Trulicity (dulaglutide) is a once-weekly injectable medication used to manage type 2 diabetes in the UK. Understanding the correct Trulicity route of administration is essential for safe, effective treatment. This glucagon-like peptide-1 (GLP-1) receptor agonist is administered subcutaneously using a pre-filled pen device, offering convenience compared to daily injections. Proper injection technique, site selection, and rotation help optimise glycaemic control whilst minimising complications. This guide provides comprehensive, evidence-based information on administering Trulicity safely at home, aligned with NICE guidance and UK clinical practice.

What Is Trulicity and How Is It Administered?

Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist licensed in the UK for the treatment of type 2 diabetes mellitus. It works by mimicking the action of the naturally occurring hormone GLP-1, which stimulates insulin secretion in a glucose-dependent manner, suppresses glucagon release, and slows gastric emptying. This mechanism helps to improve glycaemic control.

Trulicity is administered subcutaneously (under the skin) only, using a pre-filled, single-dose pen injector. The medication is designed for once-weekly administration, which may be more convenient for some people compared to daily injectable therapies. Each pen contains a fixed dose—available in 0.75 mg, 1.5 mg, 3 mg, or 4.5 mg strengths—and the device is engineered to be user-friendly.

The subcutaneous route provides reliable absorption when injected correctly. Patients do not need to coordinate the injection with meals, offering flexibility in timing. However, it is advisable to administer Trulicity on the same day each week to maintain steady therapeutic levels. The pen is intended for single use only and should be disposed of safely in a sharps container immediately after administration.

Importantly, Trulicity is not indicated for people with type 1 diabetes or diabetic ketoacidosis. When used alongside insulin or sulfonylureas, there is an increased risk of hypoglycaemia, and dose adjustments of these medications may be needed.

NICE guidance (NG28) supports the use of GLP-1 receptor agonists such as Trulicity as part of a comprehensive treatment plan that includes diet, physical activity, and other glucose-lowering medications when glycaemic targets are not achieved with existing therapy. Ideally, your first dose should be administered under the guidance of a healthcare professional.

Step-by-Step Guide to Injecting Trulicity

Administering Trulicity correctly ensures optimal drug delivery and reduces the risk of complications. Before beginning, remove the pen from the refrigerator and allow it to reach room temperature for approximately 30 minutes. This helps reduce injection discomfort; do not use external heat sources to warm the pen. Check the expiry date and inspect the pen to ensure the solution is clear and colourless; do not use if it appears cloudy, discoloured, contains particles, or if the pen appears damaged or has been frozen.

Preparation steps:

• Wash your hands thoroughly with soap and water.

• Choose an appropriate injection site (abdomen, thigh, or upper arm) and clean the area with an alcohol wipe if desired, allowing the skin to dry completely.

• Remove the base cap from the pen by pulling it straight off—do not twist, as this may damage the device.

Injection technique:

• Unlock the pen by turning the lock ring.

• Place the clear base of the pen flat against your chosen injection site. The pen should be held at a 90-degree angle to the skin.

• Press and hold the injection button. You will hear a click indicating the injection has started.

• Continue holding the pen and button in place until you hear a second click (this usually takes 5 to 10 seconds), which signals that the full dose has been delivered.

• The grey plunger will be visible in the injection window when the dose is complete.

• Lift the pen straight away from the skin and dispose of it immediately in a sharps bin.

Post-injection care:

A small amount of bleeding or bruising at the injection site is normal. Apply gentle pressure with a clean tissue or cotton wool if needed, but do not rub the area. If you experience persistent pain, swelling, or signs of infection, contact your GP or diabetes specialist nurse promptly.

Remember: Never share your Trulicity pen with another person, even if the needle has been changed, as this poses a risk of infection transmission.

Recommended Injection Sites and Rotation

Trulicity should be injected subcutaneously into areas with adequate subcutaneous tissue to ensure proper absorption. The three recommended injection sites are:

• Abdomen: The preferred site for many patients, avoiding a 5 cm radius around the navel. This area typically has good subcutaneous tissue and is easily accessible.

• Thigh: The front and outer aspects of the thigh provide a suitable injection site, particularly for patients who prefer not to inject into the abdomen.

• Upper arm: The outer, back area of the upper arm can be used, but injections at this site should be administered by another person to ensure correct technique.

Site rotation is essential to prevent lipodystrophy (abnormal fat distribution), lipoatrophy (loss of subcutaneous fat), or localised skin reactions. Repeatedly injecting into the same spot can lead to thickened or lumpy skin, which may impair drug absorption and reduce therapeutic efficacy. Patients should rotate injection sites systematically, using a different location each week within the same general area or alternating between different body regions. Ensure each injection is at least 2.5 cm away from previous injection sites.

It is important to avoid injecting into areas where the skin is tender, bruised, red, hard, scarred or infected. If you notice any persistent lumps, indentations, or skin changes at injection sites, inform your healthcare provider, as this may indicate the need to adjust your injection technique or site selection.

For patients who are also taking insulin or other injectable medications, use separate injection sites at least 2.5 cm apart to maintain the effectiveness of both medications. Trulicity and insulin can be injected into the same body region if sites are adequately spaced.

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 food. However, consistency is important—try to inject on the same day each week to maintain stable blood levels. If you need to change your injection day, ensure there is at least 72 hours (3 days) between doses.

What if I see liquid on my skin after injection?

A small amount of liquid at the injection site occasionally occurs and is usually not a cause for concern, particularly if you heard both clicks and saw the grey plunger. However, if you are uncertain whether you received the full dose, do not administer another injection. Monitor your blood glucose levels and contact your healthcare team for advice.

Can I reuse the Trulicity pen?

No. Each Trulicity pen is designed for single use only and must be disposed of after one injection, even if it appears that medication remains inside. Reusing pens increases the risk of infection, needle-stick injury, and inaccurate dosing.

Is it safe to inject through clothing?

No. Always inject directly onto clean, exposed skin. Injecting through clothing can lead to incomplete dose delivery, needle damage, or contamination.

What should I do if I experience injection-site reactions?

Mild redness, itching, or swelling at the injection site is relatively common and usually resolves within a few days. Rotating sites and ensuring proper technique can minimise these reactions. If you develop severe pain, persistent swelling, discharge, or signs of infection (warmth, increasing redness, fever), seek medical attention promptly.

Can I travel with Trulicity?

Yes. Unopened pens should be kept refrigerated (2–8°C) in their original carton to protect from light. They can be stored at room temperature (up to 30°C) for up to 14 days if necessary. Never freeze Trulicity—discard if previously frozen. When travelling, carry your medication in hand luggage when flying, along with a letter from your prescriber if required by airline or customs regulations. Consider using a cool pack for longer journeys. Arrange for a sharps bin via your GP or pharmacy for safe disposal; do not dispose of used pens in household waste.

What to Do If You Miss a Dose or Make an Error

If you miss a dose:

If you forget to inject Trulicity and there are 72 hours (3 days) or more until your next scheduled dose, administer the missed dose as soon as possible. Then resume your regular weekly schedule on your usual day.

If there are less than 72 hours until your next scheduled dose, skip the missed dose entirely and inject your next dose on the regularly scheduled day. Do not double up or take two doses within 3 days of each other, as this increases the risk of adverse effects, particularly gastrointestinal symptoms such as nausea, vomiting, and diarrhoea.

If you accidentally inject twice:

If you inadvertently administer two doses of Trulicity within a short period, contact your GP, diabetes specialist nurse, or NHS 111 for advice. Monitor for symptoms of hypoglycaemia (especially if you also take insulin or sulfonylureas) and gastrointestinal side effects. Your healthcare provider may advise temporary adjustments to your other diabetes medications.

If you inject into the wrong site or the injection is incomplete:

If you suspect the injection was not completed correctly (for example, the pen was removed too early or you did not hear the second click), do not attempt to re-inject. Monitor your blood glucose levels more frequently over the following days and contact your diabetes team for guidance.

Important safety advice:

Seek urgent medical attention if you experience severe, persistent abdominal pain (with or without vomiting), as this could indicate pancreatitis. If you develop significant gastrointestinal symptoms, maintain adequate hydration to prevent dehydration.

Keep a record of your injection dates and any issues encountered. If you frequently forget doses, consider setting a weekly alarm or using a medication reminder app. Always report any persistent difficulties with administration or concerns about efficacy to your prescriber, as alternative formulations or therapies may be more suitable for your individual circumstances.

Report any suspected side effects to the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.

Frequently Asked Questions