The nurse is teaching patients about self-injection of insulin. Which statement is true regarding injection sites?

Choice A rationale: Diabetic ketoacidosis (DKA) is a severe complication of diabetes characterized by hyperglycemia (glucose > 250 mg/dL), ketonemia, and metabolic acidosis. It typically occurs in type 1 diabetes when there is an absolute insulin deficiency, leading to increased lipolysis and ketone body production. DKA is not associated with low blood glucose levels.
Choice B rationale: Diabetic neuropathy is a long-term complication of diabetes resulting from sustained hyperglycemia, which damages nerves throughout the body. Symptoms can include pain, numbness, tingling, or muscle weakness. This condition is a chronic effect of poor glucose control and is not an acute state caused by a sudden drop in glucose levels.
Choice C rationale: Hyperosmolar hyperglycemic nonketotic syndrome (HHNS) is a serious complication, predominantly in type 2 diabetes, marked by extremely high blood glucose levels (typically > 600 mg/dL), severe dehydration, and hyperosmolarity without significant ketosis. This condition is the opposite of what the client is experiencing, as it involves very high, not low, glucose levels.
Choice D rationale: Hypoglycemia is a condition characterized by abnormally low blood glucose levels, specifically below 70 mg/dL. This occurs when there is an imbalance between insulin action and glucose intake, such as too much insulin, skipped meals, or intense exercise. The brain relies on glucose for energy, and its function is compromised in hypoglycemia, leading to symptoms like confusion, shakiness, and sweating.

Choice A rationale: Diabetic ketoacidosis (DKA) is a severe complication characterized by hyperglycemia, metabolic acidosis, and ketosis. Elevated glucose levels (typically >250 mg/dL) result from insufficient insulin. The body then breaks down fat for energy, producing ketones which lower the blood pH, resulting in metabolic acidosis. The expected finding is a low plasma bicarbonate level (normal range 22-29 mEq/L) reflecting the metabolic acidosis.
Choice B rationale: Decreased urine output is an incorrect finding. In DKA, hyperglycemia leads to osmotic diuresis, where excess glucose pulls water out of the body, leading to polyuria (increased urine output) and dehydration. The kidneys attempt to excrete the excess glucose and ketones, resulting in frequent and copious urination.
Choice C rationale: Increased respirations (Kussmaul respirations) are a compensatory mechanism for metabolic acidosis, but they lead to a decrease in pH, not an increase. The deep, rapid breathing attempts to blow off carbon dioxide, a form of carbonic acid, to raise the pH back to the normal range of 7.35-7.45.
Choice D rationale: While coma can be a late and severe complication of DKA, it is not a confirming diagnostic finding. DKA is confirmed by the specific biochemical triad of hyperglycemia, ketonemia/ketonuria, and metabolic acidosis. Patients are often awake and responsive in the early stages, experiencing symptoms like nausea, abdominal pain, and lethargy.