Diabetes Management for FNP Boards: The Complete High-Yield Guide

Clinical High-Yield · 10 min read · February 14, 2026

Why Diabetes Dominates the Boards

Type 2 diabetes affects over 37 million Americans. It's one of the most common conditions you'll manage as an FNP — and one of the most heavily tested topics on both AANP and ANCC boards.

Here's the complete high-yield framework.

Diagnosis Criteria (Know These Cold)

Type 2 Diabetes (any one of the following):

• Fasting glucose ≥126 mg/dL (confirmed on repeat)
• 2-hour glucose ≥200 mg/dL on OGTT
• A1C ≥6.5% (confirmed on repeat)
• Random glucose ≥200 mg/dL with symptoms

Prediabetes:

• Fasting glucose 100–125 mg/dL (IFG)
• 2-hour glucose 140–199 mg/dL (IGT)
• A1C 5.7–6.4%

Board pearl: Diagnosis requires confirmation on a second test unless the patient is symptomatic with random glucose ≥200.

Treatment Algorithm

First-line: Metformin + lifestyle modification (unless contraindicated)

Metformin contraindications: eGFR <30, active liver disease, excessive alcohol use, iodinated contrast (hold 48 hours)

When to add a second agent (A1C not at goal after 3 months):

• Cardiovascular disease present: Add GLP-1 agonist (liraglutide, semaglutide) or SGLT2 inhibitor (empagliflozin, canagliflozin)
• Heart failure or CKD present: Add SGLT2 inhibitor
• Weight loss needed: GLP-1 agonist
• Cost is a concern: Sulfonylurea or TZD

A1C targets:

• Most patients: <7%
• Older adults, complex patients: <8%
• Pregnant patients: <6.5%

High-Yield Diabetes Pharmacology

Metformin: Decreases hepatic glucose production. GI side effects common. Lactic acidosis (rare but serious). Vitamin B12 depletion with long-term use.

Sulfonylureas (glipizide, glimepiride, glyburide): Stimulate insulin secretion. Risk of hypoglycemia. Weight gain. Avoid glyburide in elderly (long-acting, higher hypoglycemia risk).

GLP-1 agonists (liraglutide, semaglutide, dulaglutide): Mimic GLP-1. Weight loss. Cardiovascular benefit. Nausea common. Contraindicated in personal/family history of medullary thyroid cancer or MEN2.

SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin): Block glucose reabsorption in kidney. Weight loss. Cardiovascular and renal benefit. Risk of UTI, genital mycotic infections, DKA (rare). Avoid if eGFR <30.

Insulin types:

• Rapid-acting (lispro, aspart): Onset 15 min, peak 1–2 hr
• Short-acting (regular): Onset 30–60 min, peak 2–4 hr
• Intermediate (NPH): Onset 2–4 hr, peak 4–10 hr
• Long-acting (glargine, detemir, degludec): No peak, 24-hour coverage

Diabetic Complications

Microvascular: Retinopathy (annual eye exam), nephropathy (ACE/ARB for proteinuria), neuropathy (gabapentin, duloxetine, TCAs for pain)

Macrovascular: CAD, stroke, PAD — manage with aspirin, statin, BP control

Board pearl: The order of screening for complications: Eyes annually, feet annually, kidneys annually (urine microalbumin + eGFR), A1C every 3 months until stable then every 6 months.