Jennifer K., 38F, BMI 22.4, presents for a routine physical. She is a marathon runner who eats a 'clean' high-carbohydrate diet (pasta, rice, fruit, whole grains) to fuel her training. She has no symptoms and feels well. Her physician is surprised to find: fasting glucose 108 mg/dL, HbA1c 5.9%, TG 142, HDL 38, fasting insulin 18.4 μIU/mL, HOMA-IR 4.9, ALT 52 U/L.