Increased Hepatic Glucose Production: Why Your Liver Raises Blood Sugar (And What To Do)

“There isn’t one magic lever—many things are happening at once. That’s why small, steady habits matter.”

Hey friends, it’s Amber (RD/LD, CDCES) and Richie (TRS-C). In this episode of The Diabetes Podcast, we dig into a big driver of high blood sugar: increased hepatic glucose production. That means your liver is making and releasing too much sugar. We’ll explain why this happens, how it feels in real life, what meds help, and simple steps you can take today.

We keep it real, practical, and hopeful. Yes—type 2 and prediabetes remission is possible.

What Your Liver Does (In Plain Words)

• Your liver is your steady fuel tank.

• It keeps your brain fed with a small “drip” of glucose, especially overnight.

• In an emergency (fight or flight), your liver dumps extra glucose fast so you can act.

How the Liver Makes Glucose

Two main ways:

• Glycogenolysis: breaking down stored glucose (glycogen) in the liver.

• Gluconeogenesis: making new glucose from non‑carb sources.

In a healthy body, insulin signals the liver to slow or stop glucose release after meals. It’s like a brake pedal.

What Goes Wrong in Insulin Resistance

• With insulin resistance (common in prediabetes and type 2), the liver doesn’t “hear” insulin well.

• The “off switch” is broken. Even when insulin is high after a meal, the liver keeps pushing out glucose.

• Glucagon (a hormone from the pancreas’ alpha cells) tells the liver to release glucose. In diabetes, glucagon can be too active.

• Result: blood sugar rises, even when you didn’t eat.

The “Dawn Phenomenon”

• Many people go to bed at 80–100 mg/dL and wake up at 170–190 mg/dL.

• That rise is often hormones (like cortisol and glucagon) plus insulin resistance.

• If you’ve thought, “How can this be? I didn’t eat!”—the liver did it.

Why This Matters

Ralph DeFronzo’s research points to several core defects in type 2 diabetes. Three big ones:

• Decreased glucose uptake in muscle

• Impaired insulin secretion (we’ll cover next episode)

• Increased hepatic glucose production

That third one directly pushes blood sugar up—especially overnight and between meals.

Quick Primer: Alpha and Beta Cells

• Beta cells (pancreas) make insulin. Insulin lowers blood sugar and tells the liver to stop glucose output.

• Alpha cells (pancreas) make glucagon. Glucagon raises blood sugar and tells the liver to release glucose.

• In diabetes, insulin’s “stop” signal is weak, and glucagon can be too loud.

Medications That Target Increased Hepatic Glucose Production

Metformin (a biguanide)

• How it helps: suppresses liver glucose production (lowers cyclic AMP; blunts glucagon’s effect inside liver cells).

• Common downsides: GI upset (gas, bloating, diarrhea). Some can’t tolerate it.

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

• How they help: reduce glucagon release from alpha cells and improve several core defects.

• Common downsides: nausea, vomiting, slowed stomach emptying (“food sitting”).

Thiazolidinediones (TZDs; pioglitazone/Actos)

• How they help: activate PPAR‑gamma, improve insulin sensitivity, increase glucose uptake, shift fat away from the liver to under‑the‑skin stores, reduce lipotoxicity, and can help fatty liver.

• Common downsides: fluid retention and weight gain; long‑term risk of bone loss (especially in women). Use with a plan and monitoring.

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

• How they help: slow breakdown of GLP‑1/GIP so there’s a gentler increase in GLP‑1 effect.

• Safety: generally well tolerated, often used in older adults.

• Limits: modest A1C drop (~0.4–0.8%), and they don’t slow disease progression like GLP‑1s or TZDs.

Important note: Your treatment is personal. Always work with your clinician on meds, combos, and monitoring.

What You Can Do (Behavior Beats Medicine)

Anything meds can do, your habits can often do better—especially for the long run.

Move with Purpose

• Post‑meal movement: Even 2 minutes helps lower the post‑meal spike.

• Moderate‑intensity exercise most days:

  • Think “can talk, but getting warm; light sweat after ~10 minutes.”

  • You’re in the aerobic zone (often about 60–75% of max heart rate).

  • Improves insulin signaling and helps muscles soak up glucose.

Build a Walking Base

• Make a daily post‑meal walk your non‑negotiable habit.

• Walk before you “run.” Then add more intensity as you’re ready.

Spread Carbs Through the Day

• Aim for more consistent carbohydrate intake instead of one big meal.

• A simple starting pattern: consider 15–30 grams at breakfast (mornings can be more hormone‑sensitive), then alternate 30 g and 15 g snacks/meals as fits your day.

• Use a food‑tracking app if it helps you learn (Lose It, MyFitnessPal, etc.).

Eat More Soluble Fiber

• Soluble fiber supports gut health, heart health, and can help reduce visceral fat.

• Sources include oats, beans, lentils, apples, citrus, barley, chia, and psyllium.

Limit Refined Carbs and Saturated Fat

• Reduce ultra‑processed, simple sugars that spike quickly.

• Keep saturated fat under 10% of calories to support insulin sensitivity and heart health.

Target Visceral Fat Loss

• Small changes add up. Less belly and organ fat = better hormone signals and a quieter liver.

• Exercise + fiber + steady carbs + stress/sleep care = powerful combo.

Sleep and Stress

• High cortisol makes morning glucose rise easier.

• Protect your sleep and practice simple stress tools (breathing, light stretching, a short walk).

Why This All Works

• Muscle is your biggest glucose sink. When your muscles are active and sensitive to insulin, they pull more sugar out of your blood.

• Steady carbs and more fiber ease the liver’s need to “help.”

• Less visceral fat and lower stress hormones mean better signals to the liver.

• Over time, your “off switch” gets stronger.

Real Talk

• Diabetes is a communication problem inside the body. Signals get crossed or ignored.

• There isn’t one magic lever. Many things are happening at once.

• That’s why stacking small wins matters: movement, meals, fiber, sleep, stress care, and the right med plan for you.

What’s Next

In our next episode, we’ll talk about impaired insulin secretion. Spoiler: beta‑cell stress starts earlier than most people think.

Call to Action

• Share this with someone who wakes up high and wonders why.

• Try a 10‑minute walk after your next meal. Notice the difference.

• If you’re ready for additional support and a plan, contact us at [email protected]

Take courage! You can do this, and we can help.

Disclaimer

The information in this blog post and 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.

Results vary from person to person. Examples, statistics, or studies are shared to educate, not to promise outcomes. Any discussion of medications, dosing, or side effects is general in nature and may not be appropriate for your specific situation. Do not ignore professional medical advice or delay seeking it because of something you read or heard here. If you think you are experiencing an emergency or severe side effects (such as persistent vomiting, severe diarrhea, signs of dehydration, allergic reaction, or symptoms of lactic acidosis), call your local emergency number or seek urgent care right away.

We strive for accuracy, but health information changes over time. We make no guarantees regarding completeness, timeliness, or suitability of the content and assume no liability for actions taken or not taken based on this material. Use of this content is at your own risk.

Links or references to third-party resources are provided for convenience and do not constitute endorsement. By reading, listening, or using this information, you agree to these terms and understand that you are responsible for your own health decisions in partnership with your licensed healthcare provider.