The positron-emitter-labeled glucose analogue 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) accumulates into many cancers after intravenous injection, but the effect of serum glucose levels on FDG uptake in the tumor has not been extensively studied. In vitro, elevated media glucose levels markedly diminished FDG and FDG 6-phosphate uptake and retention in human adenocarcinoma cells, while insulin had no effect. Mammary cancers were established subcutaneously in 12 rats. Six control rats with mammary tumors were fasted overnight. Hyperglycemia was established in six rats by means of continuous glucose infusion (glucose clamp). All animals were then intravenously administered 50 microCi of FDG. Serum glucose levels were 87 mg/dL (4.83 mmol/L) in the control animals and more than 900 mg/dL (49.9 mmol/L) in the hyperglycemic animals. One hour after injection of FDG, mean F-18 uptake in the tumor, brain, small bowel, and ovaries was 2.7-9.7 times lower in the hyperglycemic animals (P less than .02). Mean F-18 activity in the kidneys tended to be somewhat higher in the hyperglycemic animals. FDG uptake in other tissues was comparable between the control and hyperglycemic groups. These data suggest that high serum glucose levels may substantially impair visceral tumor imaging with FDG positron emission tomography.