In a 15-year-old with type 1 diabetes presenting with diabetic ketoacidosis who admits to skipping insulin doses to avoid weight gain and fears needle marks, which nursing diagnosis is most appropriate?

• A. Nonadherence
• B. Fear or Anxiety
• C. Risk for Deficient Fluid Volume
• D. Deficient Knowledge

Answer: (D)

The main idea is addressing an information gap that leads to unsafe management. This adolescent’s decision to skip insulin stems from incomplete or misunderstood information about why insulin is needed, how it works, and how to handle concerns about weight and injections. Deficient knowledge as a nursing diagnosis points to the need for targeted education about diabetes management, the risks of skipping doses (including diabetic ketoacidosis and dehydration), and practical strategies to manage insulin therapy and injection concerns. By providing clear, age-appropriate education—covering insulin purpose, dosing, consequences of omission, and techniques to reduce needle discomfort—the nurse helps the patient make safer choices and improves adherence.

While fear or anxiety is part of the picture, labeling this as a fear-based diagnosis doesn’t directly guide remediation. Risk for deficient fluid volume is a consequence of poor control and dehydration in DKA, not the underlying reason the patient is skipping doses. Deficient knowledge focuses on the actionable gap you can close with education, which is the most effective starting point to prevent recurring DKA and promote healthier long-term management.