A client with a diagnosis of diabetic ketoacidosis (DKA) is being treated in the emergency department. Which of the following findings would the nurse expect to note as confirming this diagnosis?

Choice A rationale: Certain antibiotics, such as fluoroquinolones, can cause both hypo- and hyperglycemia, but this effect is less common and less pronounced than the effect of corticosteroids. The significant and sustained increase in blood glucose is more characteristic of steroid use, which is a known and common side effect.
Choice B rationale: Corticosteroids stimulate gluconeogenesis in the liver and reduce glucose uptake in peripheral tissues, leading to insulin resistance. This combination results in a significant increase in blood glucose levels, a phenomenon known as steroid-induced hyperglycemia. The patient's type 2 diabetes exacerbates this effect.
Choice C rationale: Type 2 diabetes does not convert to type 1 diabetes. These are distinct pathophysiological conditions. Type 1 is an autoimmune disease with absolute insulin deficiency, while type 2 involves insulin resistance and relative deficiency. The current elevated glucose is an acute, reversible effect of medication, not a change in the underlying disease.
Choice D rationale: While hypoxia can lead to a stress response that increases blood glucose, it is not the primary cause of this sustained elevation in a patient on corticosteroids. The direct metabolic effects of corticosteroids on glucose metabolism are the most significant and likely cause of the observed hyperglycemia.

Choice A rationale: Lipodystrophy is a complication of insulin therapy where changes in subcutaneous fat tissue occur at injection sites. Repeated injections in the same area can lead to either lipohypertrophy (a lump of fat) or lipoatrophy (a depression in the skin), which can impair insulin absorption. Rotating injection sites helps prevent this condition.
Choice B rationale: The dawn phenomenon is a physiological event, not a complication of insulin therapy. It is a morning hyperglycemia caused by the normal nocturnal release of counter-regulatory hormones like growth hormone and cortisol, which increase liver glucose production and cause blood sugar levels to rise. This is an endogenous process.
Choice C rationale: Hypoglycemia is a common and serious complication of insulin therapy. It occurs when insulin levels are too high relative to the available glucose, causing blood sugar to drop below 70 mg/dL. This can result from a missed meal, excessive exercise, or an incorrect insulin dose, leading to neuroglycopenic symptoms.
Choice D rationale: The Somogyi phenomenon, or rebound hyperglycemia, is a physiological response to insulin-induced hypoglycemia. An excessive insulin dose causes blood glucose to drop during the night, triggering the release of counter-regulatory hormones that cause rebound hyperglycemia in the morning. This is not a direct complication of the insulin itself but of its administration.
Choice E rationale: Insulin resistance is a complication where the body's cells become less responsive to the effects of insulin, requiring higher and higher doses to achieve the desired glycemic control. This can be caused by various factors, including obesity, inactivity, and the development of antibodies to insulin, impairing its ability to facilitate glucose uptake.