How do you take Trulicity? Trulicity (dulaglutide) is a once-weekly injectable medication for managing type 2 diabetes in adults. As a glucagon-like peptide-1 (GLP-1) receptor agonist, it helps regulate blood sugar by stimulating insulin release, suppressing glucagon, and slowing gastric emptying. Administered via a pre-filled pen, Trulicity is typically prescribed when diet, exercise, or oral medications like metformin haven't achieved adequate glycaemic control. This guide explains the proper injection technique, timing, site selection, and what to expect when using Trulicity as part of your diabetes management plan.

What Is Trulicity and How Does It Work?

Trulicity (dulaglutide) is a once-weekly injectable medication used to manage type 2 diabetes mellitus in adults. It belongs to a class of medicines called glucagon-like peptide-1 (GLP-1) receptor agonists, which work by mimicking the action of a naturally occurring hormone in the body that helps regulate blood sugar levels.

The mechanism of action involves several complementary pathways. Trulicity stimulates insulin secretion from the pancreas when blood glucose levels are elevated, thereby lowering blood sugar in a glucose-dependent manner. This means the medication is less likely to cause hypoglycaemia (dangerously low blood sugar) compared to some other diabetes treatments. Additionally, it suppresses the release of glucagon—a hormone that raises blood glucose—and slows gastric emptying, which helps reduce post-meal blood sugar spikes. Some patients may experience modest weight loss while taking this medication.

In the UK, Trulicity is typically prescribed when diet and exercise alone are insufficient to control blood sugar, or when other oral diabetes medications such as metformin have not achieved adequate glycaemic control. According to NICE guidance (NG28), GLP-1 receptor agonists like Trulicity may be considered as part of dual or triple therapy regimens for specific patients, particularly those with a body mass index (BMI) of 35 kg/m² or above (or lower in certain ethnic groups), or when weight gain would be problematic.

Trulicity is available in pre-filled, single-use pens in various strengths. Treatment typically starts at 0.75 mg once weekly, with possible stepwise increases to 1.5 mg, 3 mg, and 4.5 mg if needed for better blood glucose control. It is important to note that Trulicity is not insulin and is not suitable for treating type 1 diabetes or diabetic ketoacidosis.

Trulicity is not recommended for people with severe gastrointestinal disease (including gastroparesis) and should be used with caution in those with a history of pancreatitis. If you are pregnant, planning pregnancy or breastfeeding, you should discuss alternative treatments with your healthcare provider.

How to Take Trulicity: Step-by-Step Injection Guide

Administering Trulicity involves using a pre-filled pen that requires no mixing or measuring. Here is a comprehensive step-by-step guide:

Before you begin:

• Remove the Trulicity pen from the refrigerator and allow it to reach room temperature for approximately 30 minutes. Do not use external heat sources to warm the pen.

• Check the pen's expiry date and ensure it hasn't been damaged.

• Wash your hands thoroughly with soap and water.

• Check the pen to ensure the medication is clear and colourless. Do not use if the solution appears cloudy, discoloured, or contains particles.

• Gather your supplies: the Trulicity pen, an alcohol wipe, and a sharps disposal container.

1. Injection steps:
2. Choose your injection site (abdomen, thigh, or upper arm) and clean the area with an alcohol wipe. Allow the skin to dry completely.
3. Unlock the pen by turning the lock ring.
4. Remove the base cap from the pen by pulling it straight off.
5. Place the clear base flat and firmly against your skin at a 90-degree angle. Do not inject through clothing.
6. Press and hold the injection button until you hear a loud click. Continue holding the pen against your skin and count slowly to 5 after you hear the second click, indicating the injection is complete.
7. Remove the pen from your skin and check that the grey plunger is visible in the window, confirming the full dose has been delivered.
8. Dispose of the used pen immediately in a sharps container. Never reuse pens or share them with others.

Note that upper arm injections should be administered by another person. Do not attempt to inject into a vein or muscle.

If you experience difficulty or the pen does not function as expected, contact your healthcare provider or pharmacist for guidance. Always refer to the Patient Information Leaflet supplied with your medication for specific instructions for your pen.

When and Where to Inject Trulicity

Timing of administration is flexible with Trulicity, which can help with treatment adherence. The medication should be injected once weekly, on the same day each week. You may take it at any time of day, with or without food. Establishing a consistent routine—such as every Monday morning or every Friday evening—can help you remember your weekly dose. If needed, you can change your weekly injection day, provided there are at least 3 days (72 hours) between doses.

If you miss a dose, the guidance depends on how much time remains until your next scheduled dose. If there are at least three days (72 hours) until your next scheduled dose, administer the injection as soon as possible. Then resume your regular weekly schedule. However, if less than three days remain until your next scheduled dose, skip the missed dose entirely and take your next dose on the regularly scheduled day. Never take two doses within three days of each other to make up for a missed dose, as this increases the risk of side effects.

Injection site selection is important for comfort and optimal absorption. Trulicity can be injected into three areas:

• Abdomen (at least 5 cm away from the navel)

• Thigh (front or outer area)

• Upper arm (back of the arm, which must be administered by another person)

Rotate injection sites each week to reduce the risk of local skin reactions and discomfort. For example, if you inject into your abdomen one week, consider using your thigh the following week. Avoid injecting into areas where the skin is tender, bruised, red, hard, or scarred.

Patients should store unused Trulicity pens in the refrigerator (2°C to 8°C) and protect them from light by keeping them in the original carton. Do not freeze Trulicity pens. If accidentally frozen, do not use. Once removed from refrigeration, the pen may be kept at room temperature (up to 30°C) for up to 14 days if needed.

Common Side Effects and What to Expect

Like all medications, Trulicity can cause side effects, although not everyone experiences them. Understanding what to expect can help you manage symptoms effectively and know when to seek medical advice.

Gastrointestinal side effects are the most commonly reported and typically occur when starting treatment or after dose increases. These include:

• Nausea

• Diarrhoea

• Vomiting

• Abdominal pain or discomfort

• Decreased appetite

• Indigestion

These symptoms are usually mild to moderate and tend to improve over time as your body adjusts to the medication. Eating smaller, more frequent meals and avoiding fatty or spicy foods may help reduce gastrointestinal discomfort.

Injection site reactions such as redness, itching, or mild swelling can occur but are generally mild and resolve on their own. Rotating injection sites as recommended can minimise these reactions.

Hypoglycaemia (low blood sugar) is uncommon with Trulicity alone but may occur if you are also taking other diabetes medications such as insulin or sulphonylureas. Symptoms include trembling, sweating, confusion, rapid heartbeat, and dizziness. Always carry a fast-acting source of glucose (such as glucose tablets or fruit juice) if you are at risk.

When to seek medical attention: Contact your GP or healthcare team promptly if you experience:

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

• Severe pain in the upper right abdomen, possibly with fever or yellowing of the skin/eyes (possible gallbladder problems)

• Signs of an allergic reaction (rash, difficulty breathing, swelling of face or throat) – call 999 if severe

• Persistent vomiting or diarrhoea leading to dehydration

• Changes in vision, particularly if you have existing diabetic retinopathy

• Symptoms that could indicate thyroid problems (lump in the neck, hoarseness, difficulty swallowing)

Trulicity is not recommended during pregnancy or breastfeeding. If you become pregnant or plan to become pregnant while taking Trulicity, consult your healthcare provider for advice on alternative treatments.

According to MHRA guidance, there is ongoing monitoring of GLP-1 receptor agonists. If you experience any side effects, including those not listed in the patient information leaflet, report them via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard. Regular follow-up with your diabetes care team, including monitoring of HbA1c levels and renal function, is essential to ensure Trulicity remains safe and effective for you.

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