# AI instructs a Type 1 diabetic to delay pre-meal insulin bolus until after eating, causing postprandial hyperglycemia

- **ID:** `medical/insulin-bolus-timing-missed`
- **Domain:** medical
- **Category:** health_risk
- **Error Code:** `DIABETES-BOLUS-TIMING-001`
- **Verification:** ai_generated
- **Fix Rate:** 82%

## 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.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| ADA Standards of Care 2024 | active | — | — |
| NICE Guideline NG28 | active | — | — |
| Dexcom G7 software v1.4.0 | active | — | — |

## Workarounds

1. **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.'** (85% success)
   ```
   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.'
   ```
2. **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.'** (78% success)
   ```
   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.'
   ```

## Dead Ends

- **** — Post-meal bolus still misses the insulin peak; monitoring does not correct the pharmacokinetic mismatch (75% fail)
- **** — Splitting complicates dosing and still delays full insulin action; not standard therapy for most meals (60% fail)
- **** — Regular insulin has slower onset (30-60 min) and longer duration, increasing hypoglycemia risk if timed incorrectly (70% fail)