Sugar Level 400: Emergency Actions and Next Steps

August 1, 2024

498 9 minutes read

If your blood sugar level has reached 400 mg/dL, it is considered a medical emergency requiring immediate attention. This guide will explain what to do right away and how to manage your blood sugar going forward to prevent serious complications.

Table of Contents

Understanding Dangerously High Blood Sugar

A blood sugar level of 400 is well above the normal range of 70-130 mg/dL (fasting) and indicates severe hyperglycemia. Hyperglycemia occurs when there is too much glucose (sugar) in the bloodstream.

Potential causes of blood sugar reaching 400 include:

Missing a dose of diabetes medication like insulin
Eating a large amount of carbohydrate-rich food
Illness or infection
Certain medications like steroids
Extreme stress

If left untreated, a blood sugar level this high can lead to life-threatening complications such as:

Diabetic ketoacidosis (DKA): When the body doesn’t have enough insulin, it breaks down fat for energy, producing acids called ketones. High levels of ketones can poison the body.
Hyperosmolar hyperglycemic state (HHS): Extremely high blood sugar causes the blood to become thick and syrupy, leading to severe dehydration and confusion.
Damage to blood vessels and nerves over time, increasing risk of heart attack, stroke, kidney disease, vision problems, and neuropathy.

That’s why it’s crucial to take action immediately if you see a reading of 400 mg/dL on your glucose meter. Don’t try to bring it down on your own – you need professional medical guidance.

Signs and Symptoms to Watch For

In addition to seeing a reading of 400 on your blood glucose meter, be on the lookout for these warning signs that often accompany dangerously high blood sugar:

Symptom	Explanation
Frequent urination	Your kidneys try to get rid of excess sugar through urine
Extreme thirst	Your body is dehydrated from losing so much fluid
Blurred vision	High blood sugar pulls fluid from the lenses of your eyes
Fatigue	Your body can’t use the sugar for energy properly
Weight loss	Without enough insulin, your body starts burning fat for fuel
Slow-healing cuts or infections	High blood sugar impairs immune function and healing

If you have any of the following severe symptoms, call 911 or go to the emergency room immediately:

Difficulty breathing
Fruity-smelling breath (may indicate DKA)
Nausea and vomiting
Confusion or trouble staying awake
Chest pain
Seizures or convulsions

Don’t delay seeking emergency care, as these symptoms could be life-threatening. If you can, have someone else drive you to the ER or call an ambulance. It’s not safe for you to drive with a blood sugar of 400.

Immediate Steps to Take

If you don’t have the severe symptoms listed above, but your blood sugar is 400, here’s what to do:

Recheck your blood sugar to make sure the reading is accurate. Wash your hands and use a fresh test strip.
Call your doctor right away, explain your symptoms and blood sugar reading. Follow their instructions precisely. They may want you to come into the office or go to urgent care for evaluation and treatment.
Drink plenty of water to help your body flush out excess sugar. Aim for 8 oz every 30 minutes, up to 2-3 liters. Don’t drink sugary or caffeinated beverages.
If you take insulin, your doctor may advise you to administer a correction dose to lower your blood sugar. Only do this under medical guidance – taking too much insulin can cause hypoglycemia (low blood sugar), which is also dangerous.
Check for ketones in your urine using a test kit. If ketones are present, it could indicate diabetic ketoacidosis. Let your doctor know right away.
Get some rest, but keep monitoring your blood sugar every 1-2 hours or as often as your doctor recommends. Keep drinking water steadily.
Once your blood sugar is back under 250 mg/dL, eat a small, balanced meal containing protein, complex carbs and healthy fats to stabilize your levels. Good options include eggs, oatmeal, nuts or yogurt.

When to Use Glucagon

Glucagon is a hormone that quickly raises blood sugar. It comes as an injection or nasal spray.

Typically, glucagon is used to treat severe hypoglycemia (very low blood sugar) in someone who is unconscious or unable to eat. However, it is sometimes used in cases of extremely high blood sugar (over 400) when the person is showing signs of hyperosmolar hyperglycemic state (HHS) like confusion or loss of consciousness.

Only a medical professional should make the call to administer glucagon for high blood sugar / HHS. Never try to inject glucagon on your own in this situation. Misusing glucagon can be very dangerous.

If you have diabetes, talk to your doctor about whether you should have a glucagon emergency kit on hand and make sure your loved ones know how and when to use it. But remember, it’s only for cases of severely low blood sugar or on a doctor’s orders.

Long-Term Blood Sugar Management

Having a blood sugar of 400 is a major wake-up call. It means that your diabetes is not well-controlled and you’re at risk for serious complications. Working closely with your healthcare team to get your blood sugar back in a healthy range and keep it there is absolutely essential.

Here are the key components of an effective long-term blood sugar management plan:

Regular Doctor Visits

Schedule an appointment with your primary care doctor or endocrinologist (diabetes specialist) as soon as possible after the emergency situation has resolved.
Be fully honest about your eating habits, medication adherence, stress levels and any other factors that could be affecting your blood sugar.
Get a thorough checkup including an A1C test, foot exam, eye exam, blood pressure check and cholesterol panel.
Work with your doctor to set realistic goals for your A1C and daily blood sugar readings.
Discuss your medications and whether any adjustments need to be made. You may need to start insulin or change your dosage.
See your doctor every 3-6 months for follow-up or more often if recommended.

Frequent Blood Sugar Checks

Check your blood sugar as often as your doctor advises, usually several times a day. Typical times to check include first thing in the morning, before meals, 1-2 hours after meals, before and after exercise and before bed.
Keep a blood sugar log with your readings, meals, exercise, medication doses and notes on how you feel. Share this with your doctor at each visit.
Learn to recognize the signs of high and low blood sugar. Treat lows with 15 grams of fast-acting carbs like glucose tabs, juice or honey.
If you often have lows, especially without warning signs, ask your doctor about a continuous glucose monitor (CGM). This wearable device measures blood sugar every few minutes and can alert you to lows before they happen.

Balanced, Carb-Conscious Diet

Adopt a diabetes-friendly eating plan with help from a registered dietitian (RD) who specializes in diabetes. They can teach you about counting carbs, reading nutrition labels, proper portion sizes and timing your meals.
Emphasize non-starchy vegetables, lean proteins, healthy fats and high-fiber foods like whole grains and legumes. These nutrients help stabilize blood sugar.
Limit sugary, refined and processed carbs like soda, juice, white bread, pasta, rice, cereal, baked goods and candy. These cause quick spikes in blood sugar.
Spread your carb intake evenly throughout the day. Aim for 30-60 grams of carbs per meal and 15-30 grams per snack, or as your RD recommends.
Choose low-glycemic fruits like berries, apples and pears instead of tropical fruits. Pair fruit with a protein or fat to blunt the blood sugar response.
Stay hydrated with water, unsweetened tea and other sugar-free beverages. Even mild dehydration can raise blood sugar.

Regular Physical Activity

Aim for at least 150 minutes per week of moderate aerobic exercise like brisk walking, swimming, dancing or cycling. Activity makes your body more sensitive to insulin.
Incorporate resistance training 2-3 times per week to build muscle. Muscles use glucose for fuel and help maintain lean body mass.
Aim to be active most days of the week. If you’re new to exercise, start slow with 10 minutes a day and gradually work up to 30-60 minutes.
Check your blood sugar before and after exercise to learn how your body responds. You may need to adjust your medication or have a snack before working out.
Stay hydrated and keep a source of fast-acting carbs with you in case your blood sugar drops during exercise.
Avoid exercising if your blood sugar is over 250 mg/dL and you have ketones in your urine, or if your blood sugar is over 300 even without ketones. Physical activity can raise blood sugar even higher in these cases.

Weight Management

Work towards achieving and maintaining a healthy weight. Losing just 5-10% of your body weight if you’re overweight can significantly improve blood sugar control.
Focus on adopting healthy eating and exercise habits you can sustain long-term rather than going on crash diets. Slow, steady weight loss of 1-2 pounds per week is most effective.
Incorporate more movement into your daily life beyond just planned exercise. Take the stairs, park farther away, do yardwork and play with your kids or pets.

Stress Reduction

Chronic stress prompts your body to release hormones that can raise blood sugar, so finding ways to relax and de-stress is important for glucose control.
Try proven stress-busting techniques like deep breathing, meditation, yoga, tai chi, massage, listening to soothing music or spending time in nature.
Make time for hobbies and activities you enjoy. Laughter has been shown to lower blood sugar!
Talk to a therapist or counselor if stress, depression or anxiety are interfering with your ability to manage diabetes.

Additional Tips for Blood Sugar Control

In addition to the core diabetes management strategies outlined above, try these tips to help keep your blood sugar in check:

Stay hydrated. Drink water steadily throughout the day to help your body flush out excess glucose. Dehydration can cause blood sugar to rise. Aim for at least 8 cups per day, more if you’re exercising or it’s hot out.
Limit alcohol. Alcoholic drinks are high in carbs and can cause blood sugar to surge and then crash. If you do imbibe, stick to 1-2 drinks max and always pair with food. Check your blood sugar often and be aware alcohol can increase risk of lows, especially overnight.
Manage other health conditions. Having high blood pressure, high cholesterol, sleep apnea, PCOS or other medical issues can make blood sugar harder to control. Work with your doctor to get all health conditions properly diagnosed and treated.
Be prepared. Always carry a source of fast-acting carbs to treat lows, and keep your glucose meter and any other supplies with you. Wear a medical ID bracelet indicating you have diabetes in case of emergency.
Get support. Lean on family and friends for practical and emotional support. Consider joining a diabetes support group in person or online to connect with others who get what you’re going through. Mirari Medical offers a variety of resources for people with diabetes.

Living Well with Diabetes

Managing blood sugar is a 24/7 job that requires diligence and dedication. But the efforts you put in now to keep your levels in a healthy range can help you live a full, active life with diabetes and prevent serious complications down the road.

The key is to find a sustainable routine you can maintain long-term. Work closely with your doctor and diabetes care team to develop an individualized plan that fits your lifestyle, preferences and cultural background.

Remember, no one is perfect and diabetes management is not always predictable. Blood sugars will go up and down sometimes despite your best efforts. The important thing is that you keep trying your best and don’t let setbacks discourage you. Every day is a fresh start!

With the right knowledge, tools, medications and support system in place, you can absolutely thrive with diabetes and prevent a 911 emergency like a 400 blood sugar from happening again.

Key Takeaways

A blood sugar level of 400 mg/dL is a medical emergency requiring immediate attention. Seek medical help if you have symptoms like shortness of breath, vomiting or confusion.
In the absence of severe symptoms, contact your doctor right away for guidance if your blood sugar reaches 400. Drink water and take any doctor-recommended medications to start bringing it down.
Adopt a healthy lifestyle for long-term blood sugar management. This includes regular doctor visits, frequent self-monitoring, a balanced diet, regular exercise, stress reduction and weight control.
Always carry fast-acting carbs to treat lows and wear a medical ID bracelet. Stay hydrated, limit alcohol and manage any other health conditions.
Build a strong support system and work with your care team to develop a personalized management plan. Remember that setbacks are normal – keep trying your best each day!

With diligent monitoring, swift action when levels are high and a commitment to healthy living, you can successfully manage your blood sugar and prevent the potentially devastating consequences of hyperglycemia. You’ve got this!