{
  "id": "medical/insulin-bolus-timing-missed",
  "signature": "AI instructs a Type 1 diabetic to delay pre-meal insulin bolus until after eating, causing postprandial hyperglycemia",
  "signature_zh": "AI建议1型糖尿病患者将餐前胰岛素推注延迟到餐后，导致餐后高血糖",
  "regex": "insulin.*(?:delay|post-meal|after.eat|timing.miss)",
  "domain": "medical",
  "category": "health_risk",
  "subcategory": null,
  "root_cause": "Rapid-acting insulin (e.g., lispro, aspart) must be administered 15-20 minutes before a meal to match the glucose absorption curve; post-meal bolus misses the insulin peak, leading to dangerous postprandial spikes above 250 mg/dL.",
  "root_cause_type": "generic",
  "root_cause_zh": "速效胰岛素（如赖脯胰岛素、门冬胰岛素）必须在餐前15-20分钟注射，以匹配葡萄糖吸收曲线；餐后推注错过胰岛素峰值，导致餐后血糖飙升至250 mg/dL以上，有危险。",
  "versions": [
    {
      "version": "ADA Standards of Care 2024",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "NICE Guideline NG28",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Dexcom G7 software v1.4.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Post-meal bolus still misses the insulin peak; monitoring does not correct the pharmacokinetic mismatch",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Splitting complicates dosing and still delays full insulin action; not standard therapy for most meals",
      "fail_rate": 0.6,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Regular insulin has slower onset (30-60 min) and longer duration, increasing hypoglycemia risk if timed incorrectly",
      "fail_rate": 0.7,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Instruct the patient to administer rapid-acting insulin 15-20 minutes before starting the meal. Use a timer or app reminder. For example: 'Set a 15-minute alarm after injecting, then begin eating.'",
      "success_rate": 0.85,
      "how": "Instruct the patient to administer rapid-acting insulin 15-20 minutes before starting the meal. Use a timer or app reminder. For example: 'Set a 15-minute alarm after injecting, then begin eating.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "If pre-meal timing is not possible (e.g., unpredictable eating schedule), use an insulin pump with extended bolus feature or ultra-rapid insulins (e.g., Fiasp) that can be taken at meal start with tighter window. Document in patient log: 'Bolus at meal start, not after.'",
      "success_rate": 0.78,
      "how": "If pre-meal timing is not possible (e.g., unpredictable eating schedule), use an insulin pump with extended bolus feature or ultra-rapid insulins (e.g., Fiasp) that can be taken at meal start with tighter window. Document in patient log: 'Bolus at meal start, not after.'",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Instruct the patient to administer rapid-acting insulin 15-20 minutes before starting the meal. Use a timer or app reminder. For example: 'Set a 15-minute alarm after injecting, then begin eating.'",
    "If pre-meal timing is not possible (e.g., unpredictable eating schedule), use an insulin pump with extended bolus feature or ultra-rapid insulins (e.g., Fiasp) that can be taken at meal start with tighter window. Document in patient log: 'Bolus at meal start, not after.'"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/insulin/timing-of-insulin",
  "official_doc_section": null,
  "error_code": "DIABETES-BOLUS-TIMING-001",
  "verification_tier": "ai_generated",
  "confidence": 0.88,
  "fix_success_rate": 0.82,
  "resolvable": "true",
  "first_seen": "2024-03-15",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}