Insulin questions

I would have started the drip provided there were titration orders including q1h finger sticks (or more often as needed), dextrose, and parameters for turning it off. I think the levemir would be going strong by that point. Remember with levemir, there isn't a peak. It just levels out and stays leveled out. Some people respond to the drip rapidly, which is fine. 300 is entirely too high, though. For regular insulin sliding scale coverage, we don't cover less than 150. For drips, we turn them off below 90. By the time you're at 90, though, the drip is down to 1 unit per hour. It not enough to sink a person. (And to be honest, when I hit 100 or so, I usually call to update the provider with the hopes they let me turn it off. Insulin drips are a time suck!)

Anyway, hope that helps!

How you manage an insulin drip is based on trajectory as much as the current BG level. With the downward trend you've already got going, you really wouldn't want to speed that up any by starting the drip. If they level out and are still out of range, then starting the drip would be indicated. Although in general the recommendation is that you should avoid a drip. Many years ago, when goal ranges were often 80-110 or other low/tight goal ranges insulin drips were often needed to hit those goals. Under current recommendations however (typically 110-180), insulin drips should not be routinely used.