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💉 NAPLEX Diabetes — High-Yield Pharmacotherapy — 2026

NAPLEX Diabetes Review 2026

Insulin types, oral hypoglycemics, GLP-1 agonists, SGLT2 inhibitors — mechanisms of action, monitoring parameters, A1c targets, and key counseling points for the NAPLEX.

Type 2 Diabetes — Pharmacotherapy Overview

Diabetes pharmacotherapy is among the highest-yield NAPLEX topics. You must know each drug class mechanism, key side effects, monitoring parameters, and which agents have cardiovascular and renal benefits beyond glucose lowering.

First-Line: Metformin

Metformin (Glucophage)
  • MOA: Decreases hepatic glucose production, increases peripheral insulin sensitivity
  • A1c reduction: ~1.5%
  • Hypoglycemia: No (when used alone)
  • Weight: Neutral or slight loss
  • Key SE: GI (nausea, diarrhea) — mitigated with ER formulation and gradual titration
  • CI: eGFR <30 mL/min (do not initiate if <30; discontinue if <30). Hold before iodinated contrast.
  • Rare but serious: Lactic acidosis (very rare with appropriate renal monitoring)
  • B12: Can decrease vitamin B12 levels — monitor with long-term use

Insulin Types — NAPLEX Quick Reference

TypeExamplesOnsetPeakDuration
Rapid-actingLispro (Humalog), Aspart (Novolog), Glulisine (Apidra)10-15 min1-2 hr3-5 hr
Short-actingRegular (Humulin R, Novolin R)30-60 min2-4 hr6-8 hr
IntermediateNPH (Humulin N, Novolin N)1-2 hr4-12 hr12-18 hr
Long-actingGlargine (Lantus, Basaglar), Detemir (Levemir)1-2 hrPeakless~24 hr
Ultra-longDegludec (Tresiba)1 hrPeakless42+ hr
NAPLEX pearl: Insulin glargine (Lantus) must NOT be mixed with any other insulin in the same syringe — its pH 4 formulation precipitates other insulins. NPH CAN be mixed with rapid/short-acting insulin (draw clear before cloudy).

Non-Insulin Injectables & Oral Agents

GLP-1 Receptor Agonists

Semaglutide, dulaglutide, liraglutide. Weight loss + CV benefit (some). GI SE (nausea). CI with personal/family MTC history. Pancreatitis risk.

SGLT2 Inhibitors

Empagliflozin, dapagliflozin, canagliflozin. CV + renal benefit. UTI/yeast infection risk. DKA (rare). Fournier gangrene (rare).

DPP-4 Inhibitors

Sitagliptin, linagliptin, saxagliptin. Weight neutral. Low hypo risk. Dose adjust for renal (except linagliptin). Possible HF risk (saxagliptin).

Sulfonylureas

Glipizide, glimepiride, glyburide. Hypoglycemia risk (especially glyburide). Weight gain. Cheap and effective. Avoid glyburide in elderly/renal.

Thiazolidinediones

Pioglitazone, rosiglitazone. Weight gain, edema, fractures. CI in NYHA Class III/IV HF. Bladder cancer risk (pioglitazone).

Monitoring Parameters

  • A1c: Every 3 months until stable, then every 6 months. Target <7% for most adults (individualize for elderly)
  • Fasting glucose: 80-130 mg/dL target
  • Post-prandial glucose: <180 mg/dL at 1-2 hours post-meal
  • Kidney: Annual eGFR and urine albumin-to-creatinine ratio (UACR)
  • Eyes: Annual dilated eye exam
  • Feet: Annual comprehensive foot exam
Calculations Quiz (Free) → ← Cardiology Review ID Review →

Practice Diabetes Questions for NAPLEX

PharmacyExam.com covers insulin, oral agents, GLP-1, SGLT2, and counseling with exam-style questions.

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