Trulicity (dulaglutide) is a once-weekly injectable medication for managing type 2 diabetes mellitus in adults. As a glucagon-like peptide-1 (GLP-1) receptor agonist, it helps regulate blood sugar by stimulating insulin secretion, suppressing glucagon release, and slowing gastric emptying. Understanding how to use Trulicity correctly—from injection technique to site rotation and storage—is essential for achieving optimal glycaemic control whilst minimising side effects. This guide provides comprehensive, step-by-step instructions on administering Trulicity safely and effectively, aligned with UK clinical guidance and best practice recommendations.

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. Importantly, this means the risk of hypoglycaemia (dangerously low blood sugar) is reduced compared to some other diabetes medications. Additionally, dulaglutide suppresses the release of glucagon—a hormone that raises blood glucose—and slows gastric emptying, which helps prevent post-meal blood sugar spikes. Many patients commonly experience modest weight loss, though this varies between individuals.

Trulicity is typically prescribed when diet, exercise and other diabetes medications are insufficient to control blood sugar. According to NICE guidance (NG28), GLP-1 receptor agonists like Trulicity are usually considered after failure of triple oral therapy and recommended for adults with type 2 diabetes who have inadequate glycaemic control and a body mass index (BMI) of 35 kg/m² or higher (with adjustment for ethnicity where appropriate), or for those with a BMI lower than 35 kg/m² when insulin therapy would have significant occupational implications or weight loss would benefit other obesity-related comorbidities. Treatment should be continued only if there is a reduction of at least 11 mmol/mol (1%) in HbA1c and a weight loss of at least 3% after 6 months.

Trulicity is available in pre-filled, single-dose pens in various strengths (0.75 mg, 1.5 mg, 3 mg, and 4.5 mg). Treatment typically starts with 0.75 mg once weekly, with possible dose increases at intervals of at least 4 weeks if additional glycaemic control is needed. The once-weekly dosing schedule offers convenience compared to daily injections, potentially improving treatment adherence.

Importantly, Trulicity is not indicated for use in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.

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

Administering Trulicity correctly ensures optimal therapeutic benefit and minimises discomfort. The medication comes in a pre-filled, single-use pen that does not require any mixing or preparation, making it user-friendly for self-injection.

Before you begin:

• Wash your hands thoroughly with soap and water

• Remove the Trulicity pen from the refrigerator and allow it to reach room temperature (approximately 30 minutes) to reduce injection site discomfort

• Check the expiry date and do not use if expired

• Check the medication through the viewing window—it should be clear and colourless to slightly yellow. Do not use if the solution is cloudy, discoloured, or contains particles

• Do not use if the pen appears damaged or has been frozen

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

Step-by-step injection process:

1. Prepare the injection site by cleaning it with an alcohol wipe and allowing the area to dry completely.

2. Remove the grey base cap from the pen. Do not replace the cap after removal.

3. Position the pen by placing the clear base flat against your chosen injection site at a 90-degree angle. Ensure the green injection button is visible.

4. Unlock the pen by turning the base lock from the locked to the unlocked position (you'll hear a click). Do not unlock the pen until the clear base is placed against your skin and you are ready to inject.

5. 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.

6. Wait for the second click (this may take up to 5-10 seconds), which signals the injection is complete. After the second click, continue holding until you can see the grey plunger has filled the viewing window.

7. Remove the pen from your skin and safely dispose of it in a sharps container. Do not recap or reuse the pen.

Trulicity should be injected once weekly on the same day each week, at any time of day, with or without food. If you miss a dose and there are at least three days (72 hours) until your next scheduled dose, administer it as soon as you remember. If fewer than three days remain, skip the missed dose and resume your regular schedule.

You can change your weekly injection day, provided there are at least 3 days (72 hours) between doses.

Never share your Trulicity pen with another person, even if the needle has been changed, as this may transmit infections.

Where to Inject Trulicity and Rotating Injection Sites

Proper injection site selection and rotation are essential for maximising medication absorption and preventing injection site complications such as lipohypertrophy (lumps under the skin) or lipoatrophy (loss of fatty tissue).

Approved injection sites for Trulicity include:

• Abdomen (stomach area): Inject at least 5 cm away from the navel (belly button).

• Thigh: Use the front or outer areas of the thigh.

• Upper arm: The outer, back area of the upper arm can be used, though this site should be administered by another person (caregiver or healthcare professional) rather than for self-injection.

You should inject Trulicity subcutaneously (under the skin, into the fatty tissue layer), not into muscle or intravenously. Avoid injecting into areas where the skin is tender, bruised, red, hard, scarred, or has stretch marks, as these conditions can affect absorption and increase discomfort.

Importance of site rotation:

Rotating injection sites is crucial to prevent localised tissue damage and maintain consistent drug absorption. Using the same spot repeatedly can lead to changes in the fatty tissue that may reduce medication effectiveness and cause discomfort. Create a systematic rotation pattern—for example, alternating between abdomen, left thigh, right thigh, and upper arms across consecutive weeks.

Keep a simple log or use a diabetes management app to track which site you used each week. Some patients find it helpful to divide each anatomical area into quadrants, further expanding their rotation options. If you notice any persistent lumps, hardness, or unusual changes at injection sites, contact your GP or diabetes specialist nurse, as you may need to avoid that area temporarily and have it assessed. Proper site rotation, combined with correct injection technique, ensures Trulicity continues to work effectively throughout your treatment.

Common Side Effects and What to Watch For

Like all medications, Trulicity can cause side effects, though not everyone experiences them. Understanding what to expect and when to seek medical advice is important for safe medication use.

Common gastrointestinal side effects (affecting more than 1 in 10 people) include:

• Nausea and vomiting: Usually most pronounced when starting treatment or increasing the dose, typically improving over several weeks

• Diarrhoea: Can range from mild to moderate; maintain adequate hydration

• Abdominal pain and decreased appetite: Often transient and manageable

• Indigestion and flatulence: Generally mild and self-limiting

To minimise gastrointestinal symptoms, eat smaller, more frequent meals, avoid high-fat or spicy foods, and stay well-hydrated. These effects typically diminish as your body adjusts to the medication.

Less common but important side effects include:

• Injection site reactions: Redness, itching, or swelling at the injection site, usually mild and resolving within a few days

• Hypoglycaemia (low blood sugar): More likely when Trulicity is used with insulin or sulfonylureas. Symptoms include trembling, sweating, confusion, rapid heartbeat, and hunger. Your doctor may need to reduce your insulin or sulfonylurea dose when starting Trulicity.

When to seek medical attention:

Stop taking Trulicity and contact your GP urgently or attend A&E if you experience:

• Severe, persistent abdominal pain radiating to the back, possibly with vomiting—this could indicate pancreatitis (inflammation of the pancreas), a rare but serious side effect

• Signs of severe allergic reaction: Difficulty breathing, swelling of the face, lips, tongue, or throat, or severe rash

Contact your healthcare team promptly if you experience:

• Severe or persistent vomiting or diarrhoea leading to dehydration, particularly if you have kidney problems

• Changes in vision or signs of diabetic retinopathy, especially if you are on insulin or have pre-existing retinopathy

• Symptoms of gallbladder disease: Sudden pain in the upper abdomen, shoulder or between the shoulder blades; nausea; vomiting; jaundice (yellowing of skin/eyes)

Trulicity is not recommended for patients with severe gastrointestinal disease, including gastroparesis (delayed stomach emptying).

If you experience recurrent hypoglycaemia, your diabetes medication regimen may need adjustment. Always carry a fast-acting source of glucose (such as glucose tablets or a sugary drink) and ensure family members know how to recognise and respond to low blood sugar episodes.

Trulicity is not recommended during pregnancy or breastfeeding. If you are planning pregnancy, pregnant, or breastfeeding, consult your doctor for advice on diabetes management.

Report any suspected side effects to your healthcare professional or via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app.

Storing Trulicity Properly and Disposal of Used Pens

Correct storage of Trulicity is essential to maintain its effectiveness and safety. Improper storage can degrade the medication, potentially reducing its therapeutic benefit.

Storage guidelines for unused Trulicity pens:

• Refrigeration: Store unopened Trulicity pens in the refrigerator at 2°C to 8°C. Do not freeze. If a pen has been frozen, discard it, as freezing can damage the medication.

• Protect from light: Keep pens in the original carton to protect from light until ready to use.

• Room temperature storage: If refrigeration is unavailable (for example, when travelling), Trulicity can be stored at room temperature (not exceeding 30°C) for up to 14 days. After this period, discard any unused pens. Do not return pens to the refrigerator after they have been kept at room temperature.

• Keep out of reach of children: Store medication safely, away from children and pets.

• Do not shake the pen as this may damage the medication.

Before injection:

Allow the pen to reach room temperature naturally (approximately 30 minutes) before injecting, as cold medication can cause discomfort. Do not attempt to warm the pen artificially using hot water, microwaves, or direct sunlight, as this can damage the medication.

Disposal of used Trulicity pens:

Proper disposal protects others from accidental needle-stick injuries and prevents environmental contamination. Never throw used pens in household rubbish or recycling bins.

• Use a sharps container: Place used pens immediately into an approved sharps disposal container (available from pharmacies or your GP surgery).

• When the container is full: Seal it according to the manufacturer's instructions and return it to your local pharmacy, GP surgery, or hospital for safe disposal. Check with your local council or NHS service for specific sharps disposal arrangements in your area.

• Temporary solutions: If a sharps container is unavailable, use a rigid, puncture-proof container (such as a heavy-duty plastic bottle with a screw cap) as a temporary measure, clearly labelling it "Used Sharps – Do Not Recycle." However, always aim to obtain a proper sharps container as soon as possible.

Travelling with Trulicity:

When travelling, carry Trulicity in your hand luggage with a letter from your doctor explaining your need for the medication and injection devices. Use a cool bag with ice packs (not in direct contact with the pens) if refrigeration is unavailable. Plan ahead to ensure you have sufficient supplies for your trip, plus extra in case of delays. Following these storage and disposal guidelines ensures Trulicity remains effective and that you manage your diabetes safely whilst protecting others and the environment.

Frequently Asked Questions