Morbidity in the diabetic population is primarily a result of cardiovascular dysfunction and failure. Ischemic heart disease is a serious complication in the diabetic population. Recent data indicate that hearts from insulin-dependent models of diabetes differ significantly in their response to ischemia from hearts of models of non-insulin-dependent diabetes. Intrinsic cardiac factors may be responsible for the altered sensitivities to ischemia in the different types of diabetes. However, vascular dysfunction is also clearly present in the diabetic animal models. Endothelial cell damage and dysfunction play a prominent role in the contractile abnormalities and lesion formation during diabetes. The present treatise focuses upon insulin as a causative factor in cardiovascular disease and the differences between insulin-dependent and non-insulin-dependent models of diabetes.