Dulaglutide (Trulicity): weekly injection for type 2 diabetes

Dulaglutide is a long-acting GLP-1 receptor agonist. The emc information says it improves blood sugar by increasing insulin release when glucose is raised, suppressing glucagon and slowing the emptying of the stomach. It is licensed for type 2 diabetes alongside diet and exercise, on its own when metformin is inappropriate, or combined with other glucose-lowering medicines.

It comes as a pre-filled pen, injected under the skin of the abdomen, thigh or upper arm once a week, on any day and at any time. The SmPC describes a lower starting dose with step-ups after at least four weeks to higher stated doses. Children aged ten and over start on the lowest strength with a lower ceiling. Your prescriber chooses the strength.

Rotating injection sites is standard good practice. Pen technique is taught by a clinician or nurse; follow the leaflet in your box.

The SmPC says that if at least three days remain until the next scheduled dose, inject the missed one as soon as possible. If fewer than three days remain, skip it and carry on with the normal schedule. Never inject two doses closer than that.

Very common effects are nausea, diarrhoea, vomiting, abdominal pain and, in some combinations, hypoglycaemia. Common ones include reduced appetite, indigestion, constipation, tiredness, taste change, a fast heart rate and a mild conduction delay on ECG. Uncommon effects include acute pancreatitis, delayed stomach emptying, dehydration, gallstones, gallbladder inflammation and injection-site reactions. Rare bowel obstruction and unknown-frequency anaphylaxis and angioedema are listed.

Gut symptoms typically peak in the first two weeks and then lessen, and the SmPC says most stopping due to such symptoms happens within four to six weeks. Persistent severe abdominal pain, with or without vomiting, needs urgent assessment.

• Seek urgent help for severe, persistent stomach pain.

• Seek urgent help for swelling of the face or throat or trouble breathing.

Pens are single-use devices that are stored and handled according to the leaflet that comes with them. Many people find it easiest to attach the weekly injection to a fixed day, such as a particular weekday, though the product information says the day can be changed provided at least three days separate two doses. Keep a note of the injection date and site so that the schedule and rotation are easy to follow, and bring unusual symptoms, such as ongoing sickness or pain in the upper abdomen, to your next review or to NHS 111 if they are severe.

It has not been studied in people with a history of pancreatitis. Vomiting and diarrhoea can cause dehydration that harms the kidneys. Combined with a sulfonylurea or insulin, hypoglycaemia risk increases and those doses may be lowered. Cases of lung aspiration have been reported with GLP-1 medicines under general anaesthesia or deep sedation, so tell anaesthetists you use one. Contraindications include type 1 diabetes and diabetic ketoacidosis.

Delayed stomach emptying could alter absorption of oral medicines, though no clinically relevant effect was seen with paracetamol, atorvastatin, digoxin, warfarin, oral contraceptives, metformin or sitagliptin. Use in pregnancy is not recommended, and it should not be used while breastfeeding. Driving is not usually affected unless hypoglycaemia occurs with other agents.

It is prescription only. This page does not describe where to obtain it. Report suspected side effects through the Yellow Card scheme.