Audit: QRS - Humulin R for Health & Longevity

Audit conducted on 04/09/2026 14:43 using AI4L / Opus 5

Iterations

Summary

Items	Count
Total	93
Passed	83
Failed	0
N/A	10
Pass Rate	100.00%

• Total = Passed + Failed + N/A
• Pass Rate = Passed / (Passed + Failed) × 100
• N/A items are excluded from the pass rate calculation

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1. General Rules

#	Description	Result	Comments
1.1	Every claim, magnitude, label, recommendation, and statement in the QRS is literally supported by content in the source ER.	🟢	Spot-checked every populated span against the ER; all trace to ER text (e.g. at-a-glance to ER Conclusion L470-472, marker rows to ER table L435-442).
1.2	Where the ER uses cautious phrasing (“not formally studied”, “None documented in human trials to date”, “theoretical concern”, “data are limited”), the QRS uses the same phrasing.	🟢	Hedges preserved: ER “is unresolved” (L472) carried as “are unresolved”; ER Speculative tiers kept as Speculative.
1.3	The QRS never strengthens an ER claim (e.g., “not formally studied” → “not required”) or softens one (e.g., “do not use during pregnancy” → “use with caution during pregnancy”).	🟢	No claim strengthened or softened; absolute contraindications remain in the Contraindications gate, cautions remain in Key Interactions.
1.4	The QRS does not relabel an ER fact under a different decision category. A “Benefit-Modifying Factor” from ER section is not surfaced as a “Caution”; a “Risk-Modifying Factor” is not surfaced as a “Side Effect”; etc.	🟢	No cross-category relabelling; Benefit- and Risk-Modifying Factors (ER L199-211, L281-289) are not surfaced anywhere in the QRS.
1.5	PubMed IDs, study citations, expert names, clinical trial identifiers (NCT*), and brand names appear in the QRS only if they appear in the source ER for the same fact.	🟢	No PMIDs, NCT IDs, study citations or expert names in the QRS; brand terms used (Humulin R, U-500, NPH) all appear in the ER.
1.6	The QRS does not introduce new attributions.	🟢	No attributions of any kind are introduced.

2. Focus, Tone & Audience

#	Description	Result	Comments
2.1	The QRS follows the tone of the ER, which is determined by the ER’s own language, phrasing, and framing.	🟢	Matches the ER’s register, including its own “blood sugar” / “low blood sugar” phrasing (ER L154, L222, L470).
2.2	The tone of the QRS is simultaneously expert, accessible, objective, and data-driven, but also empowering and encouraging	🟢	Expert and data-driven (thresholds, ranges, durations) while remaining accessible.
2.3	The QRS reads as a trusted, knowledgeable guide rather than a prescriptive doctor	🟢	Presents evidence and ranges rather than issuing instructions.
2.4	The QRS avoids language that implies medical or clinical advice	🟢	No advisory constructions; footer disclaimer retained from template.
2.5	The QRS “presents information” instead of “providing guidance”, “recommending”, or “advising”	🟢	Declarative throughout (e.g. “30 minutes before eating”, “Above 70% of readings between 70-180 mg/dL”).
2.6	The QRS never addresses “the reader” directly — it presents evidence, not guidance	🟢	No second-person address anywhere in the document.
2.7	The QRS is written in plain language, avoiding unnecessary medical jargon	🟢	Plain language throughout; technical terms used are those the ER itself uses.
2.8	Information is presented in a concise and very compact manner	🟢	Compact phrasing; trailing ER clauses stripped from all gate items.
2.9	It DOES NOT address the reader directly	🟢	No “you”/”your” in the QRS.
2.10	The target audience is health- and longevity-oriented adults who are risk-aware, proactive, and actively seeking to optimize health or apply the intervention under review.	🟢	Content is framed for proactive, risk-aware adults (fasting insulin burden, time in range, waist circumference).
2.11	The target audience is willing to employ lifestyle and behavioral changes as well as follow protocols that may be inconvenient, costly, or require effort.	🟢	Retains effortful items: 30-minute pre-meal lag, mapped site rotation implied by site inspection, CGM-based time in range.
2.12	The document is NOT written for the general population, who are unwilling to employ lifestyle and behavioral changes or follow protocols that may be inconvenient, costly, or require effort.	🟢	Not general-population framing; assumes willingness to titrate and monitor.
2.13	Framing, takeaways, and risk/benefit weighting throughout the document reflect this audience, including where an intervention’s signal for the average person differs from its signal for this audience.	🟢	Longevity signal preserved: fasting-insulin burden marker and the speculative accelerated-aging risk are both surfaced.
2.14	The document’s own voice frames usage in longevity terms, not “anti-aging” (e.g., “anti-aging clinics”, “anti-aging community”, “anti-aging medicine”). Proper names that contain “anti-aging” (e.g., “American Academy of Anti-Aging Medicine”) are quoted verbatim.	🟢	“aging” used in the at-a-glance and Speculative risk; the term “anti-aging” does not appear.
2.15	The document’s own voice uses formal clinical and scientific terminology, not colloquial or consumer-grade language (e.g., “oral medication” not “pill(s)”; “injection” not “shot”; “adverse event” not “bad reaction”). Direct quotes from sources are exempt.	🟢	Clinical register used (hypoglycemia, lipohypertrophy, hypokalemia); no colloquial substitutes such as “shot” or “pill”.

3. Template Integrity

#	Description	Result	Comments
3.1	The following labels and headings on the QRS are fixed and not modified: Card and section headings: “Protocol”, “Time to effect”, “Benefits”, “Risk & Side Effects”, “Monitoring”, “Qualitative Assessment”; Gate headings: “Contraindications”, “Key Interactions”; Tier labels: “High”, “Medium”, “Low”, “Speculative”; Table column headers in Monitoring: “Marker”, “Target”, “Why”	🟢	Diff against the template confirms all fixed headings, gate headings, tier labels and table column headers are byte-identical.
3.2	All “…” from the [qrs_template] are present in the the QRS.	🟢	All 34 template data-qrs-var names present; the repeating marker_#* and qualitative_item# spans are expanded to 8 and 5 instances.
3.3	Spans that are not addressed in a checklist item are left unchanged	🟢	Structural diff against the template shows differences only inside variable spans; the website=”…” spans and all markup are unchanged.

4. Formatting

#	Description	Result	Comments
4.1	When the source ER section is empty, the QRS uses the ER’s own empty-state phrasing verbatim. Typical phrasings are “None documented in human trials to date” and “Not formally studied”	N/A	No source ER section relied on by the QRS is empty, so no empty-state phrasing is required.
4.2	Where the ER presents a bulleted item as “Label: content”, the QRS uses the ER’s bold label verbatim as the cell or row label.	🟢	ER bold labels reused verbatim as cell/row labels: “Standard basal-bolus regimen”, “Best time of day”, “Baseline biomarkers guiding dose” (ER L344, L352, L364); marker names verbatim from the ER table.
4.3	Labels are not paraphrased, abbreviated, or invented.	🟢	No label paraphrased or invented; the Time-to-effect cell labels derive from ER L403 wording (“Glucose fall”, “Fasting glucose”, “HbA1c”).
4.4	The QRS DOES NOT use emoji indicators (no 🟩, 🟥, 🟨, etc.). Color and emphasis are conveyed through CSS and bold labels.	🟢	No emoji present; the ER’s tier emoji and the “⚠️ Conflicted” markers are stripped.
4.5	The QRS is designed to render on one A4 page. Any section that has more content in the ER than fits the per-section budget is condensed by the LLM, not extended onto a second page.	🟢	Single-sheet layout retained; every section condensed to headline facts with no added page structure.

5. Metadata

#	Description	Result	Comments
5.1	The metadata is placed inside a single HTML comment that is the first element after “<!doctype html>” and before any other comment, head, or body content.	🟢	The metadata comment at L2-14 is the first element after <!doctype html>.
5.2	Inside that HTML comment the YAML block is delimited by a line “—” opening and a line “—” closing. Text before the opening “—” is permitted but is not parsed as YAML.	🟢	YAML delimited by “—” at L3 and L13; the preamble text sits before the opening delimiter.
5.3	The metadata is not visible in any rendered view of the QRS and is not surfaced by any other element on the sheet.	🟢	Wrapped in an HTML comment and not echoed by any visible element.
5.4	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	All values trimmed; only duration: “00:03” is quoted, which is required because it contains a colon.
5.5	The filename of the source ER is stated as “er_filename: [er_filename]”	🟢	L4: er_filename: humulin_r_2026-0904-1151_Opus_ER.md
5.6	Version of the QRS.md file used to create the document is stated as “qrs_prompt_version: [Version of QRS.md]”	🟢	L5: qrs_prompt_version: 26.7.02, matching the QRS.md version badge.
5.7	Creation date and time of the document is stated as “qrs_creation_date: [YYYY-MMDD-HHMM]” (e.g., 2026-0501-1430)	🟢	L6: qrs_creation_date: 2026-0904-1406, in YYYY-MMDD-HHMM form.
5.8	The nickname of the AI used to create the document is stated as “qrs_creator_ai_nickname: [qrs_creator_ai_nickname]”	🟢	L7: qrs_creator_ai_nickname: Opus
5.9	The nickname of the AI is just a single word model name without version, etc. (e.g., Opus, Sonnet, Grok, Gemini, ChatGPT)	🟢	“Opus” is a single word with no version or qualifier.
5.10	The full name of the AI used to create the document is stated as “qrs_creator_ai_fullname: [qrs_creator_ai_fullname]”	🟢	L8: qrs_creator_ai_fullname: Opus 5
5.11	The full name of the AI consists of the [qrs_creator_ai_nickname] and the model version number and no additional qualifier (e.g., Opus 4.6, Sonnet 3.2, Grok 4.5, Gemini 3.1, ChatGPT 5.4)	🟢	“Opus 5” is nickname plus version number with no additional qualifier.
5.12	The filename of the document is stated as “qrs_filename: [filename of this document]”	🟢	L9: qrs_filename: humulin_r_2026-0904-1151_Opus_QRS.html, matching the file on disk.
5.13	All frontmatter values are trimmed: no leading or trailing whitespace, no surrounding quotes unless the value contains a colon, bracket, or leading special character that requires YAML quoting.	🟢	Values are clean and consistent; git_user and git_issue are unquoted plain scalars.

6. Page Title & Header

#	Description	Result	Comments
6.1	[page_title] is set to the [canonical_topic] of the ER frontmatter followed by “ - Quick Reference Sheet” (e.g., “Intervention - Quick Reference Sheet”). The [canonical_topic] is HTML-entity-encoded as needed (e.g., & for &)	🟢	L22: “Humulin R for Health & Longevity - Quick Reference Sheet” - canonical_topic entity-encoded plus the fixed suffix.
6.2	[header_topic] is set to the [canonical_topic] of the ER frontmatter, with HTML entities encoded as needed (e.g., & for &)	🟢	L417: “Humulin R for Health & Longevity”, matching the ER canonical_topic.
6.3	[header_subline_date] is set to [qrs_creation_date reformatted as MM/DD/YYYY]	🟢	L421: 09/04/2026, which is qrs_creation_date 2026-0904 in MM/DD/YYYY.
6.4	[header_subline_model] is set to [qrs_creator_ai_fullname]	🟢	L425: “Opus 5”, matching qrs_creator_ai_fullname.
6.5	No additional header content appears: no badge, version stamp, AKA / alternate names line, source-AI attribution, audit date, or QRS variant marker.	🟢	Header carries only the template subline; no badge, version stamp, AKA line, audit date or variant marker.

7. At-A-Glance Section

#	Description	Result	Comments
7.1	[at_a_glance] is dense, execution-oriented summary of the ER Conclusion section	🟢	Condenses ER Conclusion L470-472: cost/profile, microvascular protection, hypoglycemia, weight gain, unresolved aging question.
7.2	[at_a_glance] is no longer than 60 words	🟢	57 words.
7.3	Every fact in [at_a_glance] is supported by a distinct passage in the ER.	🟢	Each clause maps to a distinct ER Conclusion passage (L470 for the profile and eye/nerve/kidney claim, L472 for hazard, weight gain and the aging question).
7.4	It DOES NOT use acronyms or technical classifications that require specialist knowledge, uses plain-language terms instead	🟢	No acronyms or specialist classifications; “blood sugar”, “working day”, “aging” are plain-language.
7.5	It DOES NOT cite specific trials (names, years, sample sizes, p-values)	🟢	No trial names, years, or sample sizes.
7.6	It DOES NOT cite effect sizes, relative risks, or statistical results	🟢	No effect sizes, relative risks, or statistics.

8. Contraindications

#	Description	Result	Comments
8.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	Drawn from the ER “Populations who should avoid Humulin R” list inside Key Interactions & Contraindications (ER L312-320).
8.2	[stop_items] represent the Contraindications from the ER	🟢	All seven ER avoid-populations are represented, one to one.
8.3	Individual [stop_items] are formatted as <li></li>	🟢	Seven <li> elements inside the stop_items span (QRS L562-571).
8.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	All ER em-dash trailers stripped (“- absolute contraindication until corrected”, “- no approved indication and a documented risk of coma”); no rationale or citation retained.
8.5	Parenthetical qualifiers from the ER bullet — time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	Thresholds and staging preserved: 70 mg/dL, 3.3 mmol/L, Child-Pugh Class C, eGFR below 30 mL/min/1.73 m².
8.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER uses no ranking notation inside parentheses in this section.
8.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no population, condition, or scenario for which the intervention should be avoided, deferred, or used only under specialist supervision.	🟢	The section is populated, and the ER does identify populations that should avoid the intervention.
8.8	If the section is left empty, an HTML comment inside the [stop_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The section is not empty, so no explanatory HTML comment is required.

9. Key Interactions

#	Description	Result	Comments
9.1	The section is derived from the ER Key Interactions & Contraindications section	🟢	Drawn from the nine ER interaction bullets at L294-310.
9.2	[caution_items] represent the Key Interactions from the ER, excluding any that are already listed as Contraindications	🟢	All nine ER interactions represented; none duplicates an item in the Contraindications gate.
9.3	Individual [caution_items] are formatted as <li></li>	🟢	Nine <li> elements inside the caution_items span (QRS L579-596).
9.4	Items are as concise as possible. No trailing explanations, no elaborations, no mechanistic rationale, no attributions, no citations, no study details. No content after an em-dash, en-dash, or hyphen-dash (e.g., “— dose reduction required”, “— reduced efficacy”) — these trailing clauses are stripped. Just the key fact.	🟢	ER lead-ins (“Caution.”, “Monitor closely.”) and mechanistic sentences dropped; no em-dash trailers remain.
9.5	Parenthetical qualifiers from the ER bullet — example drug lists, time windows, severity classes, threshold values, clinical staging — ARE preserved as part of the item, kept as concise as possible (shortened or trimmed where needed to fit the one-page budget, but never dropped entirely).	🟢	Named example drug lists preserved for beta-blockers, corticosteroids, SGLT2 inhibitors, GLP-1 agonists, thiazolidinediones, decongestants and the glucose-lowering supplements.
9.6	When the ER uses ranking notation inside parens (e.g., “>” for severity ordering) that depends on an explanatory phrase to interpret, normalize the items to a plain comma-separated list rather than carrying through the bare symbol.	N/A	The ER uses no ranking notation inside parentheses in this section.
9.7	The section is left empty ONLY IF the ER’s Key Interactions & Contraindications section identifies no interaction, additive effect, or exposure that changes how the intervention is used.	🟢	The section is populated, and the ER does identify interactions that change how the intervention is used.
9.8	If the section is left empty, an HTML comment inside the [caution_items] span records the ER basis for the absence, naming or quoting the ER text relied on. E.g.	N/A	The section is not empty, so no explanatory HTML comment is required.

10. Protocol

#	Description	Result	Comments
10.1	The section is derived from the ER Protocol section	🟢	All three cells map to bullets in the ER Therapeutic Protocol section (L344, L352, L364).
10.2	The three sets of [action] items cover the three most important actionable implementation aspects from the ER Protocol section	🟢	Regimen, dose timing and the biomarkers that set the starting dose are the three load-bearing actionable aspects of the ER protocol.
10.3	If less that three distinct actionable implementation aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER Therapeutic Protocol section supplies well over three distinct actionable aspects, so all three sets are used.
10.4	All used [action_#label], [action#value], [action#_sub] items are filled with meaningful content derived from the ER Protocol section.	🟢	All nine action spans carry ER-derived content; none is placeholder or empty.

11. Time to Effect

#	Description	Result	Comments
11.1	The three sets of [time] items cover the three most important time-to-effect aspects from the ER	🟢	Glucose fall, fasting glucose stabilisation and HbA1c are the only time-to-effect aspects the ER states (L403).
11.2	The sets are picked and ordered by the magnitude of the related benefit	🟢	Ordered as the ER presents them, from the acute glucose-lowering effect through to the HbA1c endpoint that underpins the microvascular benefit.
11.3	If less that three distinct time-to-effect aspects are mentioned in the ER the unused sets are left empty and made invisible, not filled with placeholder text or empty-state phrasing.	N/A	The ER supplies three distinct time-to-effect aspects, so all three sets are used.
11.4	All used [time_#label], [time#value], [time#_sub] items are filled with meaningful content derived from the ER.	🟢	All nine time spans populated from ER L403 and the duration figures at ER L354.
11.5	If the ER does not provide any information on time to effect, the section is removed completely from the Protocol Panel	N/A	The ER does provide time-to-effect information, so the section is correctly retained.

12. Benefits

#	Description	Result	Comments
12.1	The section is derived from the ER Expected Benefits section	🟢	All four tiers map to the ER Expected Benefits headings at L152-196.
12.2	Key variables are [benefits_high], [benefits_medium], [benefits_low], [benefits_speculative]	🟢	All four benefit spans present and populated.
12.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Items reduced to the ER benefit headings; no magnitudes, confidence intervals or trial detail carried across.
12.4	Parenthetical content — including effect sizes, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parenthetical content retained; the ER’s “⚠️ Conflicted” marker on the intranasal item is stripped.
12.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four tiers are populated in the ER, so no span needs hiding.

13. Risks

#	Description	Result	Comments
13.1	The section is derived from the ER Potential Risks & Side Effects section	🟢	All four tiers map to the ER Potential Risks & Side Effects headings at L220-276.
13.2	Key variables are [risks_high], [risks_medium], [risks_low], [risks_speculative]	🟢	All four risk spans present and populated.
13.3	Items are as concise as possible. No explanations, no elaborations, no effect sizes, no qualifiers, no attributions, no citations, no study details, no mechanistic explanations, etc. Just the key fact.	🟢	Items reduced to the ER risk headings; no hazard ratios, odds ratios or incidence figures carried across.
13.4	Parenthetical content — including frequencies, severity grades, sample notes, mechanistic hints, and example studies — is stripped, NOT preserved.	🟢	No parenthetical content retained; the “⚠️ Conflicted” marker on cancer incidence is stripped.
13.5	If no items of a specific sub-section (high, medium, low, speculative) are present the respective is set to “display=none”, not filled with “None documented in human trials to date” or similar empty-state phrasing.	N/A	All four tiers are populated in the ER, so no span needs hiding.

14. Monitoring

#	Description	Result	Comments
14.1	The section is derived from the ER Monitoring section	🟢	Table and cadence both drawn from ER Monitoring Protocol & Defining Success (L429-442).
14.2	All measurable/quantifiable biomarkers from the Monitoring section are listed	🟢	All eight ER biomarker rows present, with targets and rationales verbatim from the ER table.
14.3	[monitoring_cadence] is populated with the monitoring cadence/frequency derived from the ER Monitoring section. It is not left with placeholder text or empty.	🟢	Cadence populated from ER L431 (glucose weekly during titration, HbA1c at three months then every three to six, potassium and creatinine at three months then annually, weight monthly, injection sites every visit).

15. Qualitative Assessment

#	Description	Result	Comments
15.1	The section is derived from the ER Monitoring section	🟢	Drawn from the ER qualitative marker list at L446-450.
15.2	All subjective/qualitative biomarkers from the Monitoring section are listed	🟢	All five ER qualitative markers present, with the ER’s trailing explanatory clauses trimmed.

Issues 04/09/2026 14:43

Pass rate 100.00%. No issues found.

Issues 04/09/2026 14:36

1. 1.3 — Approximation hedges dropped: [action_1_sub] (line 457) renders ER line 344’s “Roughly half the total daily dose is basal” as the unhedged “Half the daily dose basal”, and [action_3_sub] (line 482) renders ER line 180’s “exceed roughly 200 units” as “Over 200 units per day”, making approximate values read as exact thresholds.
2. 4.2 / 4.3 — Interaction labels paraphrased: In [caution_items], the ER bold labels “Over-the-counter medications” (ER line 304) and “Supplements with additive glucose-lowering effects” (ER line 306) appear as “Over-the-counter” (line 587) and “Glucose-lowering supplements” (line 591).

Fixes 04/09/2026 14:36

1. 1.3 — Approximation hedges restored: [action_1_sub] changed from “Half the daily dose basal, half across meals.” to “Roughly half the daily dose basal, half across meals.”, and [action_3_sub] from “Over 200 units per day…” to “Over roughly 200 units per day…”, matching the ER’s hedged wording.
2. 4.2 / 4.3 — Interaction labels restored verbatim: In [caution_items], “Over-the-counter” was restored to the ER label “Over-the-counter medications” and “Glucose-lowering supplements” to “Supplements with additive glucose-lowering effects”.

Issues 04/09/2026 14:29

1. 4.5 — One-page budget exceeded: The combined volume of the 7-item Contraindications gate, 9-item Key Interactions gate, 8-row Monitoring table with a five-clause cadence sentence, 5 qualitative items and the multi-line Protocol/Time sub-lines renders past a single A4 page; the discretionary sub-lines and the cadence sentence are the compressible surplus.

Fixes 04/09/2026 14:29

1. 4.5 — Protocol sub-lines condensed: Shortened all three action sub-lines — “Roughly half the total daily dose is basal, half divided across meals.” → “Half the daily dose basal, half across meals.”; the bedtime rationale clause and the “Fasting insulin above ~25 µIU/mL” clause were trimmed to single-line statements.
2. 4.5 — Time-to-effect sub-lines condensed: Reduced the three time sub-lines to their non-redundant content (“Onset at 30 minutes, a 2–4 hour peak and 6–8 hour duration.” → “2–4 hour peak, 6–8 hour duration.”; “Stabilizes over one to two weeks of titration.” → “Stabilizes over titration.”; “Takes about three months to reflect the new steady state.” → “Reflects the new steady state.”), removing duplication of the adjacent value cells.
3. 4.5 — Monitoring cadence tightened: Trimmed the cadence sentence from “Glucose review weekly…injection sites at every visit.” to “Glucose weekly…injection sites every visit.” while keeping every interval intact.
4. 4.5 — Qualitative items shortened: Trimmed the two longest qualitative entries (“…still felt at all” → “…still felt”; “Appearance and texture of injection sites: …” → “Injection sites: …”) to remove wrapped lines.

Issues 04/09/2026 14:22

1. 4.5 — Free text not condensed to page budget: monitoring_cadence (lines 770–775) reproduces ER line 431 verbatim at 47 words, and three qualitative_item_# entries (lines 789–806) carry the ER’s trailing rationale clauses (“which suggest nighttime lows”, “when the 6–8 hour tail of a lunchtime dose is fading”, “given the association between severe episodes and later decline”) instead of the marker alone.

Fixes 04/09/2026 14:22

1. 4.5 — Monitoring cadence condensed: Rewrote monitoring_cadence from the 47-word verbatim ER sentence to a 30-word list, keeping every frequency (“Glucose review weekly during titration; HbA1c at three months, then every three to six months; potassium and creatinine at three months, then annually; weight monthly; injection sites at every visit.”).
2. 4.5 — Qualitative rationale clauses stripped: Trimmed three qualitative_item entries to the marker alone — “Sleep continuity, night sweats and morning headaches”, “Energy stability across the afternoon” and “Cognitive clarity and short-term recall” — dropping the ER’s trailing explanatory clauses.

Issues 04/09/2026 14:14

1. 2.7 — Unexpanded “NPH” acronym: [action_1_value] at line 452 reads “Regular insulin before each meal, NPH at bedtime”, dropping the gloss the ER supplies in the same bullet (“intermediate-acting NPH (neutral protamine Hagedorn, a longer-acting human insulin)”) and leaving a bare specialist acronym in the hero panel.
2. 4.5 — Sheet overruns one A4 page: Wrapped-line estimation at the template’s print widths puts the rendered sheet at roughly 1.5–1.7 A4 pages; the decision gates alone consume 17 ([stop_items]) and 19 ([caution_items]) wrapped lines, and the protocol sub-lines at lines 469–470 and 483–484 each run to four lines in a one-third-width cell.

Fixes 04/09/2026 14:14

1. 2.7 — NPH acronym given a plain-language qualifier: [action_1_value] changed from “Regular insulin before each meal, NPH at bedtime” to “Regular insulin before each meal, intermediate-acting NPH at bedtime”, restoring the descriptor the ER supplies for the acronym.
2. 4.5 — Contraindication items condensed: All seven [stop_items] were stripped of their “Anyone with” / “People prescribed” lead-ins and redundant wording (e.g. “People with Child-Pugh Class C liver disease or an estimated glomerular filtration rate below 30 mL/min/1.73 m² without specialist dose supervision” → “Child-Pugh Class C liver disease or eGFR below 30 mL/min/1.73 m² without specialist supervision”), cutting the column from 17 to 13 wrapped lines with every threshold and qualifier retained.
3. 4.5 — Key-interaction items condensed: Three [caution_items] were tightened — “absolute contraindication in symptomatic heart failure” → “contraindicated in symptomatic heart failure”, the over-the-counter and supplement lead-ins shortened, and “Other interventions:” dropped as a redundant label — reducing the column from 19 to 18 wrapped lines while keeping every named drug and supplement.
4. 4.5 — Protocol sub-lines shortened: [action_2_sub] and [action_3_sub] were cut from four wrapped lines each to two and three respectively (“The evening intermediate dose is placed at bedtime rather than dinner, so its peak falls near dawn rather than at 2 a.m.” → “Evening intermediate dose at bedtime, not dinner, so its peak falls near dawn.”), with the 25 µIU/mL and 200 units/day thresholds preserved.