Many people taking Trulicity (dulaglutide) for type 2 diabetes wonder whether this medication can cause bladder infections. Whilst Trulicity is not directly linked to urinary tract infections in clinical studies, people with diabetes have an inherently increased risk of bladder infections due to elevated blood glucose levels and other diabetes-related factors. Understanding this distinction, recognising infection symptoms early, and adopting preventive strategies are essential for maintaining urinary health whilst managing diabetes effectively. This article examines the relationship between Trulicity and bladder infections, offering practical guidance on risk reduction and when to seek medical advice.

What Is Trulicity and How Does It Work?

Trulicity (dulaglutide) is a once-weekly injectable medication licensed in the UK for the treatment of type 2 diabetes mellitus. It belongs to a class of drugs called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone that helps regulate blood glucose levels.

The mechanism of action involves several complementary effects. Trulicity stimulates insulin secretion from pancreatic beta cells in a glucose-dependent manner, meaning it only promotes insulin release when blood sugar levels are elevated. This reduces the risk of hypoglycaemia compared to some other diabetes medications. Additionally, it suppresses glucagon secretion (a hormone that raises blood glucose), slows gastric emptying to reduce post-meal glucose spikes, and may promote modest weight loss by increasing satiety.

Trulicity is typically prescribed when diet and exercise alone are insufficient to control blood glucose, either as monotherapy or in combination with other antidiabetic agents such as metformin, sulfonylureas, or insulin. When used with insulin or sulfonylureas, there is an increased risk of hypoglycaemia, and dose reductions of these medications may be needed. Trulicity is not indicated for type 1 diabetes or diabetic ketoacidosis.

Common side effects include gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and abdominal discomfort, particularly during the initial weeks of treatment. These effects often diminish over time as the body adjusts to the medication. Rarely, serious side effects such as pancreatitis can occur – seek urgent medical attention if you experience severe, persistent abdominal pain, with or without vomiting.

Recognising Urinary Tract Infection Symptoms

Urinary tract infections (UTIs), including bladder infections (cystitis), are common bacterial infections affecting the urinary system. Whilst there is no established direct causal link between Trulicity and bladder infections in clinical trial data or product literature, people with diabetes have an inherently increased susceptibility to UTIs due to several factors related to their underlying condition.

Typical symptoms of a bladder infection include:

• A persistent, strong urge to urinate

• A burning sensation or discomfort when passing urine (dysuria)

• Passing frequent, small amounts of urine

• Cloudy, dark, or strong-smelling urine

• Blood in the urine (haematuria), which may appear pink or red

• Pelvic discomfort or lower abdominal pain, particularly in women

• A general feeling of being unwell or fatigued

In people with diabetes, UTIs may present atypically or progress more rapidly. Elevated blood glucose levels create a favourable environment for bacterial growth in the urinary tract, as glucose is excreted in urine when blood sugar control is suboptimal. Additionally, diabetic neuropathy can affect bladder function, leading to incomplete emptying and urinary retention, which further increases infection risk.

It is important to distinguish UTI symptoms from other urinary conditions. For instance, some diabetes medications (particularly SGLT2 inhibitors like dapagliflozin or empagliflozin) are associated with an increased risk of genital mycotic infections, while their association with UTIs varies by agent and is generally smaller. Trulicity does not share this mechanism and is not specifically linked to elevated UTI rates in clinical studies. If visible blood in your urine persists after successful UTI treatment, consult your GP promptly as this requires further investigation.

Managing UTI Risk While Taking Trulicity

Whilst Trulicity itself is not recognised as a direct cause of bladder infections, optimising diabetes management and adopting preventive measures can significantly reduce UTI risk for individuals taking this medication.

Blood glucose control is paramount. NICE recommends individualised HbA1c targets: typically around 48 mmol/mol (6.5%) for those not on medications causing hypoglycaemia, and around 53 mmol/mol (7.0%) for those using insulin or sulfonylureas, with personalised goals based on individual circumstances. Trulicity contributes to glycaemic control, which may indirectly lower infection susceptibility.

Practical strategies to reduce UTI risk include:

• Adequate hydration: Drinking sufficient fluids (approximately 1.5–2 litres daily unless contraindicated) helps flush bacteria from the urinary tract

• Proper hygiene: Wiping from front to back after using the toilet, particularly for women, prevents bacterial transfer from the bowel

• Regular voiding: Avoiding prolonged periods without urination and ensuring complete bladder emptying

• Post-coital urination: Passing urine shortly after sexual activity may help clear bacteria

• Avoiding irritants: Limiting use of perfumed soaps, bubble baths, or feminine hygiene products in the genital area

• Appropriate clothing: Wearing breathable cotton underwear and avoiding tight-fitting garments

For individuals experiencing recurrent UTIs (three or more episodes in 12 months), discuss this with your GP or diabetes specialist nurse. They may recommend additional investigations to identify underlying causes, such as incomplete bladder emptying due to diabetic autonomic neuropathy. Management options may include vaginal oestrogen in post-menopausal women, methenamine hippurate in appropriate patients, or targeted antibiotic prophylaxis after shared decision-making. If incomplete bladder emptying is suspected, post-void residual assessment and urology referral may be considered.

When to Seek Medical Advice About Bladder Symptoms

Recognising when bladder symptoms require professional assessment is crucial for preventing complications, particularly in people with diabetes who may be at higher risk of severe infections.

Contact your GP or NHS 111 promptly if you experience:

• Symptoms suggestive of a UTI (burning on urination, frequency, urgency, cloudy or bloody urine) that persist for more than 24–48 hours

• Lower abdominal or pelvic pain accompanying urinary symptoms

• Mild fever (temperature 37.5–38°C) with urinary symptoms

• Recurrent UTIs (more than two episodes in six months)

• Symptoms that worsen or do not improve within 48 hours of starting antibiotics

Certain groups should seek same-day assessment for suspected UTI, including pregnant people, men, children/young people, those with catheters, immunosuppressed individuals, and frail older adults.

Seek urgent medical attention (contact 999 or attend A&E) if you develop:

• High fever (temperature above 38°C) with shaking or rigors, which may indicate pyelonephritis (kidney infection)

• Severe back or flank pain, particularly if accompanied by nausea and vomiting

• Confusion, drowsiness, or altered mental state

• Signs of sepsis, including rapid heartbeat, rapid breathing, or feeling extremely unwell

For people with diabetes, UTIs can escalate more rapidly and may contribute to diabetic ketoacidosis or hyperosmolar hyperglycaemic state in severe cases. If you notice your blood glucose levels becoming persistently elevated despite usual management, or if you feel generally unwell, contact your healthcare team.

When consulting a healthcare professional about bladder symptoms whilst taking Trulicity, provide a complete medication history, including all diabetes medications. Your GP may arrange a urine dipstick test or send a sample for culture (particularly for men, pregnant people, recurrent UTIs, catheter-associated infections, or suspected pyelonephritis). If you experience unexplained visible haematuria without UTI, or if haematuria persists or recurs after successful UTI treatment, your GP should refer you urgently for further investigation. Do not discontinue Trulicity without medical advice, as maintaining diabetes control remains essential during any intercurrent illness.

If you suspect any side effects from Trulicity, report them via the MHRA Yellow Card scheme (www.mhra.gov.uk/yellowcard or the Yellow Card app).

Frequently Asked Questions