Lancet
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The 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. ⋯ 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.