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

What is Trulicity (Dulaglutide)?

Trulicity is the brand name for a molecule used in the treatment of type 2 diabetes. The generic name is Dulaglutide. It is a relatively new product and is a type of injectable therapy, but it is not insulin. It comes in the form of a disposable single use pen in either 0.75mg dose and 1.5mg dose, making it relatively safe and easy to administer.

Dulaglutide (Trulicity) is the synthetic version of a naturally occurring human hormone, called Glucagon-like peptide 1 or GLP-1 that is administered once weekly.

Whether you have diabetes, or you don’t have diabetes, we all make GLP-1. It has become clear that GLP-1 is a really important hormone to help us regulate our blood sugar levels.

How does GLP-1 work and what is the mechanism of action?

After we eat, GLP-1 is released from the small intestine.

GLP-1 has a number of actions in the body that improve blood sugar levels that include the following:

• Lowers blood glucose levels by stimulating the release of insulin from the pancreas. This process magnifies the release of insulin and is dependent on the blood sugar level. It is does occur if the blood glucose level is low and so GLP-1 medications do not tend to cause hypoglycaemia or low blood sugar levels.
• Reduces the amount of glucose that your liver is producing. Typically, the liver produces glucose, and it does this when you are in periods of starvation. So, the liver is a storage mechanism that can release sugar when your blood glucose levels are low and then store it when your blood glucose levels are high. In people with Type 2 diabetes, this process is completely impaired and the liver produces too much glucose.
• GLP-1 can cause you to feel full, so it increases early satiety. It does this by slowing gastric emptying, slowing the rate of food moving from your stomach into your small intestines. By doing this, the rate of absorption of nutrients into the blood stream is slowed, including glucose, which may reduce your food intake.

How is Trulicity (Dulaglutide) different from GLP-1?

GLP-1 is a naturally occurring hormone found in all people. Trulicity (Dulaglutide) shares 90% of the same structure as human GLP-1 but is synthetically manufactured. Dulaglutide has been modified structurally to prevent it from being broken down by an enzyme in the blood called dipeptidyl peptidase-4 or DPP-4.

The formulation causes Trulicity to have a long duration of action and it is an example of a once weekly GLP-1. Another example of long acting GLP-1 is Ozempic (generic name Semaglutide).

Drugs that block the action of DPP-4 are called DPP-4 inhibitors and these have been used in the treatment of type 2 diabetes for many years. By blockimg the enzyme that breaks down naturally occurring GLP-1 they increase amount of GLP-1 in the body. (Dipeptidyl peptidase-4 (DPP-4) inhibitors for the treatment of type 2 diabetes mellitus). Examples of DPP-4 inhibitors include:

• sitagliptin (Januvia)
• valdagliptin (Galvus)
• saxagliptin (Onglyza)
• linagliptin (Tradjenta)
• alogliptin (Nesina)

How often is Trulicity administered ?

Trulicity is administered once a week as injection under the skin.

To help remember what day to take your Trulicity, it is useful to have a reminder in your phone each week. It does not matter what day of the week to administer Trulicity (Dulaglutide) so it is best to choose a day that best fits a person's lifestyle. For example, you might choose Sunday as your day to administer Trulicity. You can place a recurring alarm in your phone, so you don't forget. You administer it once every Sunday and that's done. Pretty simple!

How do you administer Trulicity?

In the video, Dr Sultan demonstrates how to administer Trulicity. It is very simple and easy to use.

1. Take off the cap at the end – this protects the needle which you can’t see in the pen barrel
2. Put the pen against your skin
3. Turn to the unlock position – the green unlocked padlock
4. Press the button – this is the first click noise you will hear
5. Keep the pen against your skin until you hear the second click – this will take a few seconds
6. Dispose of the Trulicity pen – you can dispose of your pen in the normal rubbish bin as the needle retracts back into the pen

You may have noticed that there is also a red locked padlock. This is to prevent you from accidentally firing the pen when you don’t need to.

What is the best area of the body to administer Trulicity?

The preferred site to administer the drug is the abdomen. Trulicity is only to be administered subcutaneously into the upper arm, thigh, or your abdomen. When administering into the same body region, e.g. your abdomen, choose a different injection site each week.

What do I do if I miss a dose of Trulicty (Dulaglutide)?

If you miss your dose of Trulicity, you can administer it as soon as possible within 3 days after the missed dose. After this, you can go back to your regular dosing schedule of once per week.

If there are less than 3 days until your next scheduled dose, don’t take your missed dose. Take your next scheduled weekly dose and return back to your regularly scheduled weekly dose!

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Do I have to 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).

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.

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.