Normal fasting insulin with elevated fasting glucose, eAg, and ALT:AST could mean a declining output of insulin, insulin resistance, or possible fatty liver. A review of past fasting insulin and glucose regulation labs would best identify a trend.
In this case, depending on the degree of elevation, fasting glucose, eAG, and ALT:AST point to the possibility of insulin resistance, fatty liver, metabolic syndrome, and diabetes risk.
Therefore, further assessment should be completed, including a thorough history, physical, nutrition, medication, and lifestyle review. This will help determine individual risk for these conditions. Liver function tests, triglycerides, and oxidative stress biomarkers should also be evaluated.
Evaluating these biomarkers over time will help determine if insulin levels had been elevated in the past and then declined to indicate decreased beta cell function. It is possible that insulin was high in the past, and glucose was kept within normal limits due to increasing insulin output. However, insulin resistance can eventually set in, and beta cell function can decline.
Measuring C-peptide can also help evaluate insulin production and can be incorporated into HOMA2 (homeostasis Model Assessment) calculations.
Ultimately, a review and comparison of results over the past 2-3 years and a comprehensive clinical assessment would best determine the presence of insulin resistance or persistent blood glucose dysregulation in this case.
Recommended reading:
Please see the Optimal DX white paper on Insulin Resistance for more information: https://www.optimaldx.com/insulin-resistance-whitepaper
References
Abdul-Ghani, Muhammad A et al. “Contributions of beta-cell dysfunction and insulin resistance to the pathogenesis of impaired glucose tolerance and impaired fasting glucose.” Diabetes care vol. 29,5 (2006): 1130-9. doi:10.2337/diacare.2951130
Freeman, Andrew M. and Nicholas Pennings. “Insulin Resistance.” StatPearls, StatPearls Publishing, 4 July 2022.
Świderska, Magdalena et al. “Oxidative stress biomarkers in the serum and plasma of patients with non-alcoholic fatty liver disease (NAFLD). Can plasma AGE be a marker of NAFLD? Oxidative stress biomarkers in NAFLD patients.” Free radical research vol. 53,8 (2019): 841-850. doi:10.1080/10715762.2019.1635691
Wang, Qin et al. “Insulin resistance and systemic metabolic changes in oral glucose tolerance test in 5340 individuals: an interventional study.” BMC medicine vol. 17,1 217. 29 Nov. 2019, doi:10.1186/s12916-019-1440-4