• M W Ghilchik and A S Morris.
• Lancet. 1971 Dec 4; 2 (7736): 1227-9.

AbstractThe insulin response to a glucose load has been investigated in twenty-five patients with small-vessel disease (ischaemic lesions of toes or feet in the presence of foot pulses). The clinical presentation was similar to that of juvenile diabetic microangiopathy, but in small-vessel disease there was no glucose intolerance. Unexpectedly in the patients with small-vessel disease there was no striking insulin secretion response to the stimulus of a glucose load. Controls increased their circulating insulin levels on average sixfold over fasting levels after 50 g. oral glucose: all the small-vessel-disease patients had increases of less than three times their fasting levels, and nine of them had completely flat curves throughout the test. Tolbutamide also did not stimulate insulin secretion. The refractory state of these patients' responses to the normal stimulus of insulin output has similarities to the picture in juvenile diabetes mellitus and may be important in the aetiology of the small-vessel lesions.

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