Can you take Trulicity and Toujeo together? Yes, Trulicity (dulaglutide) and Toujeo (insulin glargine 300 units/mL) can be taken together under specialist supervision for people with type 2 diabetes requiring enhanced glycaemic control. This combination is used in clinical practice when diet, exercise, and oral medications alone are insufficient to achieve target HbA1c levels. Trulicity is a GLP-1 receptor agonist, whilst Toujeo is a long-acting basal insulin—both work through different mechanisms to lower blood glucose, making them complementary therapies. The decision to combine these injectable treatments is individualised, based on your blood glucose control, weight, hypoglycaemia risk, and treatment goals, and aligns with NICE guidance (NG28) on type 2 diabetes management.

Can You Take Trulicity and Toujeo Together?

Yes, Trulicity (dulaglutide) and Toujeo (insulin glargine 300 units/mL) can be taken together, and this combination is used in clinical practice under specialist supervision for people with type 2 diabetes who require additional glycaemic control or would benefit from weight management. Both medications are injectable therapies that work through different mechanisms to lower blood glucose levels, making them complementary rather than conflicting treatments.

Trulicity belongs to a class of medications called GLP-1 receptor agonists, whilst Toujeo is a long-acting basal insulin. When diet, exercise, and oral medications alone are insufficient to achieve target HbA1c levels, healthcare professionals may recommend combining these two injectable therapies. This approach aligns with NICE guidance (NG28) on the management of type 2 diabetes, which supports the use of GLP-1 receptor agonists alongside insulin therapy in specific circumstances, such as when weight loss would be beneficial or when other therapies are insufficient.

The decision to use both medications together is individualised and based on several factors, including your current blood glucose control, HbA1c levels, body weight, risk of hypoglycaemia, and overall treatment goals. Your diabetes specialist or GP will have carefully considered whether this combination is suitable for your specific circumstances. It is important to note that when starting a GLP-1 receptor agonist like Trulicity, your prescriber may reduce your basal insulin dose (often by 10-20%) to minimise the risk of hypoglycaemia, with ongoing adjustments based on your glucose readings.

This combination therapy requires careful coordination between you and your healthcare team, particularly regarding dosing schedules, injection techniques, and ongoing monitoring. Never start, stop, or adjust either medication without consulting your prescriber, as changes to your diabetes regimen can significantly affect your blood glucose levels and overall health.

How Trulicity and Toujeo Work in Type 2 Diabetes

Understanding how each medication works helps explain why they can be effectively combined in diabetes management. Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist that mimics the action of a naturally occurring hormone called GLP-1. This medication works by:

• Stimulating insulin secretion from the pancreas in a glucose-dependent manner (meaning it only works when blood glucose levels are elevated)

• Suppressing glucagon release, which reduces glucose production by the liver

• Slowing gastric emptying, which helps moderate the rise in blood glucose after meals

• Promoting satiety, which may lead to reduced calorie intake and potential weight loss

Trulicity is administered once weekly via a pre-filled pen. In clinical trials (REWIND), dulaglutide demonstrated a reduction in major adverse cardiovascular events in a broad population of people with type 2 diabetes, though this is not a specific licensed cardiovascular indication.

Toujeo (insulin glargine 300 units/mL) is a long-acting basal insulin that provides steady background insulin coverage over 24 hours or longer. Its mechanism of action involves:

• Facilitating glucose uptake into muscle and fat cells

• Suppressing hepatic glucose production throughout the day and night

• Providing a consistent insulin baseline without pronounced peaks

In some studies, Toujeo has shown lower rates of hypoglycaemia versus insulin glargine 100 units/mL during titration and maintenance phases. Toujeo is a more concentrated formulation than standard insulin glargine (100 units/mL), allowing for smaller injection volumes whilst delivering the same insulin dose.

The complementary mechanisms of these two medications address different aspects of the underlying pathophysiology of type 2 diabetes. Whilst Toujeo provides essential basal insulin coverage, Trulicity enhances the body's own insulin response, reduces excessive glucose production, and may help with weight management—a common concern for people requiring insulin therapy.

Safety Considerations When Combining These Medications

When taking Trulicity and Toujeo together, several important safety considerations must be understood and monitored. The primary concern with this combination is the risk of hypoglycaemia (low blood glucose), particularly because insulin directly lowers blood glucose regardless of current levels, whilst Trulicity's glucose-lowering effect is glucose-dependent and therefore carries a lower intrinsic hypoglycaemia risk.

Common side effects you should be aware of include:

• Gastrointestinal symptoms from Trulicity (nausea, vomiting, diarrhoea, constipation, abdominal discomfort), which typically improve over the first few weeks of treatment

• Injection site reactions from either medication (redness, itching, swelling)

• Hypoglycaemia symptoms such as trembling, sweating, confusion, rapid heartbeat, or hunger—particularly if insulin doses are not appropriately adjusted

No pharmacokinetic interactions are expected between these medications, and the combination is widely used when clinically indicated. However, both medications carry specific warnings that require attention.

Important precautions include:

• Both medications should be used with caution in people with a history of pancreatitis

• No routine dose adjustment is needed for Trulicity in renal impairment, but insulin requirements may be reduced with declining renal function and need individualised titration

• Trulicity may increase heart rate slightly in some individuals

• Maintain hydration, especially during illness; if persistent vomiting/diarrhoea occurs, seek advice as temporary withholding of Trulicity may be appropriate while continuing basal insulin with monitoring

Your healthcare team will have assessed your medical history before prescribing this combination. Always inform all healthcare professionals involved in your care about both medications, particularly before any surgical procedures or if you develop acute illness, as temporary adjustments may be necessary. Regarding pregnancy and breastfeeding: Trulicity is not recommended during pregnancy or breastfeeding; insulin is the preferred treatment for diabetes during these periods. Discuss contraception and pregnancy planning with your diabetes team well in advance.

If you experience any suspected side effects, report them via the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or via the Yellow Card app).

Dosing and Administration Guidelines

Proper administration of both Trulicity and Toujeo is essential for optimal diabetes control and safety. These medications are administered via subcutaneous injection but on different schedules, and understanding the correct technique and timing is crucial.

Trulicity administration:

• Given once weekly on the same day each week

• Starting dose is typically 0.75 mg once weekly

• After at least 4 weeks, may be increased to 1.5 mg weekly if needed

• If required, can be further escalated to 3.0 mg and then 4.5 mg weekly (maximum dose)

• Can be injected at any time of day, with or without food

• Injected subcutaneously into the abdomen, thigh, or upper arm

• If you miss a dose and the next scheduled dose is more than 3 days away, take it as soon as possible; if less than 3 days remain, skip the missed dose

Toujeo administration:

• Given once daily at the same time each day

• Available in pre-filled pens (SoloStar 1.5 mL or DoubleStar 3 mL)

• Injected subcutaneously into the abdomen, thigh, or upper arm

• Dosing is highly individualised and titrated based on fasting blood glucose readings

• If a dose is missed, take it as soon as possible but do not take a double dose to make up for a missed dose

Important administration considerations:

• Rotate injection sites within the same body region to prevent lipohypertrophy (lumpy areas under the skin that can affect insulin absorption)

• Both medications can be injected in the same body region but not at exactly the same spot

• Never share pens or needles with others, even if the needle is changed

• Trulicity: store unopened pens in the refrigerator; can be kept at room temperature (below 30°C) for up to 14 days before use; single-use pen should be safely disposed after injection

• Toujeo: store unopened pens in the refrigerator; once in use, can be kept at room temperature (below 30°C) for up to 6 weeks (42 days); do not refrigerate once in use

• Do not freeze either medication, and protect from direct heat and light

• Toujeo must not be mixed with other insulins, used in insulin pumps, or given intravenously

Your diabetes nurse or practice nurse should provide comprehensive training on injection technique when you first start these medications. Dose adjustments for Toujeo are typically made based on your fasting blood glucose readings, following a titration schedule provided by your healthcare team.

Monitoring Blood Sugar Levels on Dual Therapy

Regular blood glucose monitoring is essential when taking Trulicity and Toujeo together, as it allows you and your healthcare team to assess treatment effectiveness and make necessary adjustments whilst minimising the risk of hypoglycaemia or persistent hyperglycaemia.

Self-monitoring recommendations typically include:

• Fasting blood glucose (before breakfast) is particularly important when taking Toujeo, as this reading guides insulin dose adjustments

• Pre-meal and 2-hour post-meal readings may be requested periodically to assess overall glucose control

• Testing before bed can help identify patterns and reduce the risk of nocturnal hypoglycaemia

• Additional testing during illness, stress, changes in routine, or if you experience symptoms of hypo- or hyperglycaemia

• Check for ketones if unwell and glucose persistently above 15 mmol/L

Your healthcare team will provide specific guidance on testing frequency based on your individual circumstances. Some people may be advised to test multiple times daily, particularly during dose titration phases, whilst others with stable control may test less frequently.

Target blood glucose ranges are individualised but generally aim for:

• Fasting/pre-meal: 4–7 mmol/L for most adults

• 2 hours after meals: 5–9 mmol/L

• Before bed: 6–10 mmol/L (to reduce overnight hypoglycaemia risk)

HbA1c monitoring (a measure of average blood glucose over 2–3 months) is typically performed every 3–6 months. NICE recommends an HbA1c target of 53 mmol/mol (7.0%) for most adults with type 2 diabetes on drug therapy, though this may be individualised based on factors such as age, frailty, and life expectancy.

Continuous glucose monitoring (CGM) or flash glucose monitoring may be available through the NHS for some people with type 2 diabetes, particularly those on multiple daily insulin injections or with problematic hypoglycaemia. NHS provision follows local and NICE criteria. Discuss with your diabetes team whether this technology might benefit you.

Record keeping is valuable—whether using a paper logbook, smartphone app, or the memory function on your blood glucose meter. Patterns in your readings help your healthcare team make informed decisions about medication adjustments. Bring your glucose records or meter to all diabetes appointments.

When to Contact Your Healthcare Team

Knowing when to seek advice or urgent medical attention is crucial for safe diabetes management when taking Trulicity and Toujeo together. Certain situations require prompt contact with your healthcare team, whilst others necessitate immediate emergency care.

Contact your GP or diabetes specialist nurse within 1–2 working days if:

• Your fasting blood glucose readings are consistently above 10 mmol/L or below 4 mmol/L

• You experience persistent nausea, vomiting, or diarrhoea lasting more than 24 hours (particularly important with Trulicity)

• You notice unexplained weight loss or gain

• You develop persistent injection site reactions (redness, swelling, pain lasting more than a few days)

• You experience symptoms that might indicate pancreatitis (severe, persistent abdominal pain radiating to the back)

• You have questions about dose adjustments or are uncertain about your medication regimen

• You are planning pregnancy or discover you are pregnant

Seek same-day medical advice if:

• You experience repeated episodes of hypoglycaemia (more than 2–3 times per week)

• You develop symptoms of hyperglycaemia with ketones (excessive thirst, frequent urination, fruity breath odour, confusion)

• You become unwell with an infection, fever, or other acute illness that affects your eating or blood glucose control

• You experience severe gastrointestinal symptoms preventing adequate fluid or food intake

• You test your blood/urine ketones and they are positive when unwell with high glucose (e.g., above 15 mmol/L)

Call 999 or go to A&E immediately if:

• You experience severe hypoglycaemia with loss of consciousness, seizures, or inability to swallow safely

• You develop symptoms of diabetic ketoacidosis (DKA)—though less common in type 2 diabetes, it can occur

• You have severe, unrelenting abdominal pain with vomiting

• You experience symptoms of a severe allergic reaction (difficulty breathing, facial swelling, widespread rash)

During sick days, continue your basal insulin (Toujeo), but if you are unable to keep fluids down or have significant gastrointestinal illness, seek advice—temporary withholding of Trulicity may be appropriate until you are eating and drinking normally. Maintain hydration and monitor blood glucose more frequently. Have a sick day plan discussed with your diabetes team, including guidance on when to test for ketones and how to manage your medications during illness. Regular communication with your healthcare team ensures optimal diabetes management and helps prevent complications whilst taking this combination therapy.

Frequently Asked Questions