TRULICITY (DULAGLUTIDE) 1.5MG/0.5ML INJECTION 2`S

Dulaglutide is a glucagon-like peptide-1 (GLP-1) receptor agonist — a class of medicines that mimic the action of the natural incretin hormone GLP-1. It is given once weekly by subcutaneous injection. Dulaglutide works through multiple complementary mechanisms:

•       Stimulates glucose-dependent insulin secretion from the pancreatic beta cells.

•       Suppresses inappropriate glucagon secretion from the alpha cells.

•       Slows gastric emptying — reducing the post-meal rise in blood glucose.

•       Reduces appetite and food intake (via central GLP-1 receptors) — supporting weight loss.

Trulicity 1.5 mg once weekly is used to treat: type 2 diabetes mellitus in adults and children aged 10 years and older, to improve blood glucose control. It is used as monotherapy when metformin is not tolerated, or in combination with other antidiabetic medicines. It has demonstrated significant cardiovascular benefits in the REWIND trial, including reduction in major adverse cardiovascular events (MACE) in patients with established cardiovascular disease or multiple CV risk factors.

Inject once weekly on the same day each week (e.g. every Monday), at any time of day, regardless of meals. The auto-injector pen is pre-filled and single-dose — press the green button until a click is heard and hold for 5–10 seconds. Inject into the abdomen, upper arm, or thigh. Rotate injection sites each week. Each pen can only be used once.

Trulicity should not be used in: personal or family history of medullary thyroid carcinoma (MTC); Multiple Endocrine Neoplasia syndrome type 2 (MEN2); severe gastroparesis or inflammatory bowel disease; known hypersensitivity to dulaglutide; type 1 diabetes; or diabetic ketoacidosis.

Use with caution in: severe renal impairment (eGFR <15 mL/min); pancreatitis history; concomitant sulfonylurea or insulin therapy (reduce doses); and pregnancy (not recommended — insufficient safety data).

•       Sulfonylureas (gliclazide, glibenclamide): additive glucose-lowering effect — hypoglycaemia risk; reduce sulfonylurea dose when starting Trulicity.

•       Insulin: additive glucose lowering — reduce basal insulin dose by 10–20% when initiating; monitor closely.

•       Oral medicines with narrow therapeutic window: delayed gastric emptying may reduce rate (not extent) of absorption — administer time-sensitive oral medicines before Trulicity injection.

•       Warfarin: monitor INR after initiating GLP-1 agonist due to altered absorption kinetics.

Store at 2–8°C (refrigerate). Do not freeze — if a pen is frozen, discard it. Keep in original carton to protect from light. Once removed from the refrigerator, the pen can be kept at room temperature (below 30°C) for up to 14 days. Do not use after the expiry date. After use, replace the cap and dispose via a sharps container.

Trulicity's once-weekly dosing makes it one of the most convenient injectable diabetes treatments available. The pre-filled auto-injector pen is simple to use — no mixing, no dose measurement, and the needle is hidden so it is less intimidating for patients new to injection therapy. Most patients find the injection essentially painless.

Nausea in the first 4–8 weeks is very common but is usually manageable and improves substantially as the body adjusts. Eating smaller meals, avoiding very fatty foods, and eating slowly all help. Most patients who persist through the initial nausea find it resolves completely.

Weight loss of 2–5 kg (or more in some patients) is typically seen in the first year of treatment — this is a beneficial side effect in most patients with type 2 diabetes, as excess weight drives insulin resistance. Ensure you maintain adequate nutrition.

Dulaglutide 1.5 mg once weekly is the standard adult dose; 0.75 mg is available as the starting dose (reduced in some countries) to improve GI tolerability. A 3.0 mg and 4.5 mg dose are also approved (Trulicity higher doses) for additional HbA1c reduction.

The REWIND trial (n=9901, 5.4-year follow-up) demonstrated a significant 12% RRMACE reduction (CV death, non-fatal MI, non-fatal stroke) with dulaglutide vs placebo in patients with T2DM and established CVD or CV risk factors — making it a preferred agent in this population.

GI side effects: dose titration from 0.75 mg for 4 weeks then 1.5 mg can reduce nausea burden. Renal: no dose adjustment required down to eGFR 15 mL/min; not recommended if eGFR <15 mL/min. Hepatic: no dose adjustment needed in mild–moderate impairment; limited data in severe hepatic impairment.

Why is Trulicity given once a week and not daily?

Dulaglutide has been engineered with a modified IgG4-Fc backbone that gives it a very long half-life (approximately 5 days). This allows the once-weekly injection while maintaining stable blood levels throughout the week.

Will I lose weight on Trulicity?

Most patients experience weight loss — typically 2–5 kg over the first year. This is a positive effect as weight reduction improves blood sugar control, blood pressure, and cardiovascular risk. However, Trulicity should not be used as a weight-loss medicine alone — it is licensed specifically for type 2 diabetes.

Can I use Trulicity if I also take insulin?

Yes — Trulicity is often combined with insulin. When starting Trulicity alongside insulin, your insulin dose will typically need to be reduced (usually basal insulin reduced by 10–20%) to avoid hypoglycaemia. Your diabetes team will guide you through this adjustment.

How do I use the auto-injector pen?

Remove the cap; place the pen flat against your skin at the injection site (thigh, abdomen, or upper arm); press the green button firmly until you hear a click; hold for 5–10 seconds until a second click is heard; remove the pen. The needle is hidden in the device — you will not see it.

I noticed my pen looks slightly discoloured — can I still use it?

Trulicity solution should be clear and colourless. If it looks discoloured, cloudy, or contains particles, do not use it. Store it in the refrigerator as directed and return it to the pharmacy for replacement.