Possible reasons for high insulin level (28.41 uu/ml)?

Not fasting: Most common reason for high insulin is a non-fasting state. If one is fasting at time of blood draw, then high insulin is worrisome for insulin resistant state or pre-diabetes. In this case, A1c might be useful to further assess glycemic (sugar) control. Assuming good kidney function, metformin would be useful in treating those w/insulin resistance. Should also check blood pressure & cholesterol 2