Trulicity (dulaglutide) is a once-weekly GLP-1 receptor agonist used to manage type 2 diabetes. Missing a dose can affect your blood glucose control, though the impact varies between individuals. Understanding what happens when you miss an injection, recognising potential symptoms, and knowing the correct steps to take are essential for maintaining safe and effective diabetes management. This article explains the consequences of missed Trulicity doses, outlines the symptoms you may experience, provides clear guidance on what action to take, and offers practical strategies to help you maintain consistent treatment adherence.

What Happens When You Miss a Dose of Trulicity

Trulicity (dulaglutide) is a once-weekly glucagon-like peptide-1 (GLP-1) receptor agonist prescribed for type 2 diabetes management. When you miss a scheduled dose, the medication's blood glucose-lowering effects gradually diminish as the drug is metabolised and cleared from your system. Dulaglutide has a half-life of approximately 5 days, meaning it takes roughly this time for half the medication to leave your body. Consequently, missing a single dose does not cause an immediate loss of glycaemic control, but the therapeutic benefits begin to wane over the following days.

The primary consequence of a missed Trulicity injection is reduced blood glucose control. Without the medication's action on insulin secretion and glucagon suppression, your blood sugar levels may rise above your target range. This effect becomes more pronounced as time passes since your last injection. The extent of blood glucose elevation varies considerably between individuals and depends on factors including your baseline diabetes control, diet, physical activity, and any other diabetes medications you take concurrently.

It is important to understand that for most people with stable type 2 diabetes, missing one dose occasionally is unlikely to cause immediate harm. However, consistently missing doses or prolonged gaps in treatment can lead to deteriorating glycaemic control, increasing your risk of both acute hyperglycaemia and long-term diabetic complications. The risk may be higher during periods of illness, dehydration, or if you are also taking SGLT2 inhibitor medications. The medication works as part of your overall diabetes management strategy, and maintaining a regular dosing schedule is essential for optimal therapeutic outcomes.

If you miss a dose, monitor your glucose closely and seek advice if readings remain high or you feel unwell.

Recognising Symptoms After Missing Your Trulicity Injection

After missing a Trulicity dose, you may experience symptoms related to elevated blood glucose levels rather than direct withdrawal effects from the medication itself. Common hyperglycaemia symptoms include:

• Increased thirst (polydipsia) and frequent urination (polyuria)

• Unusual tiredness or fatigue

• Blurred vision

• Headaches

• Difficulty concentrating or feeling irritable

These symptoms typically develop gradually over several days as your blood glucose rises above therapeutic targets. The severity and timing depend on your individual metabolic control and how well-managed your diabetes was before missing the injection. Some patients may notice minimal symptoms, particularly if their diabetes is well-controlled with additional medications or lifestyle measures.

It is worth noting that there is no traditional 'withdrawal' syndrome when missing a Trulicity dose. Unlike some medications, GLP-1 receptor agonists do not cause physical dependence. However, you might notice a return of symptoms that were previously well-controlled by the medication, such as increased appetite or post-meal glucose spikes, as Trulicity's effects on satiety and gastric emptying diminish.

You should monitor for more serious warning signs that require immediate medical attention, including:

• Persistent high blood glucose readings (above 15 mmol/L) – check for ketones if available

• Severe, persistent abdominal pain (especially if radiating to your back) which could indicate pancreatitis

• Nausea and vomiting

• Fruity-smelling breath

• Rapid, deep breathing or confusion

• Signs of diabetic ketoacidosis (though less common in type 2 diabetes)

If your blood glucose remains above 15 mmol/L, check your ketone levels if possible, especially if you also take SGLT2 inhibitors. Seek same-day medical advice if ketones are present or if you feel unwell. Call 999 or go to A&E immediately if you experience signs of DKA (deep/rapid breathing, confusion, severe drowsiness) or severe dehydration. Regular blood glucose monitoring becomes particularly important after missing a dose, allowing you to detect significant elevations early and take appropriate action.

What to Do If You Miss a Trulicity Dose

The recommended action after missing a Trulicity dose depends on how much time remains until your next scheduled injection. If your next scheduled dose is due in 3 days (72 hours) or more, inject the missed dose as soon as possible and then continue with your usual weekly injection day. If the next scheduled dose is due in less than 3 days, skip the missed dose entirely and wait until your next regular injection day.

Never inject two doses within 3 days of each other, and do not take a double dose to compensate for the missed injection. Taking doses too close together increases the risk of adverse effects, particularly gastrointestinal symptoms such as nausea, vomiting, and diarrhoea. It also raises the risk of hypoglycaemia, especially if you take other glucose-lowering medications like sulphonylureas or insulin.

Whilst managing the missed dose, monitor your blood glucose levels more frequently than usual. This vigilance helps you identify any significant elevations requiring intervention. If your readings consistently exceed your target range, contact your diabetes care team for guidance. They may recommend temporary adjustments to your diet, physical activity, or other diabetes medications to maintain glycaemic control until your Trulicity regimen is re-established.

Maintain your usual healthy eating patterns and physical activity levels, as these lifestyle factors remain crucial for blood glucose management. Avoid the temptation to drastically restrict carbohydrates or over-exercise to compensate, as this may lead to erratic glucose levels.

If you are uncertain about what to do or have missed multiple doses, contact your GP, practice nurse, or diabetes specialist team for personalised advice. They can assess your individual circumstances, review your recent glucose control, and provide specific recommendations. Never hesitate to seek professional guidance, as appropriate management of missed doses is an important aspect of safe diabetes care.

How to Prevent Missing Future Trulicity Doses

Establishing a reliable routine is the most effective strategy for preventing missed Trulicity injections. Choose a consistent day and time each week that fits naturally into your schedule—many patients find success with weekend mornings or a specific weekday evening when they are typically at home. Consistency helps transform the injection into an automatic habit rather than something requiring conscious effort to remember.

Practical reminder strategies include:

• Setting a weekly alarm on your mobile phone with a clear label

• Using medication reminder apps specifically designed for injection schedules

• Marking your calendar or diary with injection days

• Linking your injection to a regular weekly activity (e.g., before Sunday breakfast)

• Asking a family member or friend to provide gentle reminders

Many patients find it helpful to prepare their injection supplies in advance. Keep your Trulicity pen in a visible location in the refrigerator and consider placing a reminder note on the fridge door. Some people create a dedicated 'medication station' with all necessary supplies, making the injection process more streamlined and less likely to be postponed.

For storage, follow these guidelines: keep Trulicity refrigerated (2°C to 8°C); do not freeze; protect from light. If needed, Trulicity can be kept at room temperature (not above 30°C) for up to 14 days. This is particularly useful for travel, but ensure the pen is protected from extreme temperatures and direct sunlight.

Maintain an adequate supply of medication by ordering repeat prescriptions in good time. Set a reminder to request your prescription at least one week before you expect to run out, accounting for potential pharmacy delays. If you travel frequently, plan ahead to ensure you have sufficient medication and appropriate storage during your trip.

If you experience side effects from Trulicity, report them through the MHRA Yellow Card scheme, which helps monitor medication safety. Your diabetes specialist nurse can also provide practical tips tailored to your lifestyle and any barriers you face in maintaining adherence.

If you frequently forget doses despite reminder systems, discuss this openly with your healthcare team. They can explore whether underlying factors such as needle anxiety, side effects, or practical difficulties are contributing to non-adherence. Alternative GLP-1 receptor agonists with different dosing schedules or formulations might be more suitable for your circumstances. Remember, consistent medication adherence is crucial for achieving optimal diabetes control and reducing your risk of long-term complications, making it worth investing time in developing effective strategies that work for you.

Frequently Asked Questions