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We’re back with Part 5 of our 12‑part series on the core defects in type 2 and prediabetes. Today we unpack Increased Hepatic Glucose Production. In plain words: your liver is making and releasing too much sugar. We explain why the liver does this, why it can go wrong, why your fasting glucose can be high even if you didn’t eat, and what you can do right now to calm it down. We also cover meds that target the liver and their pros and cons. Simple steps. Real talk. You’ve got this.

“Hepatic” means liver. Your liver is your body’s steady sugar pump. It:

• Feeds your brain while you sleep.
• Helps in “fight or flight” moments (think: run from a lion).
• Smooths out the time between meals.

It does this in two ways:

• Glycogenolysis: using stored sugar (glycogen) in the liver.
• Gluconeogenesis: making new sugar from other stuff (like protein parts).

In a healthy system, insulin tells the liver, “We just ate, stop making sugar.” Glucagon (another hormone) tells the liver, “We need sugar, let some out.”

With insulin resistance, the “stop” message is weak. Insulin is high, but the liver doesn’t listen well. Glucagon often stays loud. Result: the liver keeps pushing out sugar when it shouldn’t. We call this Increased Hepatic Glucose Production.

We joke, “the liver did it.” That’s why you can go to bed at 90 and wake up at 180. This is also called the dawn phenomenon. Hormones in the early morning (like cortisol and glucagon) can push sugar up, and insulin resistance makes it worse.

Big idea: diabetes is a “communication” problem. Signals are sent, but cells don’t hear them right.

High liver sugar output is one of the big three drivers of high blood sugar:

• Less sugar going into muscles (we covered this).
• The pancreas not putting out insulin well (coming next).
• Increased Hepatic Glucose Production (today).

Taming liver sugar helps your fasting numbers, protects your brain and heart, and moves you toward remission.

Note: Always talk to your clinician before starting, stopping, or changing meds.

Metformin (a biguanide; brand: Glucophage)

• What it does: Tells the liver to slow sugar output. Blunts the “make sugar” push from glucagon.
• How it helps: Lowers fasting sugar; supports weight‑neutral to slight loss.
• Common side effects: Gas, bloating, diarrhea. Some can’t tolerate it.

GLP‑1 receptor agonists (semaglutide, tirzepatide, Ozempic, etc.)

• What they do: Help the pancreas’ alpha cells quiet glucagon. This lowers liver sugar release. They also help other defects (appetite, stomach emptying, insulin release).
• How they help: Lower A1C, support weight loss, heart and kidney benefits in many.
• Common side effects: Nausea, vomiting, “food sits” feeling (slower stomach emptying).

TZDs (thiazolidinediones; pioglitazone/Actos)

• What they do: Flip a tiny cell switch (PPAR‑γ) to improve insulin sensitivity. Move fat out of the liver and into safer places under the skin.
• How they help: Reduce liver fat, improve insulin action, support long‑term control.
• Trade‑offs: Can cause fluid retention and weight gain. Long term (many years) may weaken bones (especially in women). The heart failure question is debated; talk with your clinician.

DPP‑4 inhibitors (sitagliptin/Januvia; “‑gliptin” drugs)

• What they do: Help your own GLP‑1 last longer.
• How they help: Modest A1C drop. Safe, often used in older adults.
• Trade‑offs: Smaller effect, don’t fix core problems well over time.

Our goal: lower insulin resistance, help muscles drink up sugar, and calm the liver’s sugar drip.

Move after meals (even 2 minutes helps)

• Best: 10–15 minutes of easy walking right after you eat.
• Why: Muscles pull sugar out of blood even without much insulin. This lowers the need for the liver to add more.

Add moderate‑intensity exercise most days

• How it should feel: Warm skin, light sweat after ~10 minutes, you can talk but not sing. You breathe mostly through your nose; if you must mouth‑breathe hard, it’s too intense.
• Examples: Brisk walking, easy cycling, light jogging, water aerobics.
• Why: Improves insulin signaling and makes muscles better sugar sponges.

Keep carbs steady across the day

• Spread your carbs. Many do better with smaller, steady amounts instead of one huge meal.
• A simple pattern to try: alternate 30 g and 15 g of carbs by meal/snack (example: 30 at lunch, 15 mid‑pm, 30 at dinner, 15 in the evening). Your needs may differ.
• Track to learn: apps like Lose It or MyFitnessPal can help you see your true portion.

Increase soluble fiber

• Foods: oats, beans, lentils, peas, apples, citrus, chia, flax.
• Why: Helps blood sugar, heart health, gut health, and can lower belly (visceral) fat.

Limit refined carbs and saturated fat

• Swap ultra‑processed sweets and white flours for whole foods.
• Keep saturated fat to less than 10% of calories to ease insulin signaling.

Sleep and stress care

• Aim for regular, restful sleep. Manage stress. Both lower cortisol, which helps calm dawn highs.

Target visceral fat

• Even small losses around the waist can boost hormones and improve liver signals fast.

• It’s common. Hormones rise before you wake (cortisol, glucagon).
• In insulin resistance, the “stop” signal to the liver is weak, so the liver releases sugar.
• Tip: an easy post‑dinner walk, steady evening carbs (not a big carb blast), better sleep, and your overall plan can help.

• Hepatic: liver.
• Increased Hepatic Glucose Production: liver makes and releases too much sugar.
• Glycogenolysis: using stored liver sugar (glycogen).
• Gluconeogenesis: making new sugar.
• Insulin: tells cells to take in sugar; tells the liver to stop making sugar.
• Glucagon: the opposite helper; tells the liver to release sugar.
• Beta cells: in the pancreas; make insulin.
• Alpha cells: in the pancreas; make glucagon.
• Dawn phenomenon: morning sugar rise from hormones.
• Visceral fat: fat deep in the belly around organs; causes hormone trouble.
• PPAR‑γ: a tiny cell switch that helps cells respond to insulin.
• DPP‑4: an enzyme that breaks down helpful gut hormones.

• 00:00 Welcome, Mother’s Day love, series reminder (12 core defects)
• 00:02 Topic intro: Increased Hepatic Glucose Production
• 00:03 What the liver does and why it releases sugar
• 00:05 Big words made simple: glycogenolysis and gluconeogenesis
• 00:07 Insulin resistance = broken “off switch” to the liver
• 00:09 “The liver did it” and dawn phenomenon
• 00:13 Alpha vs. beta cells; glucagon’s role
• 00:14 Meds that help the liver: metformin, GLP‑1s, TZDs, DPP‑4s
• 00:19 Side effects and trade‑offs
• 00:22 Behaviors that beat meds: movement, carbs, fiber, sleep, stress
• 00:23 What is moderate intensity?
• 00:25 How to spread carbs; simple 30/15 idea; tracking apps
• 00:28 Visceral fat, cortisol, and better sleep
• 00:30 Why drug design is hard; kidneys and SGLT‑2s note
• 00:32 Next week: impaired insulin secretion teaser

• Your liver is not “bad.” It’s doing its job. The signals are messy.
• Increased Hepatic Glucose Production is a core defect you can influence daily.
• Walk after meals. Train moderately most days. Keep carbs steady. Eat fiber. Sleep well.
• Meds can help, but your habits drive lasting change.
• Remission is real. Step by step wins the day.

• Work with your care team before changing meds or exercise.
• Try a post‑meal walk today.
• Pick one fiber food to add this week.
• Track carbs for three days to see your true baseline.

Disclaimer:

The information in this podcast is for educational and informational purposes only. It is not medical advice, diagnosis, or treatment, and it does not replace a one-on-one relationship with your physician or qualified healthcare professional. Always talk with your doctor, pharmacist, or care team before starting, stopping, or changing any medication, supplement, exercise plan, or nutrition plan—especially if you have diabetes, prediabetes, heart, liver, or kidney conditions, or take prescription drugs like metformin or insulin.

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