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.
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:
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:
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:
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.
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.
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
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!
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.
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.
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.
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!
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).
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).
The most common side effects of Trulicity are:
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.
Trulicity may also cause more serious side effects including:
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).
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.
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:
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.
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.
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.
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.
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.
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.
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:
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.
The following drugs are all based on the GLP-1 or Exendine molecule:Administered weekly
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:
Please see the following articles for more information:
For more information about different Diabetes Treatments, please follow the links below.
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