012-Short Term Pain for Long Term Gain: Nursing Implications with Lanreotide Use in Patients with Hyperinsulinism

Abstract

Background: Congenital Hyperinsulinism (CH) is caused by unregulated, increased secretion of insulin from the pancreatic beta cells. This results in severe persistent hypoglycemia which can lead to brain injury. Diffuse disease can be treated medically. Previous practice at SickKids was to treat patients with diffuse disease who did not respond to oral diazoxide and who declined pancreatectomy or had persistent hyperinsulinism post-pancreatectomy with subcutaneous octreotide injected every 8 h. There have been some studies that conclude long acting somatostatin analogue (Lanreotide) is a safe and effective alternative to octreotide therapy in CH patients with a significant improvement in blood glucose (BG) control and quality of life. As a result, the new standard of care at SickKids is monthly deep subcutaneous Lanreotide injections. Purpose: To describe the new practice of injecting Lanreotide to children. To aim to educate pediatric endocrine nurses in its use, and understand the nursing implications involved. Description of Topic: We did a Literature review and emailed Great Ormond Street Hospital (GOSH) to obtain their experience. Patients came in monthly for Lanreotide injections. Pain management and distraction techniques were utilized. Octreotide was weaned by 25% each week following the second Lanreotide injection and ceased by third Lanreotide injection. Other therapies (e.g. sirolimus) weaned after octreotide discontinued if BG stable. Communicated with community partners to coordinate care for patients in their home town. Clinical Implications: The following nursing implications should be considered when patients are treated with Lanreotide: 1) Nursing Practice (dosing, injection technique, land marking, pain management, illness management) 2) Monitoring (GI upset, TFT, yearly ultrasound for cholelithiasis, BG, weaning of Octreotide/Sirolimus during treatment) 3) Patient/Family satisfaction.