Pressure perturbation calorimetry (PPC), differential scanning calorimetry (DSC), and time-resolved Fourier transform infrared spectroscopy (FTIR) have been employed to investigate aggregation of bovine insulin at pH 1.9. The aggregation process exhibits two distinguished phases. In the first phase, an intermediate molten globule-like conformational state is transiently formed, reflected by loose tertiary contacts and a robust H/D-exchange. This is followed by unfolding of the native secondary structure. The unfolding of insulin is fast, endothermic, partly reversible, and accompanied by a volume expansion of approximately 0.2%. The second phase consists of actual aggregation: an exothermic irreversible process revealing typical features of nucleation-controlled kinetics. The volumetric changes associated with the second phase are small. The concentration-dependence of DSC scans does not support a monomer intermediate model. While insulin aggregation under ambient pressure is fast and quantitative, pressure as low as 300 bar is sufficient to prevent the aggregation completely, as high-pressure FTIR spectroscopy revealed. This is explained in terms of the high pressure having an adverse effect on the thermal unfolding of insulin, and therefore preventing occurrence of the aggregation-prone intermediate. A comparison of the aggregation in H(2)O and D(2)O shows that the isotopic substitution has diverse effects on both the phases of aggregation. In heavy water, a more pronounced volume expansion accompanies the unfolding stage, while only the second phase shifts to higher temperature.