A client tells the nurse that sometimes he gets lightheaded and shaky when he exercises. The nurse advised him to always:

Choice A rationale: Gestational diabetes mellitus is a condition characterized by hyperglycemia first recognized during pregnancy. It is caused by hormonal changes that lead to insulin resistance. This type of diabetes typically resolves after childbirth, although it increases a woman's risk for developing type 2 diabetes later in life. It is not necessarily associated with aging.
Choice B rationale: Immune-mediated diabetes mellitus is another name for type 1 diabetes, where the body's immune system destroys the insulin-producing beta cells in the pancreas. This leads to an absolute insulin deficiency. It can occur at any age, but is most commonly diagnosed in children and young adults, and is not associated with obesity.
Choice C rationale: Type 1 diabetes mellitus is an autoimmune disease resulting from the destruction of pancreatic beta cells, causing an absolute insulin deficiency. It is not typically associated with obesity or aging, and patients with this condition always require insulin therapy for survival to regulate their blood glucose levels.
Choice D rationale: Type 2 diabetes mellitus is a metabolic disorder characterized by insulin resistance and relative insulin deficiency. It is strongly associated with lifestyle factors like obesity and physical inactivity, and its prevalence increases with age. While many patients manage it with diet and oral medications, some may eventually require insulin therapy as the disease progresses.

Choice A rationale: The abdomen is actually the preferred site for insulin injections due to its consistent and rapid absorption rate compared to other sites. While absorption can vary slightly depending on the specific location within the abdomen, it is considered more predictable than other areas. Avoiding the abdomen would eliminate a prime injection site, which would make proper site rotation more difficult to achieve.
Choice B rationale: Choosing a different site at random for each injection is not the recommended approach. While it ensures rotation, it can make it difficult to monitor for site reactions or track the effectiveness of different injection sites. A systematic rotation strategy is preferred to ensure that all areas are used appropriately and consistently over time, preventing tissue damage.
Choice C rationale: Giving the injection in the same area each time, or even in the same exact spot, is the primary cause of lipohypertrophy and lipoatrophy. Repeated trauma to the same tissue leads to fibrous tissue formation and fat deposition or breakdown, which can significantly alter insulin absorption, making glycemic control unpredictable and increasing the risk of both hypoglycemia and hyperglycemia.
Choice D rationale: Rotating sites within the same anatomical location, such as the abdomen, for approximately one week before moving to a new location (e.g., the thigh or arm), is the recommended practice. This systematic approach ensures that tissue at the injection sites has time to heal, preventing the development of lipodystrophies. It also helps maintain consistent insulin absorption.