Is Trulicity insulin?

Trulicity is not insulin and it cannot replace insulin. Learn how to use Trulicity and other Type 2 diabetes medications.

By Georgia C. Yalanis, MD | Feb. 8, 2022 Medically reviewed by Anne Jacobson, MD, MPH

Diabetes can be a difficult condition to manage. With many medical options available, and companies with high advertising budgets, it can be challenging to know which medication may be the best addition to a healthful diet and exercise. In this article, we will talk about Trulicity, a non-insulin medication that can help with diabetes management.

How Trulicity works

Trulicity (dulaglutide) can help control blood sugar levels in adults with Type 2 diabetes. Trulicity works by slowing down how quickly food leaves the stomach and helping the pancreas release insulin in response to high blood sugar levels after a meal.

Type 2 diabetes mellitus can be reversed with weight loss and a healthful diet. Adults with Type 2 diabetes may use Trulicity as an addition to diet and exercise to improve blood glucose control. Trulicity is also used to reduce the risk of major adverse cardiovascular events, such as heart attack, in adults with Type 2 diabetes who have cardiovascular disease or multiple risk factors.

Trulicity is not an over-the-counter medication. It is a prescription drug manufactured by Eli Lilly and Company that should only be used under the care of a healthcare provider.

Is Trulicity insulin?

Trulicity is not insulin. Trulicity is in a class of medications called glucagon-like peptide-1 (GLP-1) receptor agonists. GLP-1 agonists are medications that stimulate insulin secretion after a meal. The stomach releases its contents more slowly, the production of glucagon (the hormone that increases blood glucose levels) decreases, and the cells in the pancreas that produce insulin are better protected.

GLP-1 agonists have also been shown to improve outcomes in people who have cardiovascular disease and Type 2 diabetes by promoting weight loss, lowering blood pressure, improving blood flow to the heart, and improving overall cardiac function. GLP-1 agonists have also been shown to lower glucose production by the liver, protect nerve cells, and act on the part of the brain that sends hunger signals to the body.

Does Trulicity replace insulin?

Trulicity is not an insulin replacement. Insulin is used in the management of both Type 1 diabetes and Type 2 diabetes. People with Type 1 diabetes do not produce insulin or they produce it in extremely low amounts. They are dependent on insulin injections to maintain blood glucose levels that are safe. Other types of medications, like Trulicity, cannot be used in Type 1 diabetes.

Insulin is not a first-line treatment for most individuals with Type 2 diabetes. People with Type 2 diabetes may or may not use insulin in addition to other medications and diet and weight loss strategies to control blood sugar.

In clinical trials for long-acting diabetes medications, it is common to compare newer medications like Trulicity to a form of long-acting insulin called insulin glargine. This comparison is not to determine if the new medication is a replacement for insulin, but instead provides a known and acceptable set of parameters to evaluate it.

Trulicity is not better than insulin and insulin is not better than Trulicity. They are different classes of medications that are prescribed based on the needs of the person with diabetes. However, if there are no symptoms of hyperglycemia or very high blood glucose levels, the American Diabetes Association has recommended the use of a GLP-1 receptor agonist over insulin when possible.

Can you take Trulicity and insulin together?

Yes. Trulicity may be used with insulin if adequate glucose management is not obtained after using Trulicity with other classes of medications first. Insulin is often used early in the treatment of individuals with complications or symptoms of extremely high blood glucose levels. If insulin is used together with GLP-1 receptor agonists, there is often greater efficacy of both medications and improved treatment outcomes. If glycemic control is not adequately obtained in a relatively short period of time with GLP-1 agonists alone, the addition of insulin or other medications should not be delayed.

There are several types of insulin available. The Food and Drug Administration (FDA) has approved Trulicity as a treatment for those who use mealtime insulin or basal insulin. Basal insulin, which is sometimes called bedtime insulin, is long-acting and usually taken once a day. Mealtime insulin is short-acting and taken before meals. Insulin doses and schedules may need to be adjusted with Trulicity to avoid low blood glucose levels. Examples of short- and long-acting insulins include:

Mealtime, short-acting insulin:

Bedtime, long-acting insulin:

Lantus, Toujeo, Basaglar (insulin glargine)
Levemir (insulin detemir)
Tresiba (insulin degludec)

Which other medications may be taken with Trulicity?

Type 2 diabetes is often a progressive disease where monotherapy (taking only one medication) is effective only for a few years. Combination therapy is often needed to adequately control blood glucose. According to the American Diabetes Association, metformin is the preferred first-line medical therapy in the treatment of Type 2 diabetes. Metformin is safe, inexpensive, and may reduce the risk of cardiovascular events and death. Compared to other classes of medications, metformin as first-line therapy has known beneficial effects on A1C, weight, and cardiovascular mortality.

In addition to comprehensive lifestyle modifications, a GLP-1 receptor agonist such as Trulicity should be considered for:

Those with a contraindication or inability to take metformin,
Individuals with a hemoglobin A1C (a long term marker of glucose control) greater than 1.5% over target, or
Individuals who do not reach their target A1C in three months, especially if they have cardiovascular risk factors.

GLP-1 receptor agonists, including medications like Trulicity, may be used as first-line therapy in individuals with Type 2 diabetes who have or are at high risk for atherosclerotic cardiovascular disease and heart failure. It may be used with caution in people who have chronic kidney disease.

Emerging data from clinical trials suggest that initial combination therapy may be more beneficial in blood glucose control.

Other classes of medications that have been used with Trulicity include:

Sulfonylureas, an older class of diabetes medication with a well-defined side effect profile
Other GLP-1 agonists such as Victoza (liraglutide), Byetta (exenatide), Ozempic or Rybelsus (semaglutide), and Adlyxin (lixisenatide)
Thiazolidinediones such as Actos (pioglitazone)

More about Trulicity

According to Stephanie Redmond, Pharm.D., a cofounder of diabetesdoctor.com, the ease of use of Trulicity is one of the main reasons it may be considered over another medication in its class. “It’s the easiest pen on the market,” Dr. Redmond says. “You don’t have to screw a needle cap on or dial up a dose. You take the cap off, set it on your abdomen, and press a button.”

Here are some other helpful tips for taking this medication.

Trulicity is used as an injectable pen. The Trulicity pen is self-administered as a subcutaneous injection in the upper arm, abdomen, or thigh. Each pen contains either a 0.75 mg, 1.5 mg, 3.0 mg, or 4.5 mg single-dose of Trulicity to be injected as a once-weekly dose.
Trulicity may be taken at any time of day but should be taken on the same day of the week, every week. Take it on the day that you will remember and will fit in best with your schedule.
A missed dose should be taken as soon as you remember. If you need to switch the day you take your medication, that is okay, as long as you do not take two doses of Trulicity within three days.
Mild irritation at the injection site is a common side effect of Trulicity, therefore rotating sites may be helpful.
It is important to follow medical advice while taking this medication. Your healthcare provider may adjust the dose of this medication to achieve adequate glycemic control.
This medication works best when combined with healthy lifestyle changes which may include weight loss, exercise, and maintaining a healthful diet.