Objective: The effects of insulin (0.18 n M–0.18 µ M) on reduced capillary perfusion, microvascular permeability increase and leukocyte adhesion induced by ischemia-reperfusion injury were investigated in the hamster cheek pouch microcirculation. To gain insight into the insulin’s mechanism of action, the effects of its higher concentration (0.18 µ M) were investigated after inhibition of tyrosine kinase (TK), nitric oxide synthase (NOS), protein kinase C (PKC), phosphatidylinositol 3-kinase and K<sup>+</sup><sub>(ATP)</sub> channels, alone or in combination. Two concentrations for each inhibitor were used. Methods: Microcirculation was visualized by fluorescence microscopy. Perfused capillary length, microvascular permeability, leukocyte adhesion to venular walls, vessel diameter and capillary red blood cell velocity were assessed by computer-assisted methods. Measurements were made at baseline (B), after 30 min of ischemia (I), and after 30 min of reperfusion (R). Results: In control animals, perfused capillary length decreased by 63 ± 5% of baseline at R. Microvascular permeability increased at I and R, while leukocyte adhesion was most pronounced in V1 postcapillary venules at R. Insulin dose-dependently preserved capillary perfusion at R (–28 ± 6 and –15 ± 6% of baseline), but was unable to prevent the increase in permeability at I (0.25 ± 0.05 and 0.29 ± 0.06 Normalized Grey Levels, NGL) and R (0.49 ± 0.10 and 0.53 ± 0.09 NGL), according to the concentrations. Adhesion of leukocytes was observed mostly in V3 venules at R (9 ± 2 and 10 ± 2/100 µm venular length, with the lower and higher concentration, respectively). Nitric oxide synthase inhibition by N<sup>G</sup>-nitro- L-arginine-methyl ester prior to insulin did not affect capillary perfusion at R (–18 ± 3% of baseline with higher concentration), but prevented permeability increase (0.20 ± 0.04 NGL, according to higher concentration) and reduced leukocyte adhesion in V3 venules at R (1.5 ± 1.0/100 µm of venular length, with higher concentration). Blockade of K<sup>+</sup><sub>(ATP)</sub> channels by glibenclamide prior to insulin decreased perfused capillary length at R (–58 ± 6% of baseline with higher concentration), attenuated leakage at R (0.30 ± 0.04 NGL, according to higher concentration) and caused leukocyte adhesion mainly in V1 venules at R (9.0 ± 1.5/100 µm of venular length, with higher concentration). Inhibition of either TK, PKC or phosphatidylinositol 3-kinase did not affect microvascular responses to insulin. Simultaneous inhibition of TK and NOS did not increase protection. Conclusions: Insulin prevents ischemia-reperfusion injury by promoting capillary perfusion through an apparent activation of K<sup>+</sup><sub>(ATP)</sub> channels and increase in nitric oxide release.