Proteinase inhibitors which act on the digestive enzymes of insect herbivores are a basic mechanism of plant defence. Attempts to exploit this defence mechanism in plant genetic engineering have used over-expression of both endogenous and exogenous inhibitors. While significant protection against insect pests has been routinely achieved, the engineered plants do not show levels of resistance considered commercially viable. As a result of selective pressures, insect herbivores have developed multiple mechanisms of adaptation to overcome the defensive effects of plant proteinase inhibitors. Common polyphagous crop pests are well adapted to deal with a range of different inhibitors, which have only limited effects on fitness as a result. A range of strategies have been attempted to improve effectiveness of proteinase inhibitors as antimetabolites towards insects, including selection for inhibitory activity against insect digestive enzymes, mutagenesis for novel inhibitory activity, and engineering inhibitors with multiple functions. However, proteinase inhibitor genes have only been used in transgenic crops in combination with other insecticidal genes. In Chinese genetically engineered cotton varieties which express Bt toxins as an insecticidal protein against lepidopteran larvae, the CpTI (cowpea trypsin inhibitor) gene has been employed as a second transgene to improve protection. This gene combination represents the only commercial deployment of a proteinase inhibitor transgene to date, with Bt/CpTI cotton grown on over 0.5 million hectares in 2005. Future prospects for using proteinase inhibitor genes to enhance insect resistance in transgenic crops will require reassessment of their mechanisms of action, particularly in affecting processes other than digestion, as exemplified by effects on sap-feeding hemipteran pests.