AGNP STUDY GUIDE 2025/2026 QUESTIONS AND
SOLUTIONS RANKED A+
✔✔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
Open wounds
✔✔Diabetic Ketoacidosis (DKA): Differences - ✔✔Occurs in Type I
Distinguished by metabolic acidosis (ph < 7.3)
Ketones in blood and urine
Develop within 24 hours
Mortality rate <5%
✔✔Hyperosmolar Hyperglycemic State (HHS): Differences - ✔✔Occurs in Type II
Severe hyperglycemia (>600)
Severe dehydration
Insidious onset
Mortality rate 15%
✔✔Diabetic Ketoacidosis (DKA): S&S - ✔✔Hyperglycemia >250
Metabolic acidosis < 7.3
Ketosis (plasma and urine)
Nausea and vomiting
Abdominal pain
Polyuria
Fruity breath
Kussmaul's respirations (severe acidosis)
✔✔Hyperosmolar Hyperglycemic State (HHS): S&S - ✔✔Severe hyperglycemia (600-
1,200)
Hyperosmolarity (Serum osmo 320-380)
Severe dehydration (Hemodynamic instability, pre-renal acotemia, decreasing urine
output)
Altered mental status
✔✔Mild DKA - ✔✔Glucose >250
Arterial pH 7.25-7.30
Bicarb 15-18
Anion gap > 10
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
✔✔Moderate DKA - ✔✔Glucose >250
Arterial pH 7.0-7.25
Bicarb 10-14
Anion gap >12
, Ketone +
Serum osmo <320
Serum Na: 125-135
Serum K: Normal to Increase
✔✔Severe DKA - ✔✔Glucose: > 250
Arterial pH <7.0
Bicarb < 10
Anion gap >12
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
✔✔HHS - ✔✔Glucose: > 600
Arterial pH >7.3
Bicarb > 15
Anion gap Variable
Ketones: Trace/small
Serum osmo: 330-380
Serum Na: 135-145
Serum K: Normal
✔✔DKA & HHS Tx - ✔✔Immediate hospitalization
Insulin
Fluids
Electrolyte replacement
Treating the underlying cause
✔✔Insulin - ✔✔Add 5% dextrose to IVs when glucose < 250mg/dl
✔✔When to start insulin - ✔✔Start subcutaneous insulin when:
-Anion gap is closed (DKA)
-Serum bicarbonate is > 15 mEq/l (DKA)
-Patient is able to eat
-Mental status improves (HHS)
✔✔Initial bloodwork - ✔✔Basic metabolic panel
Arterial blood gases
Magnesium
Phosphorus
✔✔SubQ Insulin - ✔✔Give short-acting aspart or lispro dose that is twice the current
infusion dose (eg. 4 Units/hr drip; give 8 Units Aspart SQ)
SOLUTIONS RANKED A+
✔✔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
Open wounds
✔✔Diabetic Ketoacidosis (DKA): Differences - ✔✔Occurs in Type I
Distinguished by metabolic acidosis (ph < 7.3)
Ketones in blood and urine
Develop within 24 hours
Mortality rate <5%
✔✔Hyperosmolar Hyperglycemic State (HHS): Differences - ✔✔Occurs in Type II
Severe hyperglycemia (>600)
Severe dehydration
Insidious onset
Mortality rate 15%
✔✔Diabetic Ketoacidosis (DKA): S&S - ✔✔Hyperglycemia >250
Metabolic acidosis < 7.3
Ketosis (plasma and urine)
Nausea and vomiting
Abdominal pain
Polyuria
Fruity breath
Kussmaul's respirations (severe acidosis)
✔✔Hyperosmolar Hyperglycemic State (HHS): S&S - ✔✔Severe hyperglycemia (600-
1,200)
Hyperosmolarity (Serum osmo 320-380)
Severe dehydration (Hemodynamic instability, pre-renal acotemia, decreasing urine
output)
Altered mental status
✔✔Mild DKA - ✔✔Glucose >250
Arterial pH 7.25-7.30
Bicarb 15-18
Anion gap > 10
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
✔✔Moderate DKA - ✔✔Glucose >250
Arterial pH 7.0-7.25
Bicarb 10-14
Anion gap >12
, Ketone +
Serum osmo <320
Serum Na: 125-135
Serum K: Normal to Increase
✔✔Severe DKA - ✔✔Glucose: > 250
Arterial pH <7.0
Bicarb < 10
Anion gap >12
Ketones +
Serum osmo <320
Serum Na 125-135
Serum K Normal to Increase
✔✔HHS - ✔✔Glucose: > 600
Arterial pH >7.3
Bicarb > 15
Anion gap Variable
Ketones: Trace/small
Serum osmo: 330-380
Serum Na: 135-145
Serum K: Normal
✔✔DKA & HHS Tx - ✔✔Immediate hospitalization
Insulin
Fluids
Electrolyte replacement
Treating the underlying cause
✔✔Insulin - ✔✔Add 5% dextrose to IVs when glucose < 250mg/dl
✔✔When to start insulin - ✔✔Start subcutaneous insulin when:
-Anion gap is closed (DKA)
-Serum bicarbonate is > 15 mEq/l (DKA)
-Patient is able to eat
-Mental status improves (HHS)
✔✔Initial bloodwork - ✔✔Basic metabolic panel
Arterial blood gases
Magnesium
Phosphorus
✔✔SubQ Insulin - ✔✔Give short-acting aspart or lispro dose that is twice the current
infusion dose (eg. 4 Units/hr drip; give 8 Units Aspart SQ)
