# 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

- **ID:** `medical/insulin-bolus-timing-missed`
- **领域:** medical
- **类别:** health_risk
- **错误码:** `DIABETES-BOLUS-TIMING-001`
- **验证级别:** ai_generated
- **修复率:** 82%

## 根因

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。

## 版本兼容性

| 版本 | 状态 | 引入 | 弃用 |
|------|------|------|------|
| ADA Standards of Care 2024 | active | — | — |
| NICE Guideline NG28 | active | — | — |
| Dexcom G7 software v1.4.0 | active | — | — |

## 解决方案

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.'
   ```
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.'
   ```

## 无效尝试

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