# AI instructs a diabetic patient to skip meal-time insulin bolus if blood glucose is 'normal' before eating

- **ID:** `medical/insulin-pump-carb-count-omission`
- **Domain:** medical
- **Category:** runtime_error
- **Error Code:** `DIABETES_BOLUS_OMIT`
- **Verification:** ai_generated
- **Fix Rate:** 92%

## Root Cause

Bolus insulin is required to cover carbohydrate intake regardless of pre-meal glucose level; omitting it causes postprandial hyperglycemia and diabetic ketoacidosis risk.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| insulin_pump_firmware_4.2 | active | — | — |
| cgm_software_2024.1 | active | — | — |
| diabetes_app_5.3 | active | — | — |

## Workarounds

1. **Always calculate bolus based on carbohydrate intake: (carbs_in_grams / insulin_to_carb_ratio) + correction_factor. Example: if ratio is 1:10 and meal has 60g carbs, inject 6 units.** (92% success)
   ```
   Always calculate bolus based on carbohydrate intake: (carbs_in_grams / insulin_to_carb_ratio) + correction_factor. Example: if ratio is 1:10 and meal has 60g carbs, inject 6 units.
   ```
2. **Use a bolus calculator app like MySugr or Accu-Chek Connect that integrates with your pump. Code: `bolus_units = (carbs / icr) + ((current_glucose - target_glucose) / isf)` where icr=insulin-to-carb ratio, isf=insulin sensitivity factor.** (88% success)
   ```
   Use a bolus calculator app like MySugr or Accu-Chek Connect that integrates with your pump. Code: `bolus_units = (carbs / icr) + ((current_glucose - target_glucose) / isf)` where icr=insulin-to-carb ratio, isf=insulin sensitivity factor.
   ```

## Dead Ends

- **** — User assumes AI's advice is safe because it matches common sense (don't take medicine if not needed) (85% fail)
- **** — User checks only fasting glucose and ignores meal composition (70% fail)