How to give Trulicity correctly is essential knowledge for anyone prescribed this once-weekly injectable medication for type 2 diabetes. Trulicity (dulaglutide) is a GLP-1 receptor agonist that helps regulate blood glucose levels through a convenient pre-filled pen device. Proper injection technique ensures you receive the full therapeutic benefit whilst minimising potential side effects. This comprehensive guide walks you through each step of Trulicity administration, from preparation and site selection to post-injection care, helping you confidently manage your diabetes treatment at home. Whether you're new to Trulicity or seeking to refine your technique, understanding the correct administration process is fundamental to achieving optimal glycaemic control.

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 glucose levels.

The mechanism of action involves several complementary effects. Trulicity stimulates insulin secretion from the pancreas when blood glucose levels are elevated, whilst simultaneously suppressing the release of glucagon, a hormone that raises blood sugar. Additionally, it slows gastric emptying, which helps reduce post-meal glucose spikes, and may promote a feeling of fullness that can support weight management efforts.

In the UK, Trulicity is licensed for use alongside diet and exercise modifications, either as monotherapy when metformin is inappropriate, or in combination with other glucose-lowering medications including insulin. Trulicity is not indicated for type 1 diabetes or diabetic ketoacidosis. The National Institute for Health and Care Excellence (NICE) recommends GLP-1 receptor agonists like Trulicity in several scenarios, including for people with inadequate glycaemic control despite oral therapy, particularly those with a body mass index (BMI) ≥35 kg/m² (or ≥32.5 kg/m² for people of South Asian and related ethnic groups). NICE also considers GLP-1 receptor agonists for people with type 2 diabetes who have or are at high risk of cardiovascular disease.

Trulicity comes in a pre-filled, single-use pen that delivers a fixed dose subcutaneously (under the skin) once weekly. Available strengths include 0.75 mg, 1.5 mg, 3 mg, and 4.5 mg. Treatment typically starts with 0.75 mg once weekly, with potential increases to 1.5 mg after at least 4 weeks, then to 3 mg and 4.5 mg at minimum 4-week intervals if further glycaemic control is needed and tolerated.

When used with insulin or sulfonylureas (such as gliclazide), there is an increased risk of hypoglycaemia, and dose reductions of these medications may be required. The convenience of weekly administration, combined with the pen's user-friendly design, makes Trulicity a practical option for many patients managing type 2 diabetes. Proper injection technique is essential to ensure optimal therapeutic benefit and minimise potential adverse effects.

Preparing Your Trulicity Pen for Injection

Proper preparation of your Trulicity pen is crucial for safe and effective administration. Before each injection, take time to follow these essential preparatory steps to ensure the medication is suitable for use.

Storage and temperature considerations are paramount. Trulicity should be stored in the refrigerator between 2°C and 8°C until you are ready to use it. Never freeze the pen, and if it has been frozen, it must be discarded. You may keep an unused pen at room temperature (not exceeding 30°C) for up to 14 days if necessary, but once removed from refrigeration, it should not be returned to the fridge. Remove the pen from the refrigerator approximately 30 minutes before injection to allow it to reach room temperature, as injecting cold medication can cause discomfort. Keep the pen out of direct sunlight.

Visual inspection is a critical safety step. Hold the pen up to the light and examine the solution through the viewing window. Trulicity should appear clear and colourless to slightly yellow. Do not use the pen if the liquid appears cloudy, discoloured, or contains particles or flakes. Check the expiry date printed on the pen label—never use medication past its expiration date. Do not use the pen if it appears damaged or has been dropped on a hard surface.

Gather your supplies before beginning. You will need your Trulicity pen, an alcohol wipe for cleaning the injection site, and a sharps disposal container for safe disposal after use. Wash your hands thoroughly with soap and water.

Do not remove the base cap until you are ready to inject. The pen does not require priming or assembly—it arrives ready to use. Avoid shaking the pen vigorously, as this may damage the medication. Do not store the pen with the base cap removed. By following these preparation steps carefully, you ensure the medication's integrity and set the foundation for a successful injection.

Step-by-Step Guide: How to Give Trulicity

Administering Trulicity is straightforward once you understand the pen mechanism. Follow these steps carefully for each weekly injection, referring to your Patient Information Leaflet (PIL) for specific details about your pen version:

Step 1: Select and clean your injection site. Choose an area on your abdomen (at least 5 cm away from your navel), the front of your thighs, or the back of your upper arms. Clean the chosen site with an alcohol wipe using a circular motion, and allow the skin to dry completely before proceeding.

Step 2: Prepare the pen. When you are ready to inject, pull the grey base cap straight off (do not twist it). You will see the needle is hidden. Do not replace the cap once removed, as this could damage the mechanism.

Step 3: Position the pen. Place the clear base flat and firmly against your cleaned, bare skin at a 90-degree angle.

Step 4: Unlock and inject. Depending on your pen version, you may need to unlock the pen by turning the lock ring or unlock button. Press and hold the injection button. You will hear a loud click, indicating the injection has started. Continue holding the pen firmly against your skin while the medication is being delivered.

Step 5: Complete the injection. Keep holding the pen in place until you hear a second click or until you can see the plunger has fully moved and stopped—this typically takes 5 to 10 seconds. This confirms the full dose has been delivered.

Step 6: Remove the pen. Lift the pen straight away from your skin. The injection is now complete. You may see a small amount of blood at the injection site—this is normal. If needed, press gently with a clean tissue or cotton wool, but do not rub the area.

Step 7: Dispose of the pen. Place the used pen immediately in a sharps container; never reuse or share pens. Your pharmacy, GP surgery, or local council can provide information on obtaining and disposing of sharps containers.

Choosing and Rotating Injection Sites

Proper site selection and rotation are essential practices that help maintain medication absorption, reduce injection site reactions, and prevent complications such as lipohypertrophy (thickening of fatty tissue under the skin).

Approved injection sites for Trulicity include three main areas: the abdomen (avoiding a 5 cm radius around the navel), the front and sides of the thighs, and the back of the upper arms (the latter typically requires assistance from another person). All three sites provide adequate subcutaneous tissue for proper absorption. The abdomen generally offers the most consistent absorption rates, whilst the thigh provides convenient self-administration access.

Site rotation strategy is crucial for long-term treatment success. Because Trulicity is administered weekly, you should use a different injection site each week, following a systematic rotation pattern. For example, you might use the right abdomen one week, left thigh the next, right thigh the following week, and left abdomen the week after, then repeat the cycle. Even within the same general area (such as the abdomen), inject at least 2–3 cm away from the previous week's injection site.

Areas to avoid include skin that is tender, bruised, red, hard, scarred, or has stretch marks. Do not inject into areas with visible veins. Avoid injecting into the same spot repeatedly, as this increases the risk of lipohypertrophy, which can affect medicine absorption and glycaemic control.

Keeping a record can be helpful, particularly when starting treatment. Some patients find it useful to note injection sites in a diary or diabetes management app, ensuring they maintain proper rotation. If you notice any persistent lumps, hardness, or changes in the skin at injection sites, inform your GP or diabetes specialist nurse, as you may need to avoid these areas whilst they heal. Proper site rotation is a simple yet effective strategy that supports optimal treatment outcomes throughout your Trulicity therapy.

Common Mistakes and How to Avoid Them

Understanding frequent errors in Trulicity administration helps ensure you receive the full therapeutic benefit whilst minimising potential complications.

Incomplete dose delivery is perhaps the most significant mistake. This occurs when patients remove the pen too quickly, before the injection is complete. Always wait for the second click and/or count to 10 after the first click, and confirm the plunger has stopped moving before removing the pen. If you're uncertain whether you received the full dose, do not administer another injection—contact your healthcare provider for advice.

Injecting cold medication directly from the refrigerator can cause unnecessary discomfort and may affect absorption. Always allow the pen to reach room temperature (approximately 30 minutes) before injection. However, do not attempt to warm the pen artificially using hot water, microwaves, or direct sunlight, as this may damage the medication.

Poor injection technique, such as not holding the pen firmly against the skin or injecting at an angle rather than perpendicular to the skin surface, can result in incomplete delivery or medication leakage. Ensure the clear base is flat against your skin and maintain firm, steady pressure throughout the injection process.

Reusing pens is dangerous and strictly contraindicated. Each Trulicity pen is designed for single use only with a hidden needle that cannot be replaced. Attempting to reuse pens risks infection, inaccurate dosing, and pen malfunction. Similarly, never share your pen with others, as this poses serious infection risks.

Forgetting doses can compromise glycaemic control. If you miss a dose and there are at least 3 days (72 hours) until your next scheduled dose, administer the missed dose as soon as possible, then resume your regular weekly schedule. If there are fewer than 3 days until your next scheduled dose, skip the missed dose and take your next dose on the regularly scheduled day. Never take two doses within 3 days of each other. Setting a weekly reminder on your phone or linking injection day to a regular weekly activity can help establish a consistent routine.

What to Do After Your Trulicity Injection

Post-injection care and monitoring are important aspects of safe Trulicity use that help you identify normal responses versus situations requiring medical attention.

Immediate post-injection steps include proper disposal of the used pen in a puncture-resistant sharps container—never dispose of pens in household rubbish or recycling bins. Your pharmacist, GP surgery, or local council can provide sharps containers and advise on local disposal schemes. You may apply gentle pressure to the injection site with clean gauze if there is minor bleeding, but avoid rubbing the area, as this may affect medication absorption. A small amount of bleeding or bruising is normal and not cause for concern.

Common side effects to anticipate include gastrointestinal symptoms, particularly when starting treatment or increasing doses. Nausea, vomiting, diarrhoea, and decreased appetite are the most frequently reported adverse effects, typically diminishing over several weeks as your body adjusts. Eating smaller, more frequent meals and avoiding high-fat foods may help manage these symptoms. Injection site reactions such as mild redness, itching, or swelling usually resolve within a few days.

Monitoring for hypoglycaemia is important, especially if you take Trulicity alongside insulin or sulfonylureas (such as gliclazide). Whilst Trulicity alone rarely causes low blood sugar, combination therapy increases this risk. Recognise symptoms including trembling, sweating, confusion, rapid heartbeat, and hunger. Always carry fast-acting glucose (such as glucose tablets or sugary drinks) and ensure family members know how to assist if needed.

When to seek medical advice: Contact your GP or diabetes team if you experience persistent vomiting or diarrhoea leading to dehydration (which can affect kidney function), severe abdominal pain (particularly if radiating to the back, which may indicate pancreatitis), or signs of allergic reaction (rash, difficulty breathing, swelling of face or throat). Seek immediate medical attention for signs of severe hypoglycaemia or suspected pancreatitis. Regular follow-up appointments allow your healthcare team to monitor your HbA1c, assess treatment response, and adjust therapy as needed to optimise your diabetes management.

If you experience any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the Yellow Card Scheme at www.mhra.gov.uk/yellowcard.

Frequently Asked Questions