"Anything Meds Can Do, You Can Do Better" Part 5 of 12 - Increased Hepatic Glucose Production

Increased Hepatic Glucose Production — Why Your Morning Sugar Jumps (and What To Do).

Episode snapshot

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.

What is Increased Hepatic Glucose Production?

“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.”

What goes wrong in insulin resistance

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.

Why this matters

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.

Meds that target the liver (what they do and trade‑offs)

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.

Simple steps you can do now (anything meds can do, you can often help do better)

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 patter