In brain, muscle, and pancreatic islets, depolarization induces an increase in respiration, which is dependent on calcium influx. The goal of this study was to assess the quantitative significance of this effect in islets relative to glucose-stimulated ATP turnover, to examine the molecular mechanism mediating the changes, and to investigate the functional implications with respect to insulin secretion. Glucose (3-20 mmol/l) increased steady-state levels of cytochrome c reduction (32-66%) in isolated rat islets, reflecting an increased production of NADH, and oxygen consumption rate (OCR) by 0.32 nmol/min/100 islets. Glucose-stimulated OCR was inhibited 30% by inhibitors of calcium influx (diazoxide or nimodipine), whereas a protein synthesis inhibitor (emetine) decreased it by only 24%. None of the inhibitors affected cytochrome c reduction, suggesting that calcium's effect on steady-state OCR is mediated by changes in ATP usage rather than the rate of NADH generation. 3-isobutyl-1-methylxanthine increased insulin secretion but had little effect on OCR, indicating that the processes of movement and exocytosis of secretory granules do not significantly contribute to ATP turnover. At 20 mmol/l glucose, a blocker of sarcoendoplasmic reticulum calcium ATPase (SERCA) had little effect on OCR despite a large increase in cytosolic calcium, further supporting the notion that influx of calcium, not bulk cytosolic calcium, is associated with the increase in ATP turnover. The glucose dose response of calcium influxdependent OCR showed a remarkable correlation with insulin secretion, suggesting that the process mediating the effect of calcium on ATP turnover has a role in the amplification pathway of insulin secretion. Diabetes 55: 3509 -3519, 2006 C ytosolic calcium is a major mediator governing the amount of insulin released in response to a glucose challenge (1-4). The effect of calcium in mediating energy turnover has been a point of particular interest due to the role of the metabolic coupling factors ATP and ADP in regulating calcium influx by closing ATP-sensitive K ϩ channels (K ATP channels). It has been proposed that calcium may increase ATP production by enhancing the metabolic generation of NADH mediated by calcium's activation of certain key dehydrogenases that regulate the rate of the trichloroacetic acid (TCA) cycle (5-13). Or, alternatively, calcium may mediate an increase in ATP usage associated with stimulation of ion pumping, biosynthesis, and/or the movement and exocytosis of insulin granules (14 -18). A number of characteristics required for the operation of calcium-induced stimulation of the generation of NADH have been elegantly demonstrated; studies have shown that glucose can elevate mitochondrial calcium (8,19), activate mitochondrial dehydrogenases (6,7), and increase NAD(P)H (20). However, in the context of total cellular ATP turnover during the second phase of insulin secretion, it is difficult to assess the quantitative significance of these affects. To accomplish this, oxygen consumption r...