Trulicity (Dulaglutide) - How do I use it and what does it do?

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.

Trulicity pens, 2 different doses of 0.75mg and 1.5mg, for people with type 2 diabetes

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.

Trulicity is released in the small intestines

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 blocking 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 does Trulicity (Dulaglutide) work?

If you have heard of Trulicity, you might be wondering how Trulicity works and what Trulicity does in the body. Trulicity, like GLP-1, has a number of actions in the body that help to improve blood sugar levels. Trulicity is a medication used to lower blood glucose levels and works to:

Lower blood glucose levels by stimulating the release of insulin from the pancreas
Reduce the amount of glucose that your liver is producing.
Causes you to feel full by increasing early satiety.

Is Trulicity (dulaglutide) the same as insulin?

Trulicity (dulaglutide) is not insulin but is a different type of diabetes medicine called a GLP-1 analogue. It is a small protein just like insulin (called a peptide) and because proteins are easily broken down by stomach acids, which would make the protein inactive, both insulin and Trulicity (dulaglutide) need to be injected under the skin. This allow the molecule to get into the body but bypasses the gut.

What is the dose of Trulicity (Dulaglutide)?

Trulicity is available in either 0.75mg or 1.5mg pens. Generally people should be started on the lower dose and increased after 3 to 6 months. This reduces the side effects substantially. In many countries only 1.5mg is available.

Can higher doses of Trulicity (Dulaglutide) be used?

In the Award 11 Study 1,842 adults with type 2 diabetes were given 1.5mg, 3mg or 4.5mg weekly doses. Those taken the high dose had a greater reduction in Hb A1c (1.53% for the 1.5 mg dose, 1.71% for the 3 mg dose and 1.87% for the 4.5 mg dose. The higher the dose of Trulicity the greater the weight loss with the highest 4.5mg dose associated with about 4.7kg weight loss. The increased doses are now FDA approved in the United States

How often is Trulicity (Dulaglutide) 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!

Phone reminder to take trulicity once a week for type 2 diabetes

How do you administer Trulicity (Dulaglutide)?

In the video, Dr Sultan demonstrates how to use Trulicity. Trulicity is very simple and easy to administer. To learn how to use Trulicity, you can watch the video with Dr Sultan or read on.

Take off the cap at the end – this protects the needle which you can’t see in the pen barrel
Put the pen against your skin
Turn to the unlock position – the green unlocked padlock
Press the button – this is the first click noise you will hear
Keep the pen against your skin until you hear the second click – this will take a few seconds
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.

Trulicity pen for people with type 2 diabetes

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 Trulicity (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!

DO YOU WANT TO GET YOUR DIABETES UNDER THE BEST CONTROL?

Choose the program program that best describes your situation.

newly diagnosed choose your type 2 program

Newly Diagnosed Type 2 Program

man with diabetes type 2 diabetes and his doctor endocrinologist

Developing Complications

increasing medications choose your type 2 program

Medications Increasing Program

Borderline or Prediabetes

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 thyroid cancer has lead to extensive investigations 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:

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 (Exenatide 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.

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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)
Rybelsus (oral Semaglutide)

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:

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

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