In a patient with type 2 diabetes who has insulin and glyburide ordered, the nurse should take which initial action when a discrepancy in timing is noted?

• A. Measure the vital signs
• B. Notify the primary healthcare provider
• C. Check blood glucose for hypoglycemia
• D. Assess for signs of ketoacidosis

Answer: (C)

When medications that lower blood glucose are used together, a timing discrepancy can lead to hypoglycemia. The most immediate, actionable step is to measure the patient’s current blood glucose to confirm whether hypoglycemia is present and guide the next intervention. If the reading is low, promptly give a fast-acting carbohydrate and recheck in 15 minutes, then adjust the dosing or timing to prevent recurrence. If the glucose isn’t low, continue monitoring and assess for other issues. Relying on vital signs alone isn’t sufficient to confirm hypoglycemia, and ketoacidosis is less likely to be the immediate concern with this med combination unless there are signs of significant uncontrolled hyperglycemia. The glucose measurement directly informs the appropriate response.