You are a third year medical student completing a family medicine elective. You are about to see Jessie, a 15 year old girl who has been followed by your preceptor for 4 years. Jessie was diagnosed with Insulin-dependent Diabetes Mellitus at the age of 12 after presenting to the emergency room in diabetic ketoacidosis (DKA).

Jessie was discharged from hospital one week ago after her third admission in 6 months for DKA. Up until a year ago Jessie had been maintaining good glucose control. But in the last 6-8 months you have noticed a change. Aside from the numerous hospital admissions, Jessie has also lost about 25 pounds. Jessie explains to you that her sugars have been well controlled except for the three times she caught the flu in the last six months which led to poor control and subsequent hospitalizations.

Which of the following can precipitate DKA? Check all that apply.