{
  "id": "medical/insulin-pump-circadian-basal-rate-miss",
  "signature": "AI programs an insulin pump with a 24-hour basal rate profile that ignores circadian insulin sensitivity, causing nocturnal hypoglycemia and dawn phenomenon hyperglycemia",
  "signature_zh": "AI 为胰岛素泵编程的 24 小时基础率曲线忽略昼夜胰岛素敏感性，导致夜间低血糖和黎明现象高血糖",
  "regex": "(basal\\s*rate|insulin\\s*pump|24h\\s*profile|circadian).*(hypoglycemia|dawn|hyperglycemia)",
  "domain": "medical",
  "category": "data_error",
  "subcategory": null,
  "root_cause": "Circadian insulin sensitivity varies: early morning (dawn phenomenon) requires higher basal rate, while midnight to 3 AM requires lower basal rate to prevent hypoglycemia. AI often uses a flat or incorrectly shaped basal profile, ignoring these physiological patterns.",
  "root_cause_type": "generic",
  "root_cause_zh": "昼夜胰岛素敏感性不同：清晨（黎明现象）需较高基础率，午夜至凌晨 3 点需较低基础率以防低血糖。AI 常使用平坦或形状错误的基础率曲线，忽略这些生理模式。",
  "versions": [
    {
      "version": "Medtronic MiniMed 780G 2.0",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Tandem t:slim X2 1.5",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "Insight 1.4.2",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "Use a single flat basal rate for 24 hours to simplify programming",
      "why_fails": "Flat rate causes nocturnal hypoglycemia (too high at 2 AM) and morning hyperglycemia (too low at 6 AM) in most patients",
      "fail_rate": 0.8,
      "condition": "",
      "sources": []
    },
    {
      "action": "Set lowest basal rate at midnight and highest at noon, following a simple sine wave",
      "why_fails": "The physiological nadir is 2-3 AM, not midnight; and peak is 6-8 AM (dawn phenomenon), not noon. A sine wave is too simplistic and mismatches real patterns",
      "fail_rate": 0.65,
      "condition": "",
      "sources": []
    },
    {
      "action": "Use the same basal profile for all patients, adjusting only total daily dose",
      "why_fails": "Circadian patterns vary significantly between individuals; a one-size-fits-all profile causes poor glycemic control",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Program a multi-step basal profile with 2-3 hour segments. Example for typical adult: 00:00-03:00: 0.8 U/h, 03:00-06:00: 1.0 U/h, 06:00-09:00: 1.3 U/h, 09:00-12:00: 1.1 U/h, 12:00-18:00: 1.0 U/h, 18:00-24:00: 0.9 U/h. Then fine-tune based on CGM data over 3-5 days.",
      "success_rate": 0.88,
      "how": "Program a multi-step basal profile with 2-3 hour segments. Example for typical adult: 00:00-03:00: 0.8 U/h, 03:00-06:00: 1.0 U/h, 06:00-09:00: 1.3 U/h, 09:00-12:00: 1.1 U/h, 12:00-18:00: 1.0 U/h, 18:00-24:00: 0.9 U/h. Then fine-tune based on CGM data over 3-5 days.",
      "condition": "",
      "sources": []
    },
    {
      "action": "Use automated basal rate optimization via hybrid closed-loop algorithm (e.g., Control-IQ or SmartGuard) that adjusts basal every 5 minutes based on CGM trend. This bypasses manual profile errors.",
      "success_rate": 0.92,
      "how": "Use automated basal rate optimization via hybrid closed-loop algorithm (e.g., Control-IQ or SmartGuard) that adjusts basal every 5 minutes based on CGM trend. This bypasses manual profile errors.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "Program a multi-step basal profile with 2-3 hour segments. Example for typical adult: 00:00-03:00: 0.8 U/h, 03:00-06:00: 1.0 U/h, 06:00-09:00: 1.3 U/h, 09:00-12:00: 1.1 U/h, 12:00-18:00: 1.0 U/h, 18:00-24:00: 0.9 U/h. Then fine-tune based on CGM data over 3-5 days.",
    "Use automated basal rate optimization via hybrid closed-loop algorithm (e.g., Control-IQ or SmartGuard) that adjusts basal every 5 minutes based on CGM trend. This bypasses manual profile errors."
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/insulin-pumps/basal-rates",
  "official_doc_section": null,
  "error_code": "MED-PUMP-010",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.78,
  "resolvable": "true",
  "first_seen": "2023-09-20",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}