AGNP ACTUAL EXAM EVALUATION QUESTIONS WITH
ANSWERS 2025/2026 GRADED A+
Metformin: Mechanisms - Reduces hepatic gluconeogenesis
Increased insulin sensitivity
Enhances peripheral glucose uptake
Decreases absorption of glucose from GI tract
Metformin: Advantages - No hypoglycemia
Limits weight gain
Improves lipid levels (Increase triglycerides)
Alpha Glucosidase Inhibitors: Mechanism - Competitive inhibition of intestinal α -
glucosidase
Modulate postprandial digestion and absorption - "insulin-sparing"
I.e. Precose/Glyset
Alpha Glucosidase Inhibitors: Side effects - Flatulence, diarrhea, abdominal pain
Contraindications: IBS, renal disease. Caution pt with hepatic disease
Incretin Hormones - Incretin hormones (GLP-1 & GLP) are hormones released by the
gut throughout the day and rise in response to eating
GLP-1 ( Glucagon like peptide) - Stimulates glucose-dependent insulin secretion
Delays gastric emptying
Improves satiety
GLP (Glucose-dependent insulinotropic peptide) - Stimulates insulin secretion and
regulates fat metabolism
Incretin Mimetics: Mechanism - Increases the secretion of insulin from the pancreas
Slows the absorption of glucose from the gut
Reduces the action of glucagon
Reduces appetite
I.E. Byetta
Exenatide (Byetta) - Injectable-subq
Given 1 hour prior to meal twice daily
used in combo with Metformin/Sulfonylurea
Not recommended for ESRD.
Dipeptidyl Peptidase-4 Inhibitors: Mechanism - Increase incretins GLP-1 and GLP
Stimulate insulin secretion
Block glucagon release
Sitagliptin (Januvia): Renally cleared - Cr > 30-50=> 1/2 dose; <30=> 1/4 dose
,Saxagliptin (Onglyza): Renally cleared - lower dose
Amylin Analog: Mechanism - Amylin is secreted from beta cells of pancreas along with
insulin
Slows gastric emptying
Suppresses glucagon secretion
Modulates appetite
Pramlintide acetate (Symalin) - injectable - Type 1 or Type 2 diabetics as an adjunct to
insulin
Give immediately prior to meal
Glucagon-Like Peptide-1
Receptor Agonist: Mechanism - Increases glucose-dependent insulin secretion
Decreases glucagon secretion
Delays gastric emptying
Increases satiety
Glucagon-Like Peptide-1
Receptor Agonist: Side effects - nausea and vomiting.
Sodium-Glucose Co-transporter 2 Inhibitors: Mechanism - Promote urinary excretion of
glucose by preventing tubular reabsorption via the sodium-glucose co-transporter
Sodium-Glucose Co-transporter 2 Inhibitors: Types - Inokana
Farxiga
Jardiance
**May lead to ketoacidosis
Benefits of Insulin-Oral Agent Combination: - Improves glycemic control
Simplifies insulin regimen
Less insulin is needed to achieve good
glycemic control
May improve lipid profile
Managing DM Sick Days - Blood glucose levels usually increase
Perform self-blood-glucose monitoring several times a day and check urine for ketones
Call health care provider
Vomiting with ketosis
Inability to drink fluids
Blood glucose > 240mg/dl and urine positive for ketones
Take usual dose of insulin or oral agent
Increase fluids
Drink small continuous amounts of sugar- containing liquids such as juice, Gatorade or
Coke
, Rapid Acting: Humalog (Lispro) - Onset: 15-30 min
Peak: 30-90
Duration: 3-5 hours
Rapid Acting: Novolog (Aspart) - Onset: 10-20
Peak:40-50
Duration: 3-5 hours
Rapid Acting: Apidra (Glulisine) - Onset: 20-30
Peak: 30-90
Duration: 1-1.5hour
Rapid Acting: Inhaled (Exubra) - Onset: 15-30
Peak: 30-90
Duration: 4-8 hours
Short-acting: Regular (Humulin, Novolin, Actrapid) - Onset: 30-60 min
Peak: 2-6 hours
Duration: 5-8 hours
Intermediate: NPH - Onset: 2-4 hours
Peak: 4-6 hours
Duration: 12-15 hours
Long acting: Lantus (Glargine) - Onset: 4-6 hours
No peak
Duration: 24+
Long-acting: Levemir (Detemir) - Onset: 1-4 hours
No Peak
24hrs
Combination: NPH/Regular (70/30) - Onset: 30 min
Duration: 18-24 hours
Subcutaneous Insulin Dosing - Patients at risk for hypoglycemia 0.3 units/kg
Elderly
Renal impairment
Hepatic dysfunction
Patients without serious risk 0.5 units/kg
Patients with special issues 0.7 units/kg
Obese
Metabolic Syndrome
Infections
ANSWERS 2025/2026 GRADED A+
Metformin: Mechanisms - Reduces hepatic gluconeogenesis
Increased insulin sensitivity
Enhances peripheral glucose uptake
Decreases absorption of glucose from GI tract
Metformin: Advantages - No hypoglycemia
Limits weight gain
Improves lipid levels (Increase triglycerides)
Alpha Glucosidase Inhibitors: Mechanism - Competitive inhibition of intestinal α -
glucosidase
Modulate postprandial digestion and absorption - "insulin-sparing"
I.e. Precose/Glyset
Alpha Glucosidase Inhibitors: Side effects - Flatulence, diarrhea, abdominal pain
Contraindications: IBS, renal disease. Caution pt with hepatic disease
Incretin Hormones - Incretin hormones (GLP-1 & GLP) are hormones released by the
gut throughout the day and rise in response to eating
GLP-1 ( Glucagon like peptide) - Stimulates glucose-dependent insulin secretion
Delays gastric emptying
Improves satiety
GLP (Glucose-dependent insulinotropic peptide) - Stimulates insulin secretion and
regulates fat metabolism
Incretin Mimetics: Mechanism - Increases the secretion of insulin from the pancreas
Slows the absorption of glucose from the gut
Reduces the action of glucagon
Reduces appetite
I.E. Byetta
Exenatide (Byetta) - Injectable-subq
Given 1 hour prior to meal twice daily
used in combo with Metformin/Sulfonylurea
Not recommended for ESRD.
Dipeptidyl Peptidase-4 Inhibitors: Mechanism - Increase incretins GLP-1 and GLP
Stimulate insulin secretion
Block glucagon release
Sitagliptin (Januvia): Renally cleared - Cr > 30-50=> 1/2 dose; <30=> 1/4 dose
,Saxagliptin (Onglyza): Renally cleared - lower dose
Amylin Analog: Mechanism - Amylin is secreted from beta cells of pancreas along with
insulin
Slows gastric emptying
Suppresses glucagon secretion
Modulates appetite
Pramlintide acetate (Symalin) - injectable - Type 1 or Type 2 diabetics as an adjunct to
insulin
Give immediately prior to meal
Glucagon-Like Peptide-1
Receptor Agonist: Mechanism - Increases glucose-dependent insulin secretion
Decreases glucagon secretion
Delays gastric emptying
Increases satiety
Glucagon-Like Peptide-1
Receptor Agonist: Side effects - nausea and vomiting.
Sodium-Glucose Co-transporter 2 Inhibitors: Mechanism - Promote urinary excretion of
glucose by preventing tubular reabsorption via the sodium-glucose co-transporter
Sodium-Glucose Co-transporter 2 Inhibitors: Types - Inokana
Farxiga
Jardiance
**May lead to ketoacidosis
Benefits of Insulin-Oral Agent Combination: - Improves glycemic control
Simplifies insulin regimen
Less insulin is needed to achieve good
glycemic control
May improve lipid profile
Managing DM Sick Days - Blood glucose levels usually increase
Perform self-blood-glucose monitoring several times a day and check urine for ketones
Call health care provider
Vomiting with ketosis
Inability to drink fluids
Blood glucose > 240mg/dl and urine positive for ketones
Take usual dose of insulin or oral agent
Increase fluids
Drink small continuous amounts of sugar- containing liquids such as juice, Gatorade or
Coke
, Rapid Acting: Humalog (Lispro) - Onset: 15-30 min
Peak: 30-90
Duration: 3-5 hours
Rapid Acting: Novolog (Aspart) - Onset: 10-20
Peak:40-50
Duration: 3-5 hours
Rapid Acting: Apidra (Glulisine) - Onset: 20-30
Peak: 30-90
Duration: 1-1.5hour
Rapid Acting: Inhaled (Exubra) - Onset: 15-30
Peak: 30-90
Duration: 4-8 hours
Short-acting: Regular (Humulin, Novolin, Actrapid) - Onset: 30-60 min
Peak: 2-6 hours
Duration: 5-8 hours
Intermediate: NPH - Onset: 2-4 hours
Peak: 4-6 hours
Duration: 12-15 hours
Long acting: Lantus (Glargine) - Onset: 4-6 hours
No peak
Duration: 24+
Long-acting: Levemir (Detemir) - Onset: 1-4 hours
No Peak
24hrs
Combination: NPH/Regular (70/30) - Onset: 30 min
Duration: 18-24 hours
Subcutaneous Insulin Dosing - Patients at risk for hypoglycemia 0.3 units/kg
Elderly
Renal impairment
Hepatic dysfunction
Patients without serious risk 0.5 units/kg
Patients with special issues 0.7 units/kg
Obese
Metabolic Syndrome
Infections
