A nurse is providing teaching about self-administration of insulin to the parent of a school-age child who has a new of diabetes mellitus. Which of the following statements by the parent indicates a need for further teaching?

A. Subcutaneous insulin injections are given in areas with adequate adipose (fat) tissue, such as the abdomen (preferred due to consistent absorption), outer upper arms, anterior thighs, and buttocks. These areas allow for proper absorption of insulin into the bloodstream. However, injections should not be given “randomly anywhere” but within these recommended sites. Overall, this statement demonstrates a general understanding of appropriate injection locations and is acceptable. B. Site rotation is critical to prevent lipohypertrophy (thickened, rubbery fat deposits) and lipoatrophy (loss of fat tissue), both of which can interfere with insulin absorption and lead to unpredictable blood glucose levels. Best practice is to rotate within the same anatomical area (e.g., different spots on the abdomen) rather than switching between body regions frequently, because absorption rates differ (abdomen = fastest, thighs = slower). Although “after 5 injections” is not the most precise guideline, the parent demonstrates understanding of the need to rotate sites, so this is acceptable. C. A 90-degree angle is appropriate for most subcutaneous insulin injections, especially in school-age children who have sufficient subcutaneous tissue. In very thin children, a 45-degree angle or use of a shorter needle may be considered to avoid intramuscular injection. This statement reflects correct technique and understanding. D. Aspiration (pulling back on the plunger before injection) is not recommended for insulin administration. Insulin is injected into subcutaneous tissue, which has minimal risk of hitting a blood vessel. Aspiration can cause unnecessary pain, tissue trauma, and prolonged injection time, and it is no longer part of evidence-based practice for subcutaneous injections. Teaching this outdated practice indicates a knowledge deficit, making this the correct answer.