Overview
Dulaglutide (Trulicity) is a long-acting glucagon-like peptide-1 (GLP-1) receptor agonist engineered as a fusion protein linked to an IgG4-Fc fragment.
What problem it targets: It targets poorly controlled Type 2 diabetes, chronic hyperglycemia, high cardiovascular event risk, and obesity-driven metabolic dysfunction.
What It Does
• Enhances glucose-dependent insulin secretion: Activates pancreatic beta-cell GLP-1 receptors only when blood sugar is elevated, virtually eliminating the risk of sudden hypoglycemia.
• Shuts down inappropriate post-meal glucagon: Inhibits hepatic glucose overproduction, stopping the liver from releasing unnecessary sugar into the blood.
• Slows digestion and suppresses appetite: Delays gastric emptying and acts on brain satiety centers to curb food cravings and lower total daily caloric intake.
• Realistic expectations: Administered as a convenient once-weekly injection. Produces dependable, steady reductions in HbA1c and moderate weight reduction, with mild initial nausea being the primary side effect.
Reconstitution
| Vial size | BAC water / Solvent | Concentration |
|---|---|---|
| 5 mg | + 1 mL | 5 mg/mL |
| 10 mg | + 2 mL | 5 mg/mL |
Protocol
| Phase | Frequency | Dose | Units (5 mg/mL) | Notes |
|---|---|---|---|---|
| Weeks 1–4 | Once weekly | 0.75 mg | 15u | Starting dose (FDA Trulicity). |
| Weeks 5–8 | Once weekly | 1.5 mg | 30u | Step up if tolerated. |
| Weeks 9–12 | Once weekly | 3.0 mg | 60u | |
| Week 13+ | Once weekly | 4.5 mg | 90u | Max labeled dose. Cycle: escalate every 4 weeks as tolerated to the 4.5 mg max. Continuous use is standard for the indication. Timing: same day each week, any time, with or without food. FDA: approved as Trulicity for type-2 diabetes; weight loss is moderate vs semaglutide/tirzepatide. Women: Women lose more than men at the same dose but report more GI (start lower). In PCOS they improve cycles, lower free testosterone and raise ovulation; a real unplanned-pregnancy risk. Stop before conceiving. Men: In men, excess fat lowers testosterone; GLP-1 raises total testosterone, SHBG and gonadotropins as weight drops, and improves sperm and erectile function; and preserves fertility, unlike TRT (which suppresses sperm). |
Handling & Stacking
- Freeze-dried: -4°F.
- Reconstituted: 36–46°F.
- Best used within 28 days.
- No clear reconstituted-potency data (the pen label gives an in-use date, not potency), so defer to the 28-day sterility limit. (Commercial Trulicity is pre-filled, refrigerated.)
Safety & Patient Education
- Fasting glucose / HbA1c (baseline + periodic) Renal function with significant GI losses Lipase if pancreatitis suspected Resting heart rate (GLP-1s nudge it up a few bpm) Out of range?
- Rising glucose/HbA1c = blood sugar creeping toward diabetes (recheck, tighten diet); a falling eGFR = kidney strain, usually dehydration (hydrate, hold the dose).
