Dulaglutide for type 2 diabetes

About dulaglutide

Insulin is a hormone which is made naturally in your body, in the pancreas. It helps to control the levels of sugar (glucose) in your blood. If your body does not make enough insulin, or if it does not use the insulin it makes effectively, this results in the condition called diabetes (diabetes mellitus).

People with diabetes need treatment to control the amount of sugar in their blood. This is because good control of blood sugar levels reduces the risk of complications later on. Some people with type 2 diabetes can control the sugar in their blood by making changes to the food they eat. For other people, medicines are given alongside the changes in diet. Dulaglutide is one of the medicines that are prescribed for people with type 2 diabetes.

Dulaglutide very closely resembles a natural hormone called glucagon-like peptide-1 (GLP-1) and it works in three ways. Firstly, it increases the amount of insulin produced by your body which then reduces the level of sugar in your blood.

It also reduces the amount of a substance called glucagon being produced by your pancreas. Glucagon causes your liver to produce more sugar. Reducing the amount of glucagon in your body therefore also helps to reduce the levels of sugar in your blood.

Dulaglutide also works on your stomach so that food passes more slowly through it. This means that the sugar from your meals takes longer to get into your blood.

Dulaglutide is given as an injection just under the surface of the skin. It is administered using an injection device called a pre-filled pen. Dulaglutide (brand name Trulicity®) is given as a once-weekly injection. It is used in addition to other antidiabetic medicines.

Before starting dulaglutide treatment

Some medicines are not suitable for people with certain conditions, and sometimes a medicine may only be used if extra care is taken. For these reasons, before you start using dulaglutide injections it is important that your doctor knows:

• If you are pregnant, trying for a baby, or breastfeeding.

• If you have a problem with your stomach or digestive system.

• If you have ever had an inflamed pancreas (pancreatitis).

• If you have any problems with the way your kidneys work.

• If you have type 1 diabetes or are being treated for diabetic ketoacidosis.

• If you are taking any other medicines. This includes any medicines you are taking which are available to buy without a prescription, as well as herbal and complementary medicines.

• If you have ever had an allergic reaction to a medicine.

How to use dulaglutide injections

• Before you start this treatment, read the manufacturer's printed information leaflet from inside your pack, as well as any information you are given by your doctor or diabetes clinic. The manufacturer's leaflet will give you more information about dulaglutide and a full list of side-effects which you may experience from using it.

• Use dulaglutide exactly as your doctor or nurse tells you to. Your doctor or diabetes nurse will show you how to inject yourself. Dulaglutide should be injected into the skin on your upper arms, thigh, or tummy (abdomen). Try to choose a slightly different injection site for each of your injections as this will help to prevent skin problems and difficulties in injecting.

• There are four different strengths of dulaglutide injection. Check that you have the correct strength before injecting. It is usual to start treatment with a lower dose which may be increased later if necessary.

• Dulaglutide is given as a once-weekly injection, on the same day each week. Each pre-filled pen provides a single dose and is single-use only. The injection can be given at any time of the day, and it can be given either before or after a meal.

• If you forget to use the injection on your usual day, use it as soon as you remember, and keep to your normal weekly schedule. However, if your next scheduled dose is due within three days, miss out the forgotten dose and take your next dose when it is due.

Getting the most from your treatment

• It is important that you keep your regular doctor's and clinic appointments. This is so that your progress can be monitored. You will need regular check-ups with an eye clinic and possibly a foot clinic as well as with your doctor and diabetes clinic.

• Your doctor may recommend that you test for sugar (glucose) in your blood or urine regularly to check that your diabetes is being controlled. Your doctor or diabetes nurse will show you how to do this.

• If you have been given advice by your doctor about changes to your diet, stopping smoking or taking regular exercise, it is important for you to follow the advice you have been given.

• Each time you collect a prescription, check that you have been given the brand and strength of dulaglutide that you are expecting. If anything looks different from what you have had before, ask your pharmacist to check the prescription for you.

• Make sure you know what it feels like if your blood sugar is low. This is known as hypoglycaemia, or a 'hypo'. Dulaglutide may cause low blood sugar, especially if you are taking other medicines for diabetes alongside it. The first signs of hypoglycaemia are feeling shaky or anxious, sweating, looking pale, feeling hungry, having a feeling that your heart is pounding (palpitations), and feeling dizzy. If this happens, eat something containing sugar, such as dextrose tablets, sweets or a sugary drink (non-diet), and then follow this up with a snack such as a sandwich or a banana.

• If you are a driver you should take special care, as your ability to concentrate may be affected if your diabetes is not well controlled. You may be advised to check your blood sugar levels before you travel and to have a snack with you on long journeys.

• It is important to keep hydrated during treatment with dulaglutide by drinking plenty of water or non-sugary soft drinks.

• Do not drink alcohol, as it can affect the control of your blood sugar. Ask your doctor if you need further advice about this.

• If you get unusually thirsty, pass urine more frequently than normal, or feel very tired, you should let your doctor know. These are signs that there is too much sugar in your blood and your treatment may need adjusting.

• Check with your doctor before taking up any new physical exercise, as this will have an effect on your blood sugar levels and you may need to check your blood or urine levels more regularly.

• If you are due to have an operation or dental treatment, you should tell the person carrying out the treatment that you have diabetes and give them a list of the medicines you are taking.

• If you buy any medicines, always check with a pharmacist that they are suitable for you to take. Dulaglutide can interfere with the way some other medicines are absorbed.

• Treatment for diabetes is usually lifelong. Continue with dulaglutide unless you are told otherwise by your doctor.

Can dulaglutide treatment cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with dulaglutide treatment. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: medicines like dulagutide can cause persistent and severe tummy (abdominal) pain with sickness (nausea and vomiting) in a few people. If this happens to you, you should speak with your doctor as soon as possible as these can be symptoms of an inflamed pancreas (pancreatitis).

If you experience any other symptoms which you think may be due to this medicine, speak with your doctor or pharmacist.

How to store dulaglutide injections

• Keep all medicines out of the reach and sight of children.

• Store unopened packs in the refrigerator, ensuring they do not freeze. Individual pens can be stored at room temperature for a maximum of 14 days.

• Dulaglutide pens are single-use only; store discarded pens safely after use and return them to a pharmacy for disposal.

Important information about all medicines