Screening labs obtained according to American Association of the Study of Liver Diseases (AASLD) guidance (Chalasani et al. 2018) revealed a mildly elevated alanine aminotransferase (ALT) of 50 (2–30) IU/l, aspartate aminotransferase (AST) 32 (18–67) IU/l, alkaline phosphatase (AP) 253 (74–318) U/l, total bilirubin 0.4 (0.2–1) mg/dl, albumin 4.5 (3.6–4.7) g/dl, PT 11.1 (9.3–12) sec, INR 1.1, an elevated fasting insulin of 25.43 (normal 2–17) μIU/ml, fasting glucose 91 (70–99) mg/dl, hemoglobin (Hgb) A1c 5.2 (4.1%–5.8%), total cholesterol of 233 (125–170) mg/dl, and normal thyroid studies. Here, INS is linked to liver disorder.