Basaglar and Trulicity can be taken together, and this combination is commonly prescribed for adults with type 2 diabetes mellitus in the UK. Basaglar (insulin glargine) is a long-acting basal insulin providing steady background glucose control, whilst Trulicity (dulaglutide) is a once-weekly glucagon-like peptide-1 receptor agonist (GLP-1 RA) that enhances insulin response to meals and reduces appetite. These injectable therapies work through complementary mechanisms to improve blood glucose control. This dual therapy is supported by clinical evidence and aligns with NICE guidance for treatment intensification when glycaemic targets are not met with single agents. However, combining these medications should only be done under medical supervision, with careful monitoring for hypoglycaemia and appropriate dose adjustments.

Can You Take Basaglar and Trulicity Together?

Yes, Basaglar and Trulicity can be taken together, and this combination is commonly prescribed for adults with type 2 diabetes mellitus. Both medications are injectable therapies that work through different mechanisms to improve blood glucose control, making them complementary rather than contradictory in their actions.

Basaglar (insulin glargine) is a long-acting basal insulin that provides steady background insulin coverage throughout the day and night. Trulicity (dulaglutide) is a glucagon-like peptide-1 receptor agonist (GLP-1 RA) administered once weekly. Dulaglutide is licensed for adults with type 2 diabetes only; it is not indicated for type 1 diabetes or for the treatment of diabetic ketoacidosis. When used together, they address different aspects of glucose regulation: Basaglar replaces the basal insulin your pancreas may no longer produce adequately, whilst Trulicity enhances your body's natural insulin response to meals, slows gastric emptying, and reduces appetite.

This combination therapy is supported by clinical evidence and aligns with guidance from the National Institute for Health and Care Excellence (NICE NG28), which recommends intensifying diabetes treatment when glycaemic targets are not met with single agents. Both medications are approved for use in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA), and they can be co-prescribed where clinically appropriate. When adding dulaglutide to basal insulin therapy, your healthcare team will typically review and may reduce your insulin dose to minimise the risk of hypoglycaemia (low blood sugar).

However, combining these medications should only be done under medical supervision. Your healthcare team will determine whether this dual therapy is appropriate based on your individual circumstances, including your current HbA1c levels, previous treatment responses, risk of hypoglycaemia, and overall health status. Self-adjusting or combining diabetes medications without professional guidance can lead to serious complications, including dangerously low blood sugar levels.

References: NICE NG28: Type 2 diabetes in adults: management; EMC Summary of Product Characteristics (SmPC): Basaglar; EMC SmPC: Trulicity

How Basaglar and Trulicity Work in Diabetes Management

Understanding how Basaglar and Trulicity work helps explain why they complement each other effectively in diabetes management.

Basaglar (insulin glargine) is a synthetic long-acting insulin analogue that mimics the basal insulin secretion of a healthy pancreas. After subcutaneous injection, it forms microprecipitates in the tissue that slowly release insulin over approximately 24 hours, providing a relatively constant insulin level without pronounced peaks. This steady insulin supply helps control fasting blood glucose and provides background glucose control between meals and overnight. Basaglar works by binding to insulin receptors on cells, facilitating glucose uptake from the bloodstream into muscle and fat tissue, whilst also suppressing glucose production by the liver.

Trulicity (dulaglutide) operates through a different mechanism entirely. As a GLP-1 receptor agonist, it mimics the action of naturally occurring incretin hormones that are released from the gut in response to food intake. Trulicity works by:

• Stimulating glucose-dependent insulin secretion from pancreatic beta cells when blood glucose levels are elevated

• Suppressing glucagon release from pancreatic alpha cells, reducing hepatic glucose output

• Slowing gastric emptying, which moderates the rate at which glucose enters the bloodstream after meals

• Reducing appetite and food intake through central nervous system effects, often leading to weight loss

The key advantage of this dual approach is that Basaglar addresses basal insulin deficiency, whilst Trulicity enhances the body's meal-related insulin response and provides additional metabolic benefits. Together, they target both fasting and postprandial (after-meal) glucose elevations, providing more comprehensive glycaemic control than either medication alone.

References: EMC SmPC: Basaglar (Section 5.1 Pharmacodynamic properties); EMC SmPC: Trulicity (Section 5.1 Pharmacodynamic properties); EMA EPAR: Trulicity

Benefits of Combining Basaglar with Trulicity

The combination of Basaglar and Trulicity offers several clinically significant advantages for people with type 2 diabetes who require treatment intensification.

Improved glycaemic control is the primary benefit. Clinical trials have demonstrated that adding a GLP-1 receptor agonist like Trulicity to basal insulin therapy can provide additional HbA1c reductions, with the magnitude of benefit varying by dose and individual response. This improvement helps more patients achieve their individualised glycaemic targets, typically an HbA1c below 53 mmol/mol (7.0%) for most adults, as recommended by NICE guidelines. NICE NG28 supports the use of a GLP-1 receptor agonist in combination with insulin therapy as an option for treatment intensification in appropriate patients.

Weight management represents another important advantage. Whilst basal insulin therapy alone may be associated with modest weight gain, Trulicity typically promotes weight loss, with the degree of weight reduction varying by dose. When combined with Basaglar, patients often experience weight neutrality or even weight reduction, which is particularly beneficial as obesity exacerbates insulin resistance and cardiovascular risk in type 2 diabetes.

Cardiovascular outcomes have been evaluated in the REWIND trial, which demonstrated that dulaglutide reduced the risk of major adverse cardiovascular events in people with type 2 diabetes, including those with and without established cardiovascular disease. The UK Summary of Product Characteristics for Trulicity describes these cardiovascular outcomes data, though cardiovascular risk reduction is not a separate licensed indication in the UK.

Lower risk of hypoglycaemia compared to intensifying insulin therapy alone is another key benefit. Because Trulicity's insulin-stimulating effect is glucose-dependent (it only works when blood glucose is elevated), adding Trulicity may allow for lower basal insulin doses whilst still achieving glycaemic targets, potentially reducing hypoglycaemia risk. Your healthcare team will typically review and may reduce your insulin dose when starting or increasing dulaglutide.

Simplified regimen is achieved because Trulicity requires only once-weekly administration, compared to multiple daily injections of mealtime insulin that might otherwise be needed to improve glucose control.

References: NICE NG28: Type 2 diabetes in adults: management; EMC SmPC: Trulicity (Section 5.1 Clinical efficacy and safety); REWIND trial (Gerstein HC et al., Lancet 2019)

Safety Considerations When Using Both Medications

Whilst the combination of Basaglar and Trulicity is generally well-tolerated, several safety considerations require attention to minimise risks and optimise outcomes.

Hypoglycaemia (low blood sugar) is the most significant safety concern when using any insulin-containing regimen. Although Trulicity alone carries minimal hypoglycaemia risk, the combination with Basaglar increases this possibility. When starting or increasing the dose of dulaglutide, your healthcare team may need to reduce your basal insulin dose to lower the risk of hypoglycaemia. Warning signs include trembling, sweating, confusion, palpitations, and hunger. Patients should be educated on recognising and treating hypoglycaemia with fast-acting carbohydrates (15–20 g of glucose) and should carry glucose tablets or equivalent at all times.

Gastrointestinal side effects are common with GLP-1 receptor agonists like Trulicity, particularly when initiating therapy or increasing the dose. These may include:

• Nausea

• Vomiting

• Diarrhoea

• Abdominal discomfort

• Reduced appetite

The frequency and severity of these effects are dose-dependent and typically diminish over several weeks as the body adjusts. Taking Trulicity with or without food makes no difference, but some patients find that eating smaller, more frequent meals helps manage nausea. Trulicity should be used with caution in patients with severe gastrointestinal disease, including gastroparesis.

Acute pancreatitis has been reported with GLP-1 receptor agonists. Patients should be advised to seek immediate medical attention if they experience severe, persistent abdominal pain that may radiate to the back, as this could indicate acute pancreatitis. If pancreatitis is confirmed, Trulicity should be discontinued.

Diabetic retinopathy complications have been reported in patients treated with GLP-1 receptor agonists, particularly in those with pre-existing diabetic retinopathy who experience rapid improvement in glycaemic control. Patients with a history of diabetic retinopathy should be monitored appropriately. Seek advice if you develop new visual symptoms.

Acute gallbladder disease (including cholelithiasis and cholecystitis) has been reported with GLP-1 receptor agonists. Patients should be advised to seek medical attention if they develop signs or symptoms suggestive of gallbladder disease, such as right upper abdominal pain, fever, or jaundice.

Injection site reactions may occur with either medication, including redness, itching, or lipohypertrophy (fatty lumps). Rotating injection sites within recommended areas (abdomen, thighs, upper arms) helps minimise these issues.

Renal function should be monitored, as gastrointestinal side effects from Trulicity could potentially lead to dehydration and acute kidney injury, particularly in patients with pre-existing renal impairment. Dose adjustments of Basaglar may be necessary in patients with significant renal dysfunction.

Thyroid considerations: In rodent studies, GLP-1 receptor agonists caused thyroid C-cell tumours. The relevance of this finding to humans is uncertain, and there is no established causal relationship in humans. Trulicity is not contraindicated in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 in the UK. However, patients should be counselled to report symptoms of thyroid tumours (e.g., a lump in the neck, hoarseness, dysphagia, dyspnoea).

Pregnancy and contraception: Dulaglutide is not recommended during pregnancy. If you are planning a pregnancy, discuss stopping dulaglutide with your diabetes team in advance. If you become pregnant whilst taking Trulicity, stop the medication and contact your healthcare team urgently. People who could become pregnant should use effective contraception whilst taking dulaglutide.

Reporting side effects: If you experience any side effects, talk to your doctor, pharmacist, or nurse. You can also report suspected side effects via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or by downloading the Yellow Card app.

References: EMC SmPC: Trulicity (Sections 4.4 Special warnings and precautions, 4.6 Fertility, pregnancy and lactation, 4.8 Undesirable effects); EMC SmPC: Basaglar (Section 4.4 Special warnings and precautions); NHS: Hypoglycaemia (low blood sugar)

Dosing and Administration Guidelines for Dual Therapy

Proper administration technique and dosing schedules are essential for maximising the effectiveness and safety of combined Basaglar and Trulicity therapy.

Basaglar dosing is highly individualised and typically initiated or adjusted based on fasting blood glucose readings. The usual starting dose when adding basal insulin to oral medications or GLP-1 therapy is 10 units once daily, or 0.1–0.2 units/kg body weight. Basaglar should be injected subcutaneously once daily at the same time each day (any time of day is acceptable, provided it is consistent). The dose is then titrated upwards (typically by 2–4 units every 3–7 days) based on fasting glucose measurements, aiming for individualised target levels, commonly 5–7 mmol/L upon waking, as recommended by NICE. When starting or increasing dulaglutide, your healthcare team may reduce your insulin dose to lower the risk of hypoglycaemia.

Trulicity dosing begins at 0.75 mg once weekly for most patients, administered subcutaneously on the same day each week, at any time of day, with or without meals. After at least 4 weeks, the dose may be increased to 1.5 mg weekly if additional glycaemic control is needed. Further increases to 3 mg or 4.5 mg weekly are available for patients requiring greater HbA1c reduction, though these higher doses are associated with increased gastrointestinal side effects.

Administration technique for both medications involves:

• Inspecting the medication before use (should be clear and colourless for both)

• Rotating injection sites to prevent lipohypertrophy

• Using different injection sites for each medication if administered on the same day

• Not mixing the two medications in the same syringe

• Proper disposal of used pens in a sharps container

Timing flexibility: Whilst Basaglar should be given at the same time daily, Trulicity offers more flexibility. If a weekly Trulicity dose is missed, it should be administered as soon as possible if there are at least 3 days (72 hours) until the next scheduled dose; otherwise, skip the missed dose and resume the regular weekly schedule.

Storage requirements: Both medications should be stored in the refrigerator (2–8°C) before first use. Once in use, Basaglar pens can be kept at room temperature (below 30°C) for up to 28 days, whilst Trulicity pens may be stored at room temperature for up to 14 days. Neither medication should be frozen.

References: EMC SmPC: Basaglar (Sections 4.2 Posology and method of administration, 6.6 Special precautions for disposal); EMC SmPC: Trulicity (Sections 4.2 Posology and method of administration, 6.6 Special precautions for disposal); NICE NG28: Type 2 diabetes in adults: management

When to Contact Your Healthcare Provider

Knowing when to seek medical advice is crucial for safe and effective diabetes management when using Basaglar and Trulicity together.

Seek immediate medical attention (call 999 or go to A&E) if you experience:

• Severe hypoglycaemia with confusion, loss of consciousness, seizures, or inability to treat yourself

• Severe, persistent abdominal pain that may radiate to the back (possible pancreatitis)

• Signs of diabetic ketoacidosis: excessive thirst, frequent urination, nausea, vomiting, abdominal pain, fruity-smelling breath, confusion, or difficulty breathing

• Severe allergic reaction (anaphylaxis): difficulty breathing, swelling of face or throat, rapid pulse, severe rash

Contact your GP or diabetes team within 24 hours if you notice:

• Recurrent hypoglycaemia (more than 2–3 episodes per week of blood glucose below 4 mmol/L)

• Persistent hyperglycaemia (blood glucose consistently above 15 mmol/L despite medication adherence)

• Severe or persistent gastrointestinal symptoms preventing adequate food or fluid intake

• Signs of dehydration: decreased urination, dizziness, dry mouth, particularly with vomiting or diarrhoea

• Unexplained weight loss despite good glycaemic control

• Persistent injection site reactions or signs of infection

• New visual symptoms (possible retinopathy changes)

• Right upper abdominal pain, fever, or jaundice (possible gallbladder disease)

Schedule a routine review if:

• You're planning pregnancy or have become pregnant (dulaglutide is not recommended in pregnancy; stop the medication and contact your diabetes team urgently if you become pregnant)

• You're experiencing frequent mild hypoglycaemia requiring dose adjustments

• You have questions about your injection technique or medication storage

• You're struggling with medication adherence or experiencing side effects affecting quality of life

• Your HbA1c results indicate inadequate glycaemic control

Regular monitoring should include HbA1c testing every 3–6 months, annual review of renal function, and ongoing assessment of injection sites. Your diabetes team will provide personalised guidance on self-monitoring of blood glucose and when dose adjustments may be necessary. Never adjust insulin doses significantly without professional guidance, as this can lead to dangerous glucose fluctuations.

References: EMC SmPC: Trulicity (Sections 4.4 Special warnings and precautions, 4.6 Fertility, pregnancy and lactation); NHS: Hypoglycaemia (urgent treatment guidance)

Frequently Asked Questions