with diabetes status, skill attachment, linked file entry, and open follow-up questions.

## Medical Grounding (Load First)

- This skill and its reference files are **not reviewed by a medical professional**.
- Before answering diabetes-specific health questions, read `references/diabetes-clinical-grounding.md`.
- Use it to ground responses in core diabetes priorities, red flags, and high-value follow-up questions.
- Treat it as a high-level clinical orientation for the agent, not a clinical protocol or individualized treatment plan.
- If the user asks for region-specific recommendations, clarify country/region and defer to local guidelines where they differ.

## Core Workflow

Follow these steps in order unless the user requests a narrower action.

### 1. Confirm Scope and Safety

- Identify whether the user is:
  - describing diagnosed diabetes
  - describing possible diabetes / abnormal glucose findings
  - asking a general diabetes question without personal diagnosis
- If diagnosis/status is uncertain, coordinate with `health` skill behavior:
  - use `Unconfirmed Findings` in `health.md` for inferred/uncertain diabetes
  - ask targeted follow-up questions before treating it as a confirmed diagnosis
- If severe symptoms or possible urgent complications are mentioned, prioritize urgent care / emergency guidance instead of routine tracking.

### 2. Update `health.md` (Master Record)

- Ensure diabetes appears in `## Active Health Contexts` when confirmed and active.
- Ensure `diabetes` appears in `## Skill Attachments` (`Suggested` or `Active`).
- Ensure `diabetes.md` appears in `## Linked Health Files` once created.
- Add or update diabetes-related entries in `## Information Gaps & Follow-up Questions`.
- Add provenance and confidence for agent-added facts.

### 3. Create or Update `diabetes.md` (Focused Record)

- Create `diabetes.md` if it does not exist and diabetes is confirmed (or the user explicitly wants diabetes tracking).
- Use `diabetes.md` for detailed diabetes-specific information that would clutter `health.md`.
- Keep the file human-readable and structured with stable headings.

### 4. Ask High-Value Diabetes Follow-up Questions

- Ask only what materially affects guidance or safety.
- Prioritize:
  - diabetes type (if known)
  - severe symptoms / urgent concerns
  - glucose monitoring method and recent readings (if relevant)
  - medications (including insulin and non-insulin diabetes meds)
  - recent HbA1c (if known)
  - care team / clinician follow-up
- Store unanswered questions back in `health.md`.

### 5. Keep Advice Context-Aware and Conservative

- Frame answers with diabetes context in mind (and other active contexts in `health.md`, such as pregnancy).
- Avoid certainty when key details are missing.
- Encourage clinician follow-up for medication changes, insulin dosing changes, and urgent symptoms.

## `diabetes.md` Structure (Recommended)

Use these sections when relevant. Skip sections that do not apply.

```markdown
# Diabetes Record

## Diabetes Status
- **Status:** Confirmed / Suspected / Resolved
- **Type:** Type 1 / Type 2 / Gestational / Prediabetes / Unspecified
- **Source:** user_reported / clinician_verified / ehr_export / journal_inferred
- **Confidence:** High / Medium / Low
- **Last Confirmed:** YYYY-MM-DD

## Diagnosis and History
- **Diagnosis Date:** YYYY-MM-DD (if known)
- **History Summary:** brief
- **Relevant Complications History:** none / list
- **Other Relevant Conditions:** hypertension, kidney disease, pregnancy, etc.

## Monitoring
- **Monitoring Method:** fingerstick / CGM / none
- **Recent Readings:** optional summary
- **Patterns Noted:** highs/lows, fasting/post-meal patterns
- **Last HbA1c:** value + date (if known)

## Medications
- **Insulin:** details (if any)
- **Non-Insulin Diabetes Medications:** details
- **Other Relevant Medications:** optional
- **Medication Questions for Clinician:** list

## Symptoms / Events
- **Current Symptoms:** list
- **Hypoglycemia Episodes:** none / details
- **Hyperglycemia Episodes:** none / details
- **Urgent Symptoms Reported:** none / list

## Care Team and Follow-up
- **Primary Diabetes Clinician:** PCP / Endocrinology / Clinic
- **Next Appointment:** YYYY-MM-DD (if known)
- **Education / Nutrition Support:** optional

## Goals and Self-Management (Optional)
- User goals, clinician-set targets, routines, barriers

## Follow-up Questions
- Open items for future conversations

## Notes
- Free-text notes and clarifications
```

## Sync Rules with `health.md`

- `health.md` remains the master health record and index.
- `diabetes.md` is the detailed companion file.
- When updating `diabetes.md`, also check whether `health.md` needs updates in:
  - `Active Health Contexts`
  - `Skill Attachments`
  - `Linked Health Files`
  - `Information Gaps & Follow-up Questions`
- Keep summaries short in `health.md` and details in `diabetes.md`.

## Safety Boundaries

- This skill is **not reviewed by a medical professional**.
- Do not use this skill as a substitute for medical care.
- Escalate possible severe hypoglycemia, severe hyperglycemia, or other urgent symptoms using urgent/emergency care guidance.
- Do not provide definitive insulin dosing adjustments or medication changes without appropriate clinical confirmation.
- State limitations clearly when diabetes type, medications, or recent readings are unclear.

## References

- Read `references/diabetes-record-pattern.md` for a canonical `diabetes.md` template and `health.md` sync checklist.
- Read `references/diabetes-clinical-grounding.md` for current diabetes-focused medical grounding and safety priorities.