Like "You need to see a doctor at the very least since you are running over 200... at this point you probably need more than "diet and exercise" to keep blood sugars down. If you are not already on insulin, I would definitely discuss it with your doctor as it is very helpful to get your blood sugar levels down. And to tell the truth using insulin is a lot easier than a lot of people think it is... and its not a failure, but rather a different approach to getting you healthier. (really the worst part is the first time you poke yourself with a needle - the rest is easier ) good luck "