Administering Trulicity (dulaglutide) correctly is essential for effective type 2 diabetes management. This once-weekly injectable GLP-1 receptor agonist comes in a pre-filled, single-use pen designed for subcutaneous injection into the abdomen, thigh, or upper arm. Unlike some injectable medications, Trulicity requires no priming, needle attachment, or dose dialling, making it accessible for patients with varying levels of dexterity. Proper injection technique, site rotation, and understanding when to seek medical advice ensure optimal blood glucose control whilst minimising side effects. This guide provides step-by-step instructions for safe, effective Trulicity administration in line with UK clinical guidance.

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 effects. Trulicity stimulates insulin secretion from the pancreas when blood glucose levels are elevated, thereby lowering blood sugar in a glucose-dependent manner. Simultaneously, it suppresses the release of glucagon—a hormone that raises blood glucose—when it is not needed. Additionally, Trulicity slows gastric emptying, which helps reduce post-meal blood sugar spikes and may contribute to modest weight loss in some patients.

Trulicity is typically prescribed alongside diet and exercise modifications, and may be used alone or in combination with other diabetes medications such as metformin, sulfonylureas, or insulin. According to NICE guidance (NG28), GLP-1 receptor agonists like Trulicity are recommended for adults with type 2 diabetes who have a BMI of 35 kg/m² or above (adjusted for ethnicity) and specific psychological or medical problems associated with obesity, or a BMI below 35 kg/m² where insulin therapy would have significant occupational implications or weight loss would benefit obesity-related comorbidities. Treatment should only be continued if there is a beneficial metabolic response (reduction of at least 11 mmol/mol [1.0%] in HbA1c and weight loss of at least 3% of initial body weight) after 6 months.

Important: Trulicity is not indicated for patients with type 1 diabetes or diabetic ketoacidosis. Caution is advised in patients with severe gastrointestinal disease, including gastroparesis.

The medication comes in a pre-filled, single-use pen that delivers a fixed dose subcutaneously (under the skin) once weekly. Available doses include 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg. Treatment typically starts with 0.75 mg weekly, with dose increases at intervals of at least 4 weeks, based on your individual treatment needs and response.

Preparing Your Trulicity Pen for Injection

Proper preparation is crucial for safe and effective Trulicity administration. Begin by removing the pen from the refrigerator at least 30 minutes before injection, as allowing it to reach room temperature reduces injection discomfort. Never use external heat sources to warm the pen—simply leave it at room temperature. Keep the pen in its original carton to protect from light until you are ready to use it.

Before handling the pen, wash your hands thoroughly with soap and water. Verify the medicine name and dose on the pen label before use. Inspect the pen carefully by looking through the viewing window. The solution should be clear and colourless to slightly yellow. Do not use the pen if the liquid appears cloudy, discoloured, or contains particles, or if the pen appears damaged, frozen, or has been dropped on a hard surface. Check the expiry date printed on the pen label—never use an expired medication.

Unlike some injectable medications, Trulicity pens do not require priming or air bubble removal. The pen is designed as a single-use, pre-filled device that automatically delivers the correct dose. There are no needles to attach, no dose to dial, and no complex preparation steps. This user-friendly design minimises preparation errors and makes the medication accessible to patients with varying levels of dexterity or visual acuity.

Gather your supplies: You will need the Trulicity pen, an alcohol wipe, and a sharps disposal container. If you are administering the injection for the first time, it may be helpful to have the patient information leaflet nearby for reference. Ensure you have identified an appropriate injection site and that the area is clean and free from irritation, redness, or broken skin. Taking time to prepare properly helps ensure a smooth, safe injection experience and reduces anxiety, particularly for patients new to self-injection.

Step-by-Step Guide to Administering Trulicity

Administering Trulicity is straightforward once you understand the pen mechanism. Step 1: Select your injection site (abdomen, thigh, or upper arm) and clean the area with an alcohol wipe, allowing it to dry completely. Injecting into damp skin can cause stinging. Do not inject through clothing.

Step 2: Remove the base cap by pulling it straight off. Once removed, do not replace the cap, as this may damage the pen. You should see a grey safety guard covering the needle at the base of the pen. The green injection button on top should not be pressed yet.

Step 3: Place the clear base of the pen flat against your chosen injection site at a 90-degree angle. The grey safety guard must be pressed firmly against the skin to unlock the injection mechanism. You should feel the pen sitting securely against your skin.

Step 4: Press and hold the green injection button firmly. You will hear a loud click indicating the injection has started. Continue holding the pen against your skin and keep the button pressed. You will hear a second click after approximately 5–10 seconds, signalling that the injection is complete. The grey plunger in the viewing window will move and the window will turn grey when the injection is complete.

Step 5: After the second click, continue to hold the pen against your skin and count slowly to 5 before removing the pen. This ensures the full dose has been delivered. When you lift the pen away, the grey safety guard will automatically lock over the needle, preventing accidental needle-stick injuries.

Important: If you do not hear the second click or the grey plunger is not visible in the viewing window, the full dose may not have been delivered. Contact your healthcare provider or diabetes specialist nurse for guidance. Never attempt to reuse a Trulicity pen—each pen is designed for single use only.

Choosing and Rotating Injection Sites

Selecting appropriate injection sites and rotating them regularly is essential for preventing lipohypertrophy (lumpy skin caused by repeated injections in the same area) and ensuring consistent medication absorption. Trulicity should be injected subcutaneously into one of three recommended areas: the abdomen (except for a 5 cm radius around the navel), the front or side of the thighs, or the back of the upper arms.

The abdomen is often the preferred site for self-injection due to ease of access and consistent absorption. When injecting into the abdomen, choose areas at least 5 cm away from the belly button and avoid the waistline where clothing may rub. The thighs offer a convenient alternative, particularly the front and outer aspects of the upper leg. The upper arm may be more challenging for self-injection and typically requires assistance from a family member or carer, as reaching the correct area (the fatty tissue at the back of the upper arm) can be difficult.

Site rotation is crucial for maintaining healthy injection sites and optimal drug absorption. Avoid injecting into the same spot each week. A practical approach is to divide each injection area into quadrants and rotate systematically—for example, using the right abdomen one week, left abdomen the next, then alternating thighs. Keep a simple log or use a body diagram to track your injection sites.

Avoid injecting into areas that are:

• Tender, bruised, red, or swollen

• Scarred or have stretch marks

• Hard, lumpy, or thickened from previous injections

• Within 5 cm of surgical scars or the navel

If you notice persistent lumps, hardness, or changes in your injection sites, inform your diabetes care team. These changes can affect how well your medication is absorbed and may impact your blood glucose control.

What to Do After Your Trulicity Injection

After completing your Trulicity injection, immediate disposal of the used pen is essential for safety. Place the pen directly into a sharps disposal container—never throw it in household rubbish or recycling bins. The locked safety guard protects against needle-stick injuries, but proper disposal prevents accidental exposure to others, particularly children. If you do not have a sharps container, your GP surgery or community pharmacy can provide one, and many offer disposal services for full containers.

Do not rub or massage the injection site after administration, as this may affect medication absorption. A small amount of bleeding or bruising is normal and usually resolves quickly. If bleeding occurs, apply gentle pressure with a clean tissue or cotton wool. You may apply a small plaster if desired, though this is not typically necessary.

Monitor for immediate reactions in the hours following injection. Mild injection site reactions—such as redness, itching, or slight swelling—are common and usually resolve within a few days. However, seek immediate medical attention if you experience signs of a severe allergic reaction, including difficulty breathing, severe swelling of the face or throat, rapid heartbeat, or widespread rash. Also seek urgent medical help if you develop persistent, severe abdominal pain (with or without vomiting), as this could indicate pancreatitis.

Common side effects of Trulicity include nausea, diarrhoea, vomiting, and abdominal discomfort, particularly when starting treatment or increasing the dose. These gastrointestinal effects typically improve over several weeks as your body adjusts. Eating smaller, more frequent meals and avoiding fatty or spicy foods may help manage these symptoms. If you experience any side effects, you can report them via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk.

Record your injection in a diary or diabetes management app, noting the date, time, dose, and injection site. This helps ensure you maintain your once-weekly schedule and rotate sites appropriately. Set a reminder for your next injection, ideally on the same day each week. If you miss a dose and it has been less than 3 days until your next scheduled dose, skip the missed dose and resume your regular schedule. If more than 3 days remain, administer the missed dose as soon as possible. Never take two doses within 3 days (72 hours) of each other.

Common Questions About Trulicity Administration

Can I inject Trulicity at any time of day? Yes, Trulicity can be administered at any time, with or without meals. Choose a time that fits your routine and try to inject on the same day each week. If you need to change your injection day, ensure at least 3 days (72 hours) have passed since your last dose.

What if I see air bubbles in the pen? Small air bubbles are normal and will not affect your dose or harm you. The Trulicity pen is pre-measured to deliver the correct amount of medication regardless of air bubbles present. Do not attempt to remove them.

Can I travel with Trulicity? Yes, but planning is essential. Unused pens should be stored in a refrigerator between 2°C and 8°C in the original carton to protect from light. When travelling, transport pens in a cool bag with ice packs, ensuring they do not freeze. A pen may be kept out of the refrigerator for up to 14 days at temperatures not above 30°C. Always carry Trulicity in hand luggage when flying, along with a letter from your doctor confirming your need for injectable medication.

What if the pen doesn't click or seems faulty? If you do not hear both clicks or the grey plunger is not visible in the viewing window, the full dose may not have been delivered. Do not attempt a second injection without medical guidance. Contact your healthcare provider, diabetes specialist nurse, or the manufacturer's helpline for advice.

Are there any medications that interact with Trulicity? Trulicity may slow gastric emptying, potentially affecting the absorption of oral medications, particularly those requiring rapid gastrointestinal uptake. It can increase the risk of hypoglycaemia (low blood sugar) when used with insulin or sulfonylureas—your doctor may need to adjust doses of these medications. Always inform healthcare professionals about all medications you are taking.

What about pregnancy and breastfeeding? Trulicity is not recommended during pregnancy or breastfeeding. If you are planning pregnancy, pregnant, or breastfeeding, discuss this with your healthcare provider. Women of childbearing potential should use effective contraception while taking Trulicity.

When should I contact my GP? Seek medical advice if you experience persistent severe abdominal pain (which may indicate pancreatitis), signs of kidney problems (reduced urination, swelling, fatigue), or symptoms of hypoglycaemia (trembling, sweating, confusion, rapid heartbeat). Regular monitoring through your diabetes care team, including HbA1c checks and kidney function tests, is essential for safe, effective treatment with Trulicity.

Frequently Asked Questions