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
AI instructs a Type 1 diabetic to delay pre-meal insulin bolus until after eating, causing postprandial hyperglycemia
ID: medical/insulin-bolus-timing-missed
版本兼容性
| 版本 | 状态 | 引入 | 弃用 | 备注 |
|---|---|---|---|---|
| ADA Standards of Care 2024 | active | — | — | — |
| NICE Guideline NG28 | active | — | — | — |
| Dexcom G7 software v1.4.0 | active | — | — | — |
根因分析
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。
English
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.
官方文档
https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/insulin/timing-of-insulin解决方案
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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.'
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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.'
无效尝试
常见但无效的做法:
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75% 失败
Post-meal bolus still misses the insulin peak; monitoring does not correct the pharmacokinetic mismatch
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60% 失败
Splitting complicates dosing and still delays full insulin action; not standard therapy for most meals
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70% 失败
Regular insulin has slower onset (30-60 min) and longer duration, increasing hypoglycemia risk if timed incorrectly