Insulin tests at Direct to Consumer labs are only $30-$35. I have fasting BG drawn at the same time, can plug those two numbers into the HOMA-IR formula, or ideally, look for fasting insulin under 5. But as you said insulin can be impacted by how long fasted, foods eaten day before, etc. One year I fasted 18 hours and insulin dropped below normal (1.7?) so stick with the recommended 12-14hr.

Good that you are thinking of improving diet wherever you can, but I still wonder about the non-diet reasons you can have enlarged liver. The enzymes are normal, could the liver enlargemnet have occurred when you did have Hep C and been there all along? Go through any period you took NSAIDs? Could your livers have been fat before going LC and not recovered?

Your ultrasound results reminds me of the book by Dr Gilbert Welch, Over-Diagnosed:Making people Sick in the Pursuit of Health,...you're healthy, the enzyme levels are fine, liver seems to be functioning...but a test shows something maybe perfectly normal probably related to age that now worries you.

Another thought...have you read the radiologist's report yourself? You can get a copy of the ultrasound and the report, and should be able to talk to the radiologist directly. Get your top questions ready. They spend most of their day sitting in dark rooms...I have found them to be open and willing to talk to patients.