The aim of this study was to optimize the metabolic conditions for planar myocardial fluorine-l8 fluorodeoxyglucose (FDG) imaging. The effects of high and low insulin levels during euglycaemic clamping on myocardial and femoral muscle FDG uptake were compared since insulin plays a major role in glucose metabolism. FDG uptake in 11 patients was studied using planar scintigraphy. Patients were studied twice: in the low-dose insulin protocol (LDI), insulin was infused at a rate of 20 mU/kg per hour, starting 1 h before FDG administration, while in the high-dose insulin protocol (HDI) it was infused at a rate of 100 mU/kg per hour. Glucose infusion rate was adjusted according to frequently determined blood glucose levels. Somatostatin was infused to block endogenous insulin release. Planar images were obtained from the thorax region and femoral muscles. Regions of interest were drawn over normal and abnormal myocardial areas (based on angiographic and thallium-201 data) and over lung, liver and muscle areas. After clamping, insulin levels during LDI and HDI at t=60 were 30.6±13.3 and 129.6±30.5 mU/1 respectively (P<0.0001). Femoral muscle uptake was significantly higher during HDI (P<0.001). Uptake in normal and abnormal myocardial areas did not differ between the two protocols. Heart/lung ratios (NS) and heart/liver ratios (P<0.05) increased during HDI. It may be concluded that planar FDG imaging is influenced by plasma insulin levels. The euglycaemic hyperinsulinaemic clamp technique, although more demanding, gives an adjustable metabolic steady state without significantly altering the FDG uptake patterns in normal and abnormal myocardial regions. The image quality of planar FDG images improves due to lower background uptake of FDG during clamping with high plasma insulin levels.