The case was a 41-year-old male patient with obesity and hypertension until 2015. He became 102 kg with body mass index (BMI) of 32.5 and HbA1c value increased to 6.6% in January 2016. Then, he started a low carbohydrate diet (LCD) and continued successfully. His body weight was decreased to 77 kg within nine months with 5.7% in HbA1c. His lipid profiles were improved as follows: triglyceride 143 to 33 mg/dL, LDL-C 130 to 102 mg/dL, HDL-C 40 to 76 mg/dL. After that, he has continued LCD but has always meals with excess calories. Then, his weight became 88 kg in January 2020 with 6.4% in HbA1c. During three years, values of HbA1c and lipid profiles became gradually worse. He has been prescribed for antihypertensive drugs and not for an oral hypoglycemic agent (OHA) so far. The adequate treatment would be discussed from now