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When I read your step 5, the light finally went on in my brain, and when I added exactly 1 ml of air into the top of the vial, I was able to draw the 1 ml dose and properly inject
10.1681/ASN.0000000636 50
The binding site for the hydrophobic electrophiles, or H site, is located immediately adjacent to the G site and forms part of the solvent-exposed cleft between both domains
If you draw 50 units but 5 units of that is air, you are only injecting 45 units of solution, which is 10% less tirzepatide than intended