A 15-year-old with type 1 diabetes who skipped insulin doses to avoid weight gain demonstrates which nursing diagnosis as most appropriate?

• A. Noncompliance
• B. Anxiety
• C. Ineffective coping
• D. Knowledge deficit

Answer: (A)

Adherence to prescribed therapy in chronic illness is being tested. The teen’s act of skipping insulin doses to avoid weight gain is a deliberate choice not to follow the prescribed diabetes regimen, which fits the nursing diagnosis of nonadherence to treatment. This behavior shows a barrier to maintaining the regimen rather than a lack of knowledge about the treatment or a transient emotional response. It isn’t primarily an anxiety issue or ineffective coping, because the core problem here is not about handling stress or mood but about choosing not to adhere to the prescribed insulin plan.

Understanding why adherence is critical helps: skipping insulin can lead to hyperglycemia and risk for diabetic ketoacidosis, so recognizing and addressing the barrier—here, concern about weight gain—is essential. The nurse should explore the patient’s weight-related fears, provide supportive education to reinforce the importance of consistent insulin use, and engage the patient and family in strategies to manage weight while maintaining glycemic control. Consider collaborating with a nutritionist or psychologist as needed to support adherence and address body image concerns in adolescence.