I had a patient who was hyperkalemic with a potassium of 6-something. The doctor ordered the typical insulin and dextrose combination. I was busy with other patients, but asked the tech if they could check the patient’s blood sugar in about 20 minutes. About 45 minutes to an hour later the technician came up to me to let me know that the patient rang their call bell and seemed a little out of it. I go into the patient’s room and she was acting loopy then just passed out. I froze and then thought about her blood sugar. I asked the tech if they took the blood sugar and they said they got caught up with another patient. I checked the patient’s blood sugar and it was in the 20s! I ran to the pyxis and overrode the dextrose then gave it to her. Shortly after the patient started to wake up and breathed a sigh of relief. Fifteen minutes later, I checked her blood sugar again and she was stable in the low 100s. I checked her blood sugar another 15 minutes after that and it was still stable. As much as I would like to blame it on the tech, I am the nurse and it was ultimately my responsibility. We all get busy and it can be easy for things to slip our minds, but unfortunately this could have cost this patient her life. If there is something important that needs to be done, set an alarm and make sure it gets done. Checking a patient’s blood sugar after giving insulin is extremely important. Whenever I give the insulin and dextrose combination for hyperkalemia, I make sure a blood sugar is checked about 15-20 minutes later.