NR505NP WEEK 7 KEY CONCEPTS AND
CLINICAL APPLICATIONS 2026
◉ HBA1C Value considered diagnostic of diabetes. Answer: a value
of 6.5% or greater
◉ HbA1C Measuring Interval. Answer: every 3 months until value is
<7%; every 6 months thereafter
◉ HbA1C Goal for Older Adults. Answer: <7.5% [58 mmol/mol]),
while those with multiple coexisting chronic illnesses, cognitive
impairment, or functional dependence should have less stringent
glycemic goals (such as A1C <8.0-8.5% [64-69 mmol/mol]).
◉ Criteria for the Diagnosis of Diabetes Mellitus. Answer: -Fasting
plasma glucose ≥126 mg/dL
-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes
-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200
mg/dLcor
-Hemoglobin A1c 6.5% or higher
◉ T1DM Etiology and MOA. Answer: Autoimmune process; Loss of
pancreatic β cells;
,◉ T2DM Etiology and MOA. Answer: Unknown—but there is a
strong familial association, suggesting that heredity is a risk factor;
Insulin resistance and inappropriate insulin secretion
◉ the total daily dose (TDD) of insulin calculation. Answer: total
weight of the patient in kilograms (kg), multiplied by 0.6 units
◉ Basal insulin replacement. Answer: 50% of the total daily insulin
dose which replaces insulin from fasting (overnight) and between
meals.
◉ Bolus insulin replacement. Answer: 50% of the total daily insulin
dose and provides carbohydrate coverage and high blood sugar
correction.
◉ Biguanides Drug Class. Answer: Metformin
◉ Metformin. Answer: Decreases glucose production by the liver
(glucogenesis), increases tissue response to insulin;
Decrease glucose absorption; Increase glucose uptake
drug of choice for initial therapy in most patients with type 2
diabetes
,◉ Metformin contraindications. Answer: renal disease, acidosis from
hepatic disease, alcoholics, or in patients with hypoxia.
◉ Metformin Major AE. Answer: Gastrointestinal (GI) symptoms:
decreased appetite, nausea, diarrhea
Lactic acidosis (rarely)
◉ Sulfonylureas Prototype/MOA. Answer: Glyburide (Prototype
Drug)
-Promote insulin secretion by the pancreas; may also increase tissue
response to insulin;
-stimulate beta cells of the pancreas to secrete more insulin
◉ Sulfonylureas AE. Answer: high risk of severe hypoglycemia;
photosensitivity; therefore, patient education is needed regarding
sunscreen.
blood dyscrasias
weight gain.
, ◉ Sulfonylureas Contraindication. Answer: should be avoided in
patients with impaired hepatic or renal function.
◉ Meglitinides (Glinides) Prototype/MOA. Answer: -Repaglinide
(Prototype Drug)
-stimulation of pancreatic insulin release though shorter acting then
sulfonylureas and are taken with each meal
-Facilitates calcium influx in pancreatic β cells, which leads to
increased insulin release
◉ Meglitinides Main AE. Answer: Hypoglycemia
◉ Meglitinides Contraindications. Answer: Use with caution in
patients with liver impairment and those taking gemfibrozil.
◉ Thiazolidinediones (Glitazones) Prototype/MOA. Answer: -
Pioglitazone (Prototype Drug)
-enhance insulin sensitivity/decrease insulin resistance in muscle
tissue and reduce glucagon production in the liver
-Mainly an add on to Metformin
CLINICAL APPLICATIONS 2026
◉ HBA1C Value considered diagnostic of diabetes. Answer: a value
of 6.5% or greater
◉ HbA1C Measuring Interval. Answer: every 3 months until value is
<7%; every 6 months thereafter
◉ HbA1C Goal for Older Adults. Answer: <7.5% [58 mmol/mol]),
while those with multiple coexisting chronic illnesses, cognitive
impairment, or functional dependence should have less stringent
glycemic goals (such as A1C <8.0-8.5% [64-69 mmol/mol]).
◉ Criteria for the Diagnosis of Diabetes Mellitus. Answer: -Fasting
plasma glucose ≥126 mg/dL
-Random plasma glucose ≥ 200 mg/dL plus symptoms of diabetes
-Oral glucose tolerance test (OGTT): 2-h plasma glucose ≥200
mg/dLcor
-Hemoglobin A1c 6.5% or higher
◉ T1DM Etiology and MOA. Answer: Autoimmune process; Loss of
pancreatic β cells;
,◉ T2DM Etiology and MOA. Answer: Unknown—but there is a
strong familial association, suggesting that heredity is a risk factor;
Insulin resistance and inappropriate insulin secretion
◉ the total daily dose (TDD) of insulin calculation. Answer: total
weight of the patient in kilograms (kg), multiplied by 0.6 units
◉ Basal insulin replacement. Answer: 50% of the total daily insulin
dose which replaces insulin from fasting (overnight) and between
meals.
◉ Bolus insulin replacement. Answer: 50% of the total daily insulin
dose and provides carbohydrate coverage and high blood sugar
correction.
◉ Biguanides Drug Class. Answer: Metformin
◉ Metformin. Answer: Decreases glucose production by the liver
(glucogenesis), increases tissue response to insulin;
Decrease glucose absorption; Increase glucose uptake
drug of choice for initial therapy in most patients with type 2
diabetes
,◉ Metformin contraindications. Answer: renal disease, acidosis from
hepatic disease, alcoholics, or in patients with hypoxia.
◉ Metformin Major AE. Answer: Gastrointestinal (GI) symptoms:
decreased appetite, nausea, diarrhea
Lactic acidosis (rarely)
◉ Sulfonylureas Prototype/MOA. Answer: Glyburide (Prototype
Drug)
-Promote insulin secretion by the pancreas; may also increase tissue
response to insulin;
-stimulate beta cells of the pancreas to secrete more insulin
◉ Sulfonylureas AE. Answer: high risk of severe hypoglycemia;
photosensitivity; therefore, patient education is needed regarding
sunscreen.
blood dyscrasias
weight gain.
, ◉ Sulfonylureas Contraindication. Answer: should be avoided in
patients with impaired hepatic or renal function.
◉ Meglitinides (Glinides) Prototype/MOA. Answer: -Repaglinide
(Prototype Drug)
-stimulation of pancreatic insulin release though shorter acting then
sulfonylureas and are taken with each meal
-Facilitates calcium influx in pancreatic β cells, which leads to
increased insulin release
◉ Meglitinides Main AE. Answer: Hypoglycemia
◉ Meglitinides Contraindications. Answer: Use with caution in
patients with liver impairment and those taking gemfibrozil.
◉ Thiazolidinediones (Glitazones) Prototype/MOA. Answer: -
Pioglitazone (Prototype Drug)
-enhance insulin sensitivity/decrease insulin resistance in muscle
tissue and reduce glucagon production in the liver
-Mainly an add on to Metformin
