Can you take Trulicity with Tresiba? Yes, Trulicity (dulaglutide) and Tresiba (insulin degludec) can be safely taken together under medical supervision. This combination is commonly prescribed for people with type 2 diabetes who require both basal insulin and additional glycaemic control. Trulicity, a GLP-1 receptor agonist, and Tresiba, a long-acting basal insulin, work through complementary mechanisms to address different aspects of glucose regulation. The National Institute for Health and Care Excellence (NICE) recognises this combination therapy as an appropriate treatment strategy in their guideline NG28. Your diabetes specialist or GP will determine whether this combination suits your individual circumstances, including HbA1c levels, body weight, and treatment goals.

Can You Take Trulicity with Tresiba Together?

Yes, Trulicity (dulaglutide) and Tresiba (insulin degludec) can be taken together, and this combination is commonly prescribed for people with type 2 diabetes who require both basal insulin and additional glycaemic control. Both medications are injectable treatments that work through different mechanisms, making them complementary rather than conflicting in their actions.

Trulicity belongs to a class of medications called GLP-1 receptor agonists, whilst Tresiba is a long-acting basal insulin. When oral medications and lifestyle modifications are insufficient to achieve target blood glucose levels, healthcare professionals may prescribe this combination to address different aspects of glucose regulation. The National Institute for Health and Care Excellence (NICE) recognises combination therapy involving GLP-1 receptor agonists and basal insulin as an appropriate treatment strategy for type 2 diabetes management in their guideline NG28.

This combination is typically considered when basal insulin alone does not provide adequate glycaemic control, or when a patient on a GLP-1 receptor agonist requires additional support to manage fasting blood glucose levels. Your diabetes specialist or GP will determine whether this combination is suitable based on your individual circumstances, including your HbA1c levels, body weight, risk of hypoglycaemia, and overall treatment goals.

It is important to note that this combination is specifically for type 2 diabetes and is not indicated for type 1 diabetes or for treating diabetic ketoacidosis. When starting Trulicity alongside Tresiba, your doctor may consider reducing your insulin dose to minimise the risk of hypoglycaemia.

It is essential that whilst these medications can be used together safely, they should only be combined under medical supervision. Never start, stop, or adjust the doses of either medication without consulting your healthcare team, as doing so could lead to inadequate glucose control or increase the risk of adverse effects such as hypoglycaemia.

How Trulicity and Tresiba Work in Diabetes Management

Understanding how Trulicity and Tresiba work helps explain why they are often prescribed together. Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist that mimics the action of the naturally occurring hormone GLP-1. It works by:

• Stimulating insulin secretion from pancreatic beta cells in a glucose-dependent manner (meaning it only works when blood glucose is elevated)

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

• Slowing gastric emptying, which helps moderate post-meal blood glucose rises

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

Trulicity is administered once weekly via subcutaneous injection and has a prolonged duration of action, making it convenient for many patients. Because its insulin-stimulating effect is glucose-dependent, the risk of hypoglycaemia when used alone is relatively low. However, this risk increases significantly when combined with insulin or sulfonylureas, which is why dose adjustments of these medications may be necessary when starting Trulicity.

Tresiba (insulin degludec) is an ultra-long-acting basal insulin with a duration of action exceeding 42 hours. Its mechanism involves:

• Binding to insulin receptors on cells throughout the body

• Facilitating glucose uptake into muscle and fat cells

• Suppressing hepatic glucose production

• Providing steady, consistent background insulin coverage throughout the day and night

Tresiba's unique formulation creates a depot under the skin that releases insulin gradually and predictably, resulting in stable blood glucose control. Clinical studies have shown that Tresiba may be associated with lower rates of nocturnal hypoglycaemia compared to insulin glargine U100 in some patient groups, as noted in its European Medicines Agency assessment.

When combined, Trulicity addresses post-meal glucose excursions and provides additional metabolic benefits, whilst Tresiba ensures consistent basal glucose control, creating a comprehensive approach to diabetes management that targets multiple pathophysiological defects in type 2 diabetes.

Safety Considerations When Combining These Medications

When taking Trulicity and Tresiba together, several safety considerations warrant attention, though the combination is generally well-tolerated when properly managed. The primary concern is the potential for hypoglycaemia (low blood sugar), particularly as insulin doses are adjusted. Whilst Trulicity alone carries a low hypoglycaemia risk, combining it with basal insulin increases this possibility, especially if meals are skipped or physical activity increases unexpectedly.

Common side effects to be aware of include:

• Gastrointestinal symptoms from Trulicity (nausea, vomiting, diarrhoea, abdominal discomfort) – these typically diminish over the first few weeks

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

• Hypoglycaemia symptoms (trembling, sweating, confusion, rapid heartbeat, dizziness)

Patients should be educated to recognise hypoglycaemia symptoms and always carry fast-acting carbohydrates (glucose tablets, sugary drinks).

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

• Severe hypoglycaemia that you cannot manage yourself

• Signs of severe allergic reaction (rash, difficulty breathing, swelling of face/throat)

Contact your GP or diabetes nurse urgently if you experience:

• Severe or recurrent hypoglycaemia

• Severe abdominal pain with or without vomiting (stop taking Trulicity immediately as this could indicate pancreatitis)

• Right upper abdominal pain, fever or yellowing of the skin/eyes (potential gallbladder problems)

• Unexplained weight loss or persistent fatigue

Important precautions: Trulicity should be used with caution in patients with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2. No dose adjustment is required for Trulicity in renal impairment, though insulin doses may need individualisation based on blood glucose monitoring.

Regarding pregnancy, Trulicity is not recommended during pregnancy and should be discontinued at least one month before a planned pregnancy. Insulin is the preferred treatment for diabetes during pregnancy, so discuss with your healthcare team well in advance if you are planning pregnancy. Women of childbearing potential should use effective contraception while taking Trulicity.

Regular follow-up appointments are essential to monitor treatment response, adjust doses appropriately, and screen for complications. Report any suspected side effects via the MHRA Yellow Card scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Dosing and Timing: Using Trulicity and Tresiba

Proper dosing and timing are crucial for maximising the benefits of Trulicity and Tresiba whilst minimising side effects. Fortunately, both medications offer flexibility that can accommodate most lifestyles.

Trulicity dosing and administration:

• Administered once weekly via subcutaneous injection

• Available doses: 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg

• Starting dose is typically 0.75 mg weekly, with gradual titration in steps of at least 4 weeks based on response

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

• Injection sites include abdomen, thigh, or upper arm (rotate sites to prevent lipohypertrophy)

• Comes in a pre-filled, single-use pen for convenience

If you miss a Trulicity dose, administer it as soon as possible if there are at least 3 days (72 hours) until your next scheduled dose. If less than 3 days remain until your next scheduled dose, skip the missed dose and take the next dose on the regularly scheduled day.

Tresiba dosing and administration:

• Administered once daily via subcutaneous injection

• Dosing is highly individualised, typically starting at 10 units or based on previous insulin regimen

• Can be injected at any time of day, but consistency is generally recommended

• If timing needs to vary, ensure a minimum of 8 hours between injections

• Injection sites include abdomen, thigh, or upper arm (rotate sites)

• Available in pre-filled pens (FlexTouch) in different strengths

Practical considerations for combination therapy:

When initiating Trulicity in patients already on insulin, consider reducing the insulin dose to minimise hypoglycaemia risk. You can administer both medications on the same day without concern, as they work through different mechanisms. Many patients find it convenient to inject Tresiba daily in the evening and Trulicity weekly on the same day each week (e.g., every Sunday morning). The injections should be given at different sites – do not mix them in the same syringe or inject in exactly the same location.

Store both medications in the refrigerator before first use, though in-use pens can be kept at room temperature according to manufacturer guidelines (21 days for Trulicity; 8 weeks for Tresiba). Always follow your healthcare professional's specific instructions regarding dose adjustments, as these will be tailored to your individual glucose patterns and treatment response.

Monitoring Blood Sugar Levels on Both Treatments

Regular blood glucose monitoring is essential when using Trulicity and Tresiba together, as it enables you and your healthcare team to assess treatment effectiveness, make informed dose adjustments, and prevent complications. The monitoring approach should be individualised based on your treatment goals, risk factors, and overall diabetes management plan.

Self-monitoring of blood glucose (SMBG) recommendations typically include:

• Fasting blood glucose (before breakfast) – particularly important for assessing Tresiba effectiveness

• Pre-meal readings – to guide mealtime decisions and identify patterns

• Occasional post-meal readings (2 hours after eating) – to evaluate overall glucose control

• Before bed – to ensure safe overnight glucose levels and reduce hypoglycaemia risk

• When experiencing symptoms of hypoglycaemia or hyperglycaemia

• During illness or when routine changes (increased frequency may be needed)

Your diabetes team will advise on the appropriate testing frequency for your circumstances. Some patients may benefit from continuous glucose monitoring (CGM) or flash glucose monitoring systems, which provide real-time glucose data and trend information, making it easier to identify patterns and optimise treatment.

Target blood glucose ranges (as per NICE guidance for most adults with type 2 diabetes):

• Fasting: 5–7 mmol/L

• Before meals: 4–7 mmol/L

• Two hours after meals: less than 8.5 mmol/L

However, targets should be individualised, particularly for older adults or those with comorbidities.

HbA1c monitoring remains the gold standard for assessing long-term glycaemic control. Your GP or diabetes team will typically check HbA1c every 3–6 months, with a common target of 48–53 mmol/mol (6.5–7.0%) for most people with type 2 diabetes, though this may be adjusted based on individual circumstances as recommended in NICE guideline NG28.

Keep a glucose diary or use a diabetes management app to record readings, medication doses, meals, and physical activity. This information is invaluable during consultations and helps identify patterns that may require treatment adjustments. Contact your healthcare team if you notice:

• Frequent hypoglycaemia (readings below 4 mmol/L)

• Persistent hyperglycaemia despite medication adherence

• Unexplained glucose variability

• Difficulty achieving target ranges

If you are taking insulin and driving, follow DVLA guidance: always check your blood glucose before driving and every 2 hours on longer journeys. Do not drive if your blood glucose is below 5 mmol/L or you feel hypoglycaemic.

Regular monitoring, combined with ongoing communication with your diabetes team, ensures that your Trulicity and Tresiba combination therapy remains optimally effective and safe.

Frequently Asked Questions