ALT/AST about tripled over three months, what is going on

Hello, f(31) here- I’m trying to figure out how worried I should be/what I should do next. My ALT has been in the 90s since 2019 with a pretty normal AST. Diagnosed with NAFLD via ultrasound a few years back.

Starting this summer, things have gotten much much worse. ALT was 130 in June, 210 in August, and now 311 in September. AST jumped to 223. I was very ill at the end of June/beginning of July with all sorts of crazy bloodwork that has since returned to normal, with the exception of my liver enzymes.

My GI has tested my for hepatitis (including autoimmune, as I have autoimmune arthritis), biliary duct disorders, Wilson’s- all were normal. My NASH Fibroscan came back with no fibrosis but very severe steatosis. Ultrasound shows fatty infiltrate and inflammation but that’s it.

My GI says he’s seen numbers “100 times as high” as mine and not to be worried- but this is happening very rapidly and dramatically and we should be doing something, right? I just don’t know what, and don’t know what to advocate for.

The only thing I can think that would maaaaybe be causing this is some severe (severe!) insulin resistance. My insulin (not blood sugar) was 517 a few months back- but since then I’ve gotten on metformin (normal A1C) so shouldn’t my liver have gotten better, not worse? I had been off of it for a few days before this most recent 311 ALT result though (because I was doing other testing that required me to be off of it)- and before that had reduced my dose my half for about two weeks. Is the liver problem just my insulin issue? Is it something else entirely? Haven’t started any other new meds other than a pain patch, which I’ve been guaranteed isn’t causing this because it’s transdermal, don’t take supplements, and haven’t had a drop of alcohol in many months.

Idk, please help a girl out. Thanks!