Learning how to give a Trulicity shot correctly is essential for effective type 2 diabetes management. Trulicity (dulaglutide) is a once-weekly GLP-1 receptor agonist administered via a pre-filled pen designed for ease of use. The pen features a hidden needle that automatically inserts, delivers the dose, and retracts, making self-injection straightforward even for those new to injectable medications. Proper injection technique, site selection, and understanding when to seek medical advice ensure safe, effective treatment. This guide provides step-by-step instructions on preparing your pen, choosing injection sites, administering the medication, and recognising potential side effects to help you confidently manage your diabetes therapy at home.

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 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) when used alone, though the risk increases when combined with insulin or sulphonylureas. 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. Many patients also experience modest weight loss, as the medication can reduce appetite.

NICE guidance recommends GLP-1 receptor agonists like Trulicity as a treatment option for type 2 diabetes when other medications have not achieved adequate glycaemic control, or when certain clinical criteria are met. The medication is typically prescribed alongside dietary modifications, exercise, and often in combination with other antidiabetic agents such as metformin.

Trulicity comes in a pre-filled, single-use pen that delivers a fixed dose subcutaneously once weekly. The standard starting dose is 0.75 mg weekly, which may be increased to 1.5 mg after at least 4 weeks if needed. Higher doses of 3 mg and 4.5 mg are available for patients requiring additional glycaemic control. The pen is designed for ease of use, making it accessible for patients who may be anxious about self-injection.

It's important to note that Trulicity is not indicated for people with type 1 diabetes or diabetic ketoacidosis. If you miss a dose, you should administer it as soon as possible if within 3 days (72 hours) of the scheduled time. If more than 3 days have passed, skip the missed dose and take the next dose on your regularly scheduled day.

Preparing Your Trulicity Pen Before Injection

Proper preparation is essential to ensure safe and effective administration of your Trulicity injection. Before handling the pen, wash your hands thoroughly with soap and water to minimise infection risk at the injection site.

Storage considerations are important: Trulicity pens should be stored in the refrigerator at 2°C to 8°C until needed. Keep the pen in its original carton to protect from light. Do not freeze the medication, and if a pen has been frozen, it must be discarded. You may keep an unused pen at room temperature (up to 30°C) for up to 14 days if necessary. Remove the pen from the refrigerator approximately 30 minutes before injection to allow it to reach room temperature naturally—do not use external heat sources to warm the pen and do not shake it, as injecting cold medication can cause discomfort.

Before use, inspect the pen carefully. Check the expiration date printed on the label—never use an expired pen. Look through the viewing window to examine the solution, which should be clear and colourless to slightly yellow. Do not use the pen if the liquid appears cloudy, discoloured, or contains particles or flakes. Check that the pen has not been damaged and that the base cap is securely in place. If the pen has been dropped or appears damaged in any way, do not use it.

Gather your supplies: You'll need the Trulicity pen, an alcohol wipe for cleaning the injection site, and a sharps disposal container for safe disposal after use. The NHS provides sharps bins, which can be obtained through your GP surgery or pharmacy. Never dispose of used pens in household waste.

It's advisable to keep a record of your injections, noting the date, time, and injection site used. This helps ensure you maintain your weekly schedule and rotate injection sites appropriately. Try to take your injection on the same day each week. If you have any concerns about the pen's appearance or are unsure about any aspect of preparation, contact your healthcare provider or pharmacist before proceeding.

Step-by-Step Guide to Administering Trulicity

Administering Trulicity is straightforward once you understand the process. The pen is designed with a hidden needle that automatically inserts, injects, and retracts, making it user-friendly even for those uncomfortable with injections.

Step 1: Select and clean your injection site. Choose an area on your abdomen (at least 5 cm away from your navel), thigh, or upper arm (upper arm injections should be given by another person). Clean the site with an alcohol wipe using a circular motion, and allow the skin to dry completely—injecting through wet skin can cause stinging.

Step 2: Prepare the pen. Remove the grey base cap by pulling it straight off. Do not twist the cap. Once removed, you'll see the pen's components. Do not replace the base cap once removed, as this could damage the needle.

Step 3: Position the pen. Place the clear base flat against your cleaned injection site at a 90-degree angle (perpendicular to the skin). The pen must be flat against the skin for the unlock mechanism to work properly.

Step 4: Unlock the pen. Turn the lock ring to unlock the pen.

Step 5: Press and hold. Press and hold the green injection button. You'll hear a loud click when the injection begins. Continue holding the pen firmly against your skin and keep the button pressed. You'll hear a second click after approximately 5 to 10 seconds, indicating the injection is complete. After the second click, continue holding for 5 more seconds to ensure the full dose is delivered.

Step 6: Remove and dispose. Lift the pen straight away from your skin. The needle automatically retracts into the pen. You'll see a grey plunger in the viewing window, confirming the full dose was delivered. Immediately place the used pen in your sharps container—never attempt to reuse it.

If you don't hear the clicks or the grey plunger doesn't appear in the window, the full dose may not have been delivered. Do not attempt a second injection. Contact your healthcare provider for guidance. Never share your Trulicity pen with others, even if the needle is changed, as this poses serious infection risks.

Remember that Trulicity is for subcutaneous injection only. Do not inject into a vein or muscle.

Choosing the Right Injection Site

Selecting and rotating injection sites is crucial for optimal medication absorption and to prevent complications such as injection site reactions or nodules.

Trulicity can be injected into three main areas:

• Abdomen (stomach area): This is often the preferred site for many patients. Inject into the soft, fatty tissue at least 5 cm (approximately two finger-widths) away from your navel. Avoid areas with scars, stretch marks, or any skin abnormalities.

• Thigh: Use the front and outer areas of your thighs, in the middle section between your knee and hip. This site is easily accessible and convenient for self-injection.

• Upper arm: The back of the upper arm, in the fatty tissue, can be used. However, upper arm injections should be administered by another person such as a family member or carer.

Site rotation is essential. Using the same injection site repeatedly can lead to injection site reactions or nodules, which can affect how well the medication is absorbed. Develop a systematic rotation pattern—for example, alternating between left and right sides and moving to different areas within each site. Keep a written record or use a body diagram to track where you've injected.

Avoid injecting into areas that are:

• Tender, bruised, red, or swollen

• Scarred or have stretch marks

• Hard or lumpy

• Within 5 cm of surgical scars or the navel

If you notice persistent redness, swelling, or discomfort at injection sites, or if you develop lumps under the skin, inform your GP or diabetes nurse. They can assess whether you're rotating sites adequately and check for any complications. Proper site selection and rotation help ensure consistent medication effectiveness and minimise discomfort throughout your treatment.

Common Side Effects and When to Seek Help

Like all medications, Trulicity can cause side effects, though not everyone experiences them. Understanding what to expect and recognising warning signs helps ensure safe treatment.

Common gastrointestinal side effects are the most frequently reported and typically occur when starting treatment or increasing the dose. These include:

• Nausea and vomiting: Often mild to moderate and usually improve over several weeks as your body adjusts

• Diarrhoea or constipation: Can affect fluid balance and require dietary adjustments

• Abdominal pain or discomfort: Generally temporary but should be monitored

• Decreased appetite: May contribute to weight loss

To minimise gastrointestinal symptoms, eat smaller, more frequent meals, avoid fatty or spicy foods, and stay well hydrated. Maintaining adequate hydration is particularly important as dehydration from persistent vomiting or diarrhoea can lead to acute kidney injury. If symptoms are severe or persistent beyond the first few weeks, consult your healthcare provider—they may adjust your dose or suggest management strategies.

Injection site reactions such as redness, itching, or mild swelling can occur but are usually minor and resolve quickly. Proper site rotation and technique help prevent these reactions.

Hypoglycaemia (low blood sugar) is uncommon with Trulicity alone but can occur if you're taking it with other diabetes medications, particularly insulin or sulphonylureas. If you're on these medications, discuss with your healthcare provider whether their doses should be reduced. Symptoms of hypoglycaemia include trembling, sweating, confusion, rapid heartbeat, and hunger. Always carry fast-acting glucose (tablets or sugary drink) and ensure family members know how to help if needed.

Seek immediate medical attention if you experience:

• Severe, persistent abdominal pain radiating to your back, possibly with vomiting—this could indicate pancreatitis, a rare but serious side effect. If pancreatitis is suspected, stop taking Trulicity and seek urgent medical care.

• Signs of gallbladder problems: severe pain in the upper right abdomen, fever, yellowing of skin/eyes (jaundice)

• Signs of allergic reaction: difficulty breathing, severe rash, swelling of face, lips, or throat

• Symptoms of thyroid tumours: lump in the neck, hoarseness, difficulty swallowing (extremely rare but requires investigation)

• Severe dehydration from persistent vomiting or diarrhoea

Contact your GP or diabetes team if:

• Side effects persist beyond the first month

• You experience recurrent hypoglycaemia

• You have concerns about injection technique or site reactions

• You miss a dose and are unsure how to proceed

• You notice changes in vision, particularly if you have pre-existing diabetic retinopathy

You can report any suspected side effects directly to the MHRA through the Yellow Card Scheme at yellowcard.mhra.gov.uk. Regular follow-up appointments are essential to monitor your diabetes control, assess for complications, and ensure Trulicity remains the appropriate treatment for your needs.

Frequently Asked Questions