Diabetes mellitus is associated with an increased risk of atherothrombotic complications. There is accumulating evidence of platelet hyperreactivity in diabetes, which may be of importance in the pathogenesis of diabetic vascular complications. Platelets possess insulin receptors, but their physiological relevance is not clear, and data on insulin effects on platelet function in the literature are less than consistent. We therefore investigated the influence of insulin on platelet activation in vitro. Fasting blood samples were collected in 20 healthy males, using citrate or hirudin as anticoagulants. Platelet activation was measured as platelet P-selectin expression and fibrinogen binding using whole blood flow cytometry in unstimulated and adenosine diphosphate (ADP) stimulated samples, incubated with 0-10000 microU/ml insulin for 20 min. The effect of insulin (30 or 300 microU/ml, incubated for 3 min) on platelet aggregation was studied using Born aggregometry in platelet-rich plasma (PRP). Insulin enhanced platelet fibrinogen binding more than P-selectin expression in unstimulated and ADP stimulated samples (P<.001 by analysis of variance [ANOVA]; n=20). Insulin (30 or 300 microU/ml) also enhanced ADP-induced platelet aggregation in PRP (P<.01 or P<.001; n=14). The platelet activating effect of insulin was verified in hirudinized samples (n=12), indicating that it was not dependent on unphysiologically low extracellular calcium concentrations. Thus, insulin enhances platelet activation in vitro, independently of extracellular calcium concentrations. Beneficial effects of insulin treatment on platelet function in vivo are probably related to improved metabolic control, rather than to direct platelet stabilizing effects.