Postprandial glucose 200 despite diet control and exercise. What to do?

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Please update your FBS (fasting blood sugar) and HbA1c (glycosylated hemoglobin). Anyway, your sugar values are high. So, you have to take the necessary precautions to prevent the progression of the disease. First is adequate exercise. Daily do aerobic exercise for at least 30 minutes, then comes diet control. Small frequent low carbohydrate meals. Avoid oily food. Increase amount of leafy vegetables. Reduce salt intake. It is better to add drugs like Metformin or SGLT2 inhibitors to reduce your sugar values. These drugs will help you to reduce your weight too. Check your lipid profile and thyroid status.

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There are three possibilities. One is type 2 diabetes and others are MODY (maturity-onset diabetes in young) and LADA (latent autoimmune diabetes of adults). Type 2 DM is due to insulin resistance and low insulin secretion and responds nicely to oral hypoglycemic agents. MODY should have a strong family history of two or more generations. It is a rare disorder but responds to drugs. LADA looks like type 1. Autoimmune cause and it responds less likely to OHA (oral hypoglycemic agents) and need Insulin. It is a rare disorder. There will be low BMI than type 2. Islet cell antibodies, anti-GAD antibodies may be positive.

The onset of complications depends on the severity and type of diabetes. If it is not controlled, complications may start after 5 to 10 years. Diabetes can be easily controlled with treatment. First, you start with exercise and diet. If not improving, add drugs. If it comes normal, it would be type 2 diabetes. If not responding with one or two drugs, plan for Insulin therapy.