Patients with diabetes mellitus have a 2-4-fold increased risk for coronary artery disease. They suffer from both microvascular (nephropathy and retinopathy) and macrovascular (peripheral artery disease) complications (1). Apart from increased concentrations of certain coagulation factors (2), patients with diabetes mellitus type I and II have platelets that show increased adhesion, aggregation, thromboxane production, and P-selectin expression (3). The hyperactivity might be caused by the absence of insulin inhibition, since intensive insulin treatment in diabetic patients reduced platelet aggregation (4).The insulin receptor is a heterotetrameric transmembrane glycoprotein composed of two extracellular ␣ subunits (135 kDa each) and two transmembrane  subunits (95 kDa each) that function as allosteric enzymes in which the ␣ subunit inhibits the tyrosine kinase activity of the  subunit. Insulin binding to the ␣ subunit relieves the inhibition of the kinase activity in the  subunit leading to autophosphorylation of the  subunits and a conformational change that further increases the kinase activity. The insulin receptor tyrosine kinase phosphorylates proteins such as Shc and the insulin receptor substrates IRS-1 (165-185 kDa) and . IRS-1 and IRS-2 have a highly conserved amino terminus, which contains a pleckstrin homology domain, a phosphotyrosine binding domain, and a carboxyl terminus with several tyrosine phosphorylation sites. IRS-1 and IRS-2 are complementary and act as "docking sites" to several Src homology 2 domains containing proteins, such as the regulatory subunits of phosphatidylinositol 3-kinase (PI3K) 1 (5). GTP-binding proteins (G-proteins) can also act as signal transducers for the insulin receptor. G-proteins are guanine nucleotide-binding regulatory proteins that function as molecular switches between a GTP-bound "on state" and a GDPbound "off state." These proteins amplify, transmit, and integrate signals. The major G-proteins involved in platelet aggregation and secretion are G q ␣, which mediates increases in cytosolic Ca 2ϩ concentration, [Ca 2ϩ ] i , and G i ␣, which inhibits adenylyl cyclase thereby suppressing cAMP that is an inhibitor of platelets (6). Receptors that couple to G-proteins are generally seven-transmembrane proteins, but there are important exceptions. The insulin-like growth factor II receptor has a single transmembrane domain and couples directly to G i2 in a manner similar to that of conventional G-protein-coupled receptors (7). Studies have been reported suggesting that the insulin receptor binds G i ␣ 2 (8, 9).The insulin receptor is present on muscle, liver, and adipose tissue but also on endothelial cells, lymphocytes, erythrocytes, and platelets. A human platelet contains ϳ570 insulin receptors (10). Insulin binding induces phosphorylation of the  subunits (11,12), demonstrating that the receptor is func-