What is Trulicity (Dulaglutide) and how does it work?

Do I have to have Trulicity with food?

You can administer Trulicity with or without food (Trulicity (Dulaglutide): A New GLP-1 Receptor Agonist Once-Weekly Subcutaneous Injection Approved for the Treatment of Patients with Type 2 Diabetes).

What are the Trulicity (Dulaglutide) side effects?

Although Trulicity is an effective medication for the treatment of type 2 diabetes, Trulicity has a number of side effects (Trulicity (Dulaglutide): A New GLP-1 Receptor Agonist Once-Weekly Subcutaneous Injection Approved for the Treatment of Patients with Type 2 Diabetes).

Common side effects of Trulicity

The most common side effects of Trulicity are:

• nausea
• diarrhoea
• vomiting
• abdominal pain
• decreased appetite

These gastrointestinal side effects may be experienced by over 10% of people using Trulicity. The feeling is similar to the sensations felt if a person really over eats.

These gastrointestinal side effects will subside in most people within 8-12 weeks and dulaglutide is well tolerated in the long term.

Serious side effects of Trulicity

Trulicity may also cause more serious side effects including:

• inflammation of the pancreas
• hypoglycaemia
• allergic reactions

Does Trulicity cause thyroid cancer?

The simple answer is no, GLP-1s do not cause thyroid cancer in humans.

Early studies demonstrated that when rats were treated with dulaglutide and other GLP-1 therapies many developed a very rare and lethal thyroid cancer called medullary thyroid carcinoma. Rats have very high levels of GLP-1 receptors in their thyroids. These are not present in human thyroid cell.

The early concern that GLP-1 causes thyriod cancer has lead to extensive investiagtions and studies looking at this issues and to date there has been nothing to suggest a concern despite millions of people being treated with GLP-1 therapies around the world. It is not recommended to use GLP-1 therapies like Trulicity and Victoza (liraglutide) if there is a family history of medullary cell carcinoma of the thyroid or Multiple Endocrine Neoplasia Type 2 (MEN 2).

Who can use Trulicity?

Trulicity is designed to be used by people with type 2 diabetes. In combination with diet and exercise, Trulicity can help to improve glycaemic control. It is not approved for use in people with type 1 diabetes.

Is Trulicity ok to use during pregnancy?

Currently, Trulicity is not recommended for pregnant women. Other types of medications are used to treat diabetes in pregnant women.

If you have type 2 diabetes and are looking to start a family or add a new member, it is recommended that prior to conception and throughout pregnancy, your blood glucose levels and HbA1c levels are kept as close as possible to the target goals. These goals may be set by your doctor.

Please see the following articles for more information and diabetes and pregnancy:

• Pregnancy diet and diabetes: Preparing for pregnancy
• Diabetes and diet in pregnancy
• Medications in pregnancy: Safe or unsafe?
• Key steps to reduce having gestational diabetes again

Do I have to change my diet if I use Trulicity?

If you have type 2 diabetes, making lifestyle changes, for example exercising and eating a healthier diet, is very important.

For ideas on how to reduce the carb content of some of your favourite foods, the article How to reduce carbs in your diet has many great ideas that won’t leave you missing out on flavour.

Does Trulicity (Dulaglutide) need to be refrigerated?

Yes. If you have excess Trulicity injectable pens at home, they need to be stored in the fridge.

The best place to store your Trulicity pens in the fridge, is on the top shelf of the fridge door. The butter compartment is usually the safest place. You shouldn’t store your Trulicity pens in the coldest part of your fridge. If the Trulicity injectable pen becomes too cold, then the Dulaglutide will degrade, making it less effective, leading to higher blood glucose levels.

Can Trulicity (Dulaglutide) be injected cold?

Yes Trulicity can be injected cold but it may sting a little. It is still effective.
The weekly GLP-1 that should not be injected cold is Bydureon (Exenetide Extended Release) as it needs to be mixed thoroughly.

How long does it take for Trulicity to start working?

It may take Trulicity (Dulaglutide) up to 5 weeks to start lowering your blood glucose levels but the maximum effect will not been seen for 3-6 months.

How long does Trulicity stay in your system?

If a person takes Trulicity for a few months and then stops it then it will take about 5 weeks to completely clear the system. As a general rule with medication if a drug is taken daily then it takes 5 days to get to a steady level and 5 days to clear the system. If a drug is taken weekly then it is 5 weeks to get in and 5 weeks to clear.

Does Trulicity cause weight loss?

Yes. Trulicity can cause weight loss, although it is not a weight loss drug.

There have been a number of studies examining the effectiveness of Trulicity (Dulaglutide) in managing type 2 diabetes. These studies, the AWARD studies, also looked at the associated weight loss in patients using Trulicity. In one of the AWARD studies Efficacy and Safety of Dulaglutide Versus Sitagliptin After 52 Weeks in Type 2 Diabetes in a Randomized Controlled Trial (AWARD-5), it showed that Trulicity was more effective in causing weight loss compared to another type 2 diabetes medication, called sitagliptin (a DPP-4 inhibitor). The average change in body weight was 2.6kg (with the 0.75mg weekly dose of Trulicity) and 3kg (with the 1.5mg weekly dose of Trulicity). This is compared to a 1.53kg weight loss with patients who used sitagliptin.

Trulicity (Dulaglutide) vs Ozempic (Semaglutide)

The Sustain 7 study compared the treatment outcomes of Ozempic with Trulicity. Both of these drugs are once weekly GLP-1 analogues used in the treatment of type 2 diabetes.

Ozempic compared to Trulicity led to:

• lower blood sugars based on HbA1c by about 0.3% (-1.4% vs -1.1%).
• Twice as much weight loss with Ozempic (4.6kg-6.5kg depending on dose).
• More people had HbA1c below the 7% to suggest safer sugar levels.
• People using Ozempic had more nausea compared to Trulicity.

Trulicity (Dulaglutide) vs Victoza (Liraglutide)

The AWARD-6 study looked at comparing once weekly Trulicity with once daily Victoza (Liraglutide). The results of this study in people with type 2 diabetes suggests that they are similar in terms of Hb A1c reduction. There was slightly more weight loss with Victoza. Nausea rates were similar with both drugs.

Trulicity (Dulaglutide) alternatives

The following drugs are all based on the GLP-1 or Exendine molecule:

Administered weekly

• Ozempic (Semaglutide)
• Trulicity (Dulaglutide)
• Bydureon (Exenatide ER)

Administered daily

• Victoza (Liraglutide)
• Byetta (Exenatide)
• Lyxumia (Lixisenatide)

What are the other effects of Trulicity (Dulaglutide)?

Did you know that GLP-1 has many effects in the body?

As we’ve discussed above, GLP-1 is a hormone that is released from our small intestines in response to food. When GLP-1 is released, it binds to specific GLP-1 receptors. These receptors can be found in various areas of the body (GLP-1 Receptor Localization in Monkey and Human Tissue: Novel Distribution Revealed With Extensively Validated Monoclonal Antibody), including in the:

• pancreas
• stomach
• kidney
• lung
• heart
• skin
• immune cells
• hypothalamus

Please see the following articles for more information:

• What is Ryzodeg insulin and how do I use it?
• Where Do You Keep Your Insulin?
• Managing Diabetes with Insulin: Is it necessary?
• Type 2 diabetes signs and symptoms
• How is Diabetes Diagnosed?
• Prioritising self when you have diabetes – Is it selfish?

More Articles on Diabetes Treatments

For more information about different Diabetes Treatments, please follow the links below.

Oral Medications for Diabetes

• Starting on Metformin. What you need to know.
• Benefits of Metformin… A Wonder Drug?
• Metformin in Pregnancy. Is it safe?
• Metformin and diarrhoea.
• Vitamin B12 deficiency and diabetes.
• What is an SGLT2 inhibitor? It's a novel way to lower blood sugars, lose weight and maybe live longer.
• Rybelsus (Semaglutide) - A new oral medication to treat Type 2 Diabetes.

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Insulin for Diabetes

• What is Ryzodeg insulin and how do I use it?
• Fiasp insulin. Fast acting insulin aspart.
• Managing Diabetes with Insulin: Is it necessary?
• Lantas. Solostar insulin glargine.

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Injections for Diabetes

• What is Trulicity (Dulaglutide) and how does it work?
• Ozempic (Semaglutide) is a new treatment for type 2 diabetes.
• What is glucagon and how can a glucagon kit help someone with diabetes?

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Other Medications for Diabetes

• What is Baqsimi and how does it work?

Video Transcript

Trulicity (also known as Dulaglutide) is a treatment for people with Type 2 diabetes. This video explains how Trulicity (Dulaglutide) works, what the side effects are and how to administer it.

Today, I'm going to talk about Dulaglutide or Trulicity and specifically I want to show you how to use this pen so you can administer it safely and easily. So this is a new product used widely around the world and it contains a compound called dulaglutide and dulaglutide is essentially a naturally occurring human chemical called GLP-1 or Glucagon-like peptide 1. GLP-1s are in essence chemicals that the body produces in response to food.

It does 3 things, if you eat, it increases insulin production out of the pancreas, which helps lower your blood sugar after eating.

It also interestingly reduces the amount of sugar that the liver is producing. Typically the liver produces sugar, and it does this when you are in periods of starvation. So if you like, it is a storage mechanism that can release sugar when your blood sugars are low and then suck it up when your blood sugars are high. In people with Type 2 diabetes, that process is completely impaired and the liver just produces too much sugar. The third action, which I think is also critical, is it causes a person to feel full. In other words, it increases satiety. So after eating, what you want to do is increase your insulin reduce the liver sugar and feel full.

All of those 3 things are done by GLP-1 and this is a version of GLP-1. One of the clever things about re-packaging GLP-1 and changing slightly the way the molecule is and binding it up to, in this case, an antibody, is that you can change the duration of action.

Trulicity is given once a week. So in order to do it effectively, you choose a day, let's say it is Sunday, something you can remember. You want to put something in your phone so that you get a reminder each week and you don't forget. You administer it once a week, and that's done. Pretty simple.

Now let's just look a little bit about how to administer it. On the end of this is a cap, and you would remove the cap. And the needle actually is there but you won't see it because it is hidden within the device, which is quite clever. The other couple of things to say is that there is a lock which is a red triangle and an open and that is so you don't fire the product accidentally when you don't mean to.

So we might look at that in more detail. This is a dummy device, but it does highlight exactly how it gets used. So essentially you take off the cap, you put it against your skin, you move to the unlock position, and press the button. And you know when it's done when you hear the second click. Which will happen any second now. There it is. That is safely and easily disposed of in the bins in the normal way.

But beyond that simple, easy and likely to achieve for a lot of people pretty good sugar control with a bit of weight loss.

Dr Sultan