1 00:00:00,215 --> 00:00:02,340 JOHN ESSIGMANN: There are many different treatments 2 00:00:02,340 --> 00:00:03,420 for diabetes. 3 00:00:03,420 --> 00:00:05,700 I'll just use myself as a case study. 4 00:00:05,700 --> 00:00:07,410 One of the things I did to myself 5 00:00:07,410 --> 00:00:11,880 is I measure my blood sugar at different times during the day, 6 00:00:11,880 --> 00:00:17,220 and my blood sugar this morning was 116. 7 00:00:17,220 --> 00:00:21,240 And my blood sugar at about five o'clock this afternoon 8 00:00:21,240 --> 00:00:24,450 will probably be in the high 80s or 90. 9 00:00:24,450 --> 00:00:31,380 My blood sugar after I have a meal might go up to 160, 170, 10 00:00:31,380 --> 00:00:33,480 and it shouldn't go that high. 11 00:00:33,480 --> 00:00:35,580 And some mornings, like a couple of days ago, 12 00:00:35,580 --> 00:00:40,410 my blood sugar was 146, which is too high. 13 00:00:40,410 --> 00:00:43,867 And that reflects two things, what I ate the night before, 14 00:00:43,867 --> 00:00:45,450 but the second thing is the one that's 15 00:00:45,450 --> 00:00:47,700 my problem, which is gluconeogenesis. 16 00:00:51,386 --> 00:00:54,980 Gluconeogenesis technically means new synthesis of glucose 17 00:00:54,980 --> 00:00:56,960 from non-carbohydrate precursors. 18 00:00:56,960 --> 00:01:02,090 For example, I could take the amino acid aspartate, 19 00:01:02,090 --> 00:01:05,000 and I could find a path by which I could convert that 20 00:01:05,000 --> 00:01:06,320 into glucose. 21 00:01:06,320 --> 00:01:08,900 I could take lactate, and I could convert it into glucose. 22 00:01:11,840 --> 00:01:16,070 OK, so during the day, I use my glucose, and I stay active, 23 00:01:16,070 --> 00:01:17,510 and I walk around. 24 00:01:17,510 --> 00:01:18,960 I ride my bike and so on. 25 00:01:18,960 --> 00:01:21,620 So my glucose level, it's pretty reasonable by the time 26 00:01:21,620 --> 00:01:23,210 I go to bed. 27 00:01:23,210 --> 00:01:29,300 But then at night, when I stop moving around a lot, 28 00:01:29,300 --> 00:01:32,900 this gluconeogenesis process continues in me, 29 00:01:32,900 --> 00:01:36,770 and that's what causes my blood sugar to go up. 30 00:01:36,770 --> 00:01:39,065 The medicine I take is called Metformin. 31 00:01:39,065 --> 00:01:41,990 It has a number of targets, but one of them 32 00:01:41,990 --> 00:01:51,530 is one of the enzymes, called PEPCK, Pyruvate Carboxykinase, 33 00:01:51,530 --> 00:01:53,640 that's in the gluconeogenic pathway. 34 00:01:53,640 --> 00:01:56,060 Let me say a word about gluconeogenesis, another word 35 00:01:56,060 --> 00:01:57,950 actually. 36 00:01:57,950 --> 00:02:03,380 So we all have dinner, like say six to nine o'clock at night. 37 00:02:03,380 --> 00:02:08,090 We go to bed, and there are certain organs 38 00:02:08,090 --> 00:02:11,870 in the body, the brain, our red blood 39 00:02:11,870 --> 00:02:15,590 cells, that require glucose. 40 00:02:15,590 --> 00:02:18,210 They can't work with anything else. 41 00:02:18,210 --> 00:02:23,120 So gluconeogenesis, by principally the liver, 42 00:02:23,120 --> 00:02:26,360 provides a constant stream of glucose 43 00:02:26,360 --> 00:02:30,990 to these organs that absolutely require it, like our brain. 44 00:02:30,990 --> 00:02:36,800 Now, when we go to sleep at night, as time gets longer 45 00:02:36,800 --> 00:02:39,710 and longer and longer, after the meal, 46 00:02:39,710 --> 00:02:42,750 our glucose level, our natural glucose level, 47 00:02:42,750 --> 00:02:44,480 is going to start to fall off. 48 00:02:44,480 --> 00:02:47,510 And the liver then compensates by increasing 49 00:02:47,510 --> 00:02:50,090 the amount of gluconeogenesis in order 50 00:02:50,090 --> 00:02:53,390 to keep our blood glucose at about 100 51 00:02:53,390 --> 00:02:54,770 while we're not eating. 52 00:02:54,770 --> 00:02:58,280 What I do, during the night, is to take this drug that 53 00:02:58,280 --> 00:03:02,610 will prevent the switch to produce more and more sugar 54 00:03:02,610 --> 00:03:06,100 by gluconeogenesis.