Trulicity (dulaglutide) is a once-weekly injectable medication used to manage type 2 diabetes mellitus. Knowing the best place to take your Trulicity shot is essential for ensuring effective medication delivery, minimising discomfort, and maintaining healthy injection sites. This guide explains the three approved injection sites—abdomen, thigh, and upper arm—and provides practical advice on selecting the most suitable location for your circumstances. You'll also learn proper injection technique, the importance of site rotation, and how to manage common injection site reactions to support optimal diabetes control.

Where to Inject Trulicity: Recommended Injection Sites

Trulicity (dulaglutide) is a once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist administered via subcutaneous injection for the management of type 2 diabetes mellitus. The medication is designed to be injected into areas of the body where there is adequate subcutaneous tissue—the layer of fat beneath the skin but above the muscle. For subcutaneous use only—do not inject into a vein or muscle.

The three approved injection sites for Trulicity are:

• Abdomen (stomach area): This is often considered the most convenient site for many patients. Inject into the soft, fatty tissue of your abdomen, avoiding a 5 cm (2-inch) radius around your navel (umbilicus). The abdomen typically provides consistent absorption and is easily accessible for self-administration.

• Thigh: The front and outer areas of the thigh offer another suitable injection site. Choose the middle portion of the thigh, avoiding the inner thigh where there is less subcutaneous tissue and more sensitive areas.

• Upper arm: The back of the upper arm, in the fatty tissue area, can be used, though this site may require assistance from another person due to the angle required for proper injection technique.

Any of the approved sites (abdomen, thigh, upper arm) may be used as per the Summary of Product Characteristics (SmPC). Remember to rotate your injection sites with each weekly dose to maintain healthy tissue and optimal absorption (see the section on rotation below).

How to Choose the Best Injection Site for Trulicity

Selecting the most appropriate injection site for your Trulicity dose involves considering several practical and clinical factors. Whilst all three approved sites—abdomen, thigh, and upper arm—are equally effective, individual circumstances may make one site preferable to another at any given time.

Personal comfort and accessibility are primary considerations. Many patients find the abdomen most convenient for self-administration, as it provides good visibility and easy reach. The thigh is another accessible option, particularly for those who prefer not to inject into their stomach area. The upper arm, whilst suitable, often requires assistance from a family member or carer due to the positioning required.

Skin condition at potential injection sites should be carefully assessed before each dose. Avoid areas with:

• Active skin conditions (eczema, psoriasis, dermatitis)

• Bruising, scarring, or recent wounds

• As a general good practice, avoid injecting into moles, tattoos, or areas of skin irritation

• Stretch marks or areas of hardened tissue from previous injections

Body composition may influence site selection. Individuals with less subcutaneous fat may find certain areas more comfortable than others. The abdomen typically has more subcutaneous tissue in most people, making it a reliable choice. If you are particularly lean, the abdomen or thigh may be preferable—speak to your diabetes nurse or pharmacist for personalised guidance.

Clothing and daily activities might also factor into your decision. If you wear tight waistbands or belts, you may prefer to use your thigh on days when abdominal injection might cause discomfort. Similarly, athletes or those engaging in activities that involve significant leg movement might opt for the abdomen to avoid potential irritation at the injection site during exercise.

Rotating Injection Sites: Why It Matters

Rotating your Trulicity injection sites is a crucial practice that helps maintain healthy subcutaneous tissue and ensures consistent medication absorption. Repeatedly injecting into the same spot can lead to several complications that may affect both your comfort and the effectiveness of your diabetes management.

Lipohypertrophy is the most common consequence of inadequate site rotation. This condition involves the abnormal accumulation of fatty tissue at frequently used injection sites, creating lumps or thickened areas under the skin. These areas not only feel uncomfortable but can impair medication absorption, potentially leading to unpredictable blood glucose control. While most evidence on absorption variability comes from insulin studies, the principles apply to subcutaneous injections including GLP-1 receptor agonists. Once lipohypertrophy develops, it can take months to resolve, and the affected areas should be avoided for future injections.

Lipoatrophy, though less common with modern formulations, involves the loss of fatty tissue at injection sites, creating indentations in the skin. This condition can be both cosmetically concerning and functionally problematic, as these areas provide less cushioning for future injections.

Proper rotation technique involves systematically moving your injection site with each weekly dose. A practical approach is to divide each approved area into multiple zones. For example, if using the abdomen, you might mentally divide it into four quadrants (upper right, upper left, lower right, lower left), ensuring you use a different quadrant each week. Within each quadrant, inject at least 2.5 cm (1 inch) away from your previous injection site, in line with Forum for Injection Technique (FIT) UK guidance.

Keeping a simple injection diary or using a smartphone app can help you track which sites you've used. This is particularly important with Trulicity's once-weekly dosing schedule, as it's easy to forget which site you used the previous week. Some patients find it helpful to follow a consistent pattern—for instance, rotating clockwise around the abdomen or alternating between abdomen and thighs on a regular schedule.

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. Following the correct administration technique ensures optimal medication delivery and minimises discomfort.

Preparation (before injection):

1. Remove the pen from the refrigerator at least 30 minutes before injection to allow it to reach room temperature. Cold medication can cause discomfort during injection.

2. Wash your hands thoroughly with soap and water.

3. Inspect the pen through the viewing window. The solution should be clear and colourless to slightly yellow. Do not use if the liquid appears cloudy, discoloured, or contains particles.

4. Select and clean your injection site using an alcohol wipe. Allow the skin to dry completely before proceeding—injecting through wet skin can cause stinging.

5. Do not remove the base cap until you are ready to inject.

Administration technique:

1. Unlock the grey base ring (if your pen has one) by turning it.

2. Pull off the clear base cap and discard it. Follow the indicators exactly as shown in the official Instructions for Use for your pen strength.

3. Place the clear base of the pen flat against your chosen injection site. The pen must be positioned at a 90-degree angle to your skin. For subcutaneous use only—do not inject into a vein or muscle.

4. Press and hold the injection button firmly. You will hear a click. Continue holding the pen against your skin.

5. Wait for the second click and then count slowly to 5 before removing the pen, following the exact timing in your pen's Instructions for Use. The plunger will be visible in the window, confirming the full dose has been delivered.

6. Dispose of the used pen immediately in a sharps container. Obtain a sharps bin from your GP or pharmacy and return it when full according to local arrangements. Never reuse the pen or share it with others.

Post-injection care:

If a small amount of blood appears at the injection site, apply gentle pressure with a clean cotton ball or gauze. Do not rub the area, as this may affect absorption. If you experience any concerns about whether the full dose was delivered, contact your diabetes specialist nurse or GP for guidance—do not administer a second dose without professional advice.

Storage reminder: Keep unused pens refrigerated (2–8°C). Once removed from the refrigerator, the pen may be kept at room temperature (below 30°C) for up to 14 days.

Common Injection Site Reactions and How to Manage Them

Injection site reactions can occur with Trulicity and are usually mild and transient, although gastrointestinal effects are more commonly reported with dulaglutide according to the SmPC.

Common injection site reactions include:

• Mild pain or discomfort: This usually resolves within a few hours. Ensuring the medication is at room temperature before injection and using proper technique can minimise discomfort.

• Redness (erythema): A small area of redness around the injection site is normal and typically fades within 24–48 hours.

• Itching or mild swelling: These reactions are generally self-limiting and require no specific treatment beyond avoiding scratching the area.

• Bruising: Small bruises may occur if a tiny blood vessel is inadvertently punctured. This is harmless and will resolve naturally.

Management strategies for injection site reactions:

For mild discomfort or redness, applying a cool compress (not ice directly on skin) for 10–15 minutes can provide relief. Avoid applying heat, as this may increase inflammation. Over-the-counter oral antihistamines may help if itching is bothersome, but consult your pharmacist or GP before taking any new medication.

Ensure you are rotating injection sites properly, as repeated use of the same area increases the likelihood of reactions. Review your injection technique with your diabetes nurse if reactions persist, as incorrect administration angle or speed may contribute to discomfort.

When to seek medical advice:

Whilst most injection site reactions are benign, certain symptoms warrant prompt medical attention:

• Severe pain, extensive swelling, or spreading redness that worsens after 48 hours may indicate infection or allergic reaction

• Signs of infection including warmth, pus, or fever

• Persistent lumps or hard areas that don't resolve within a few weeks

• Severe allergic reactions such as difficulty breathing, facial swelling, or widespread rash (call 999 or go to A&E immediately)

If you experience recurrent or troublesome injection site reactions, discuss this with your diabetes care team. In rare cases, alternative GLP-1 receptor agonists or adjustments to your injection technique may be considered. Never discontinue Trulicity without consulting your prescriber, as this may compromise your glycaemic control.

Suspected side effects should be reported via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk).

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