A lthough the efficacy of continuous subcutaneous insulin infusion (CSII) has been proven, there are few data about its use in elderly patients. Previous studies of CSII use in elderly patients have shown an improvement in glycemic control 1,2 and severe hypoglycemia (SH) rates. 3,4 Impaired awareness of hypoglycemia (IAH), a major risk factor for SH, increases with age and duration of diabetes, 5 with over 45% of those with >15 years of diabetes duration reporting IAH. 6 Elderly people have impaired symptomatic and hormonal responses to hypoglycemia, which are activated at a lower glucose level and to a lower amplitude. 7,8 With better care and increasing life expectancy of people with type 1 diabetes mellitus (T1DM), there is the potential for increased numbers of older patients with T1DM and IAH. Large insulin pump audits conducted worldwide have shown that the mean ages of patients treated with CSII were younger, between 34 and 39 (SD 10-14) years, than those on multiple daily insulin injections. 9,10 Although this may represent the greater use of CSII in the pediatric population, it may also suggest that use is being limited in older patients. Therein lies a particularly vulnerable population of patients with increased risks of hypoglycemia and IAH, who may benefit from CSII, but for whom access to this technology may be limited by cognitive function, by manual dexterity, and potentially by healthcare professional attitudes.A retrospective case-note audit was performed in all patients started on CSII over the past 12 years, with a minimum duration of 1 year on CSII, in our unit, a tertiary referral center with an approximate average of 50 pump starts per year over the past 3 years. Information such as age at initiation of CSII, gender, duration of diabetes prior to start of CSII, main indication for CSII, baseline glycated hemoglobin (HbA1c) level, HbA1c level at the end of year 1 of CSII therapy, and mean annual HbA1c level thereafter was obtained. In a proportion of patients, hypoglycemia history (frequency of mild/moderate hypoglycemia and SH 11 ) and hypoglycemia awareness status according to physician letters and Gold score 12 were available. Rates of SH, requiring external assistance, 11 routinely reported by patients as episodes since the last clinic visit, were calculated for the 1 year prior to CSII and in the last 12 months of follow-up. Data were analyzed using SPSS software version 22.0 (SPSS, Inc., Chicago, IL). Results are reported as mean (SD) or median (interquartile range), unless otherwise stated. Groups were compared using paired t test or Wilcoxon test, as appropriate. A value of P < 0.05 was considered statistically significant.From a total of 360 patients on CSII with at least 1 year of follow-up, 34 patients (9.4%) were ‡60 years of age at the time of starting CSII. Mean (SD) age at commencement of CSII was 65.4 (4.5) years, with the oldest patient being 77 years old. The majority (64.7%) were women. Diabetes duration was 30.4 (16.7) years. Thirty-one patients had T1DM, two had type 2 ...

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Extrapancreatic somatostatinomas are uncommon neuroendocrine tumours. Information related to its long-term prognosis is scarce. The prognosis of patients with advanced somatostatinoma is expected to be poor, but some tumours show low malignant potential and long-term survival rates have been described, even in the presence of metastases. We present a case of a 30-year-old patient, diagnosed with jejunal somatostatinoma. Multiple liver metastases were present at diagnosis. The primary tumour was removed and somatostatin analogues were prescribed. The patient survived for 12 years, with acceptable quality of life, although he suffered from repeated episodes of abdominal pain, diarrhea and vomiting along with severe hyperglycaemia followed by hypoglycaemia. Finally, he died because of severe ascitis and dyspnea due to tumour progression.