Trulicity (dulaglutide) is a once-weekly injectable medication used to manage type 2 diabetes mellitus. Knowing the best place to give a Trulicity shot is essential for safe, effective treatment and patient comfort. The medication is administered subcutaneously into fatty tissue beneath the skin, with three approved injection sites: the abdomen, thigh, and upper arm. Proper site selection and rotation help ensure consistent drug absorption, minimise discomfort, and reduce the risk of injection site reactions. This guide provides evidence-based advice on choosing and rotating injection sites, step-by-step administration instructions, and guidance on managing common side effects in line with UK clinical practice.

Where to Inject Trulicity: Recommended Injection Sites

Trulicity (dulaglutide) is a once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist used in the management of type 2 diabetes mellitus. It is administered subcutaneously, meaning the injection is given into the fatty tissue layer just beneath the skin. According to the MHRA-approved prescribing information and UK Patient Information Leaflet, there are three recommended injection sites for Trulicity: the abdomen (avoiding a 5 cm radius around the navel), the thigh (front or outer area), and the upper arm (back or outer area).

The abdomen is often considered the most convenient site for self-administration, as it is easily accessible and typically has adequate subcutaneous tissue. Many patients find this area comfortable and straightforward to reach without assistance. The thigh is another popular choice, particularly for those who prefer sitting down during injection or who find the abdomen less comfortable. The upper arm may require assistance from a caregiver or family member, as reaching the correct area can be challenging when self-injecting.

It is important to note that Trulicity should never be injected intramuscularly or intravenously. The subcutaneous route ensures appropriate absorption and reduces the risk of adverse effects. Each of these sites has sufficient subcutaneous fat to allow for proper drug delivery. Patients should select a site that feels comfortable and is free from skin abnormalities such as scars, bruises, or areas of active skin disease. Choosing an appropriate injection site contributes to treatment efficacy and helps minimise injection-related discomfort.

How to Choose the Best Injection Site for Trulicity

Selecting the optimal injection site for Trulicity involves considering several practical and clinical factors. Accessibility is paramount—patients who self-administer typically find the abdomen or thigh most convenient, whilst those receiving assistance may opt for the upper arm. The chosen site should have adequate subcutaneous tissue; individuals with lower body fat may find certain areas more suitable than others.

Skin condition at the injection site is equally important. Avoid areas with active inflammation, infection, rashes, or broken skin. Sites with significant scarring or prominent moles should also be avoided, as these may interfere with drug absorption or cause discomfort. Fully healed tattoos may be used provided the skin is healthy and intact. If you have had recent surgery or trauma to a particular area, select an alternative site until full healing has occurred.

Some patients report differences in comfort levels between sites. The abdomen generally causes less discomfort for many individuals, though personal preference varies. If you experience persistent pain or discomfort at one site, it is entirely appropriate to favour another approved location. Pharmacokinetic studies indicate no clinically relevant differences in dulaglutide absorption between the approved injection sites, so patient comfort and adherence should guide the decision.

Practical considerations matter too. If you wear tight clothing around your waist, the thigh might be preferable. Similarly, if you engage in activities that put pressure on certain body areas (such as wearing a rucksack), choose a site less likely to be affected. Patients should feel empowered to experiment within the three approved sites to determine which works best for their lifestyle and comfort. If uncertainty persists, your practice nurse or diabetes specialist nurse can provide personalised guidance during your routine diabetes reviews.

Rotating Injection Sites: Why It Matters

Site rotation is a fundamental principle in subcutaneous injection technique and is strongly recommended for all patients using Trulicity. Repeatedly injecting into the same spot can lead to lipohypertrophy—a localised accumulation of fatty tissue that creates lumps or thickened areas under the skin. Whilst this condition is most extensively documented with insulin therapy, rotation remains good practice for all subcutaneous injections, including GLP-1 receptor agonists, to reduce the risk of localised reactions and promote consistent drug absorption.

Lipohypertrophy can cause cosmetic concerns and may potentially affect medication absorption. Once established, these areas may become less vascularised and have altered tissue characteristics. Additionally, these areas may become less sensitive, which might seem advantageous but actually masks the problem and encourages continued use of unsuitable sites.

Proper rotation technique involves moving the injection site by at least 1–2 cm from the previous injection, even when staying within the same general area (such as the abdomen). A systematic approach works well: for example, dividing your abdomen into quadrants and rotating through them weekly, or alternating between abdomen and thigh each week. Keep a simple record if needed, particularly when starting treatment.

Beyond helping to prevent lipohypertrophy, site rotation reduces the risk of localised injection site reactions, including redness, itching, or discomfort. It also helps maintain the integrity of subcutaneous tissue throughout your treatment journey. During your annual diabetes review or routine appointments, your healthcare provider should examine your injection sites for any signs of tissue changes. If lipohypertrophy is detected, those areas should be avoided to allow tissue recovery.

Step-by-Step Guide to Administering Your Trulicity Injection

Trulicity is supplied in a single-dose, pre-filled pen designed for ease of use, requiring no dose preparation or needle attachment. Before administration, remove the pen from the refrigerator and allow it to reach room temperature for approximately 30 minutes—this reduces injection discomfort. Check the expiration date and inspect the solution through the viewing window; it should be clear and colourless to slightly yellow. Do not use if the solution appears cloudy, discoloured, or contains particles.

Preparation steps:

• Wash your hands thoroughly with soap and water

• Select your injection site and ensure the skin is clean and dry (alcohol swabs are not routinely necessary for clean skin)

• Remove the base cap from the pen—the exact steps and terminology vary by pen design

Administration technique:

It is essential to follow the Instructions for Use supplied with your Trulicity pen, as device steps and terminology are specific to the pen version you have been prescribed. The general principle involves placing the pen against your chosen injection site at a 90-degree angle, unlocking the device (if required), pressing the injection button, and holding the pen firmly in place for the full duration specified in your Instructions for Use (typically until you hear a second click). This ensures complete dose delivery.

After the injection is complete, lift the pen straight away from your skin. The safety mechanism will automatically cover the needle. Dispose of the used pen immediately in a sharps container—never attempt to reuse it. Do not recap the pen. A small amount of blood at the injection site is normal; apply gentle pressure with a clean tissue if needed, but do not rub the area.

Important safety points: Never share your Trulicity pen with others, even if the needle is changed. If you miss a dose and your next scheduled dose is more than 3 days away, administer the missed dose as soon as possible. If less than 3 days remain, skip the missed dose and resume your regular schedule. Contact your GP or diabetes nurse if you have questions about missed doses or experience difficulties with the injection technique. Always refer to the Instructions for Use provided with your pen for device-specific guidance.

Common Injection Site Reactions and How to Manage Them

Injection site reactions are among the commonly reported adverse effects of Trulicity, though most are mild and self-limiting. According to the Summary of Product Characteristics, injection site reactions are classified as common (occurring in up to 1 in 10 patients). The most frequent manifestations include redness (erythema), itching (pruritus), and mild swelling at the injection site. These typically appear within hours of injection and resolve within a few days without specific intervention.

Mild reactions can often be managed with simple measures. Applying a cool compress (not ice directly on skin) for 10–15 minutes can reduce swelling and discomfort. Avoid rubbing or scratching the area, as this may worsen irritation. Over-the-counter oral antihistamines may help if itching is bothersome, though consult your pharmacist first to ensure no interactions with your other medications. Ensuring proper injection technique—particularly allowing the medication to reach room temperature and rotating sites consistently—can reduce the frequency of these reactions.

When to seek medical advice: Whilst most injection site reactions are benign, certain symptoms warrant prompt evaluation. Contact your GP or diabetes specialist nurse if you experience:

• Severe pain, increasing redness, or warmth at the injection site (possible infection)

• Reactions that worsen rather than improve after 2–3 days

• Hard lumps or significant swelling that persists

• Signs of allergic reaction, including widespread rash, difficulty breathing, or facial swelling

• Recurrent reactions at multiple different sites

Rare but serious reactions include hypersensitivity and anaphylaxis. Seek immediate medical attention (call 999) if you develop difficulty breathing, severe dizziness, rapid heartbeat, or swelling of the face, lips, or throat following injection. Very rarely, patients may develop persistent nodules at injection sites; these should be assessed by your healthcare provider to rule out other causes.

If you experience any side effects, including those not listed in the Patient Information Leaflet, you can report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or by downloading the Yellow Card app. Maintaining open communication with your diabetes care team about any injection-related concerns ensures optimal treatment outcomes and patient safety.

Frequently Asked Questions