Insulin mediates its own access and that of glucose to muscle by capillary recruitment and an increase in bulk blood flow. In addition, insulin resistance of muscle may result in part from an impaired hemodynamic action of insulin. The present review examines some of the factors that influence the effects of insulin both at the level of hemodynamics and metabolism in muscle. Factors include fatty acids, the inflammatory cytokine TNFalpha, vasodilators that relax the blood vessels and increase bulk flow, and elevated blood pressure that may be mediated by endothelin, a potent locally released vasoconstrictor, or other vasoconstrictor influences.