Makindo Medical Notes

💡 Missed dose advice: If a dose is delayed by more than 12 hours, the missed dose should be skipped and the next scheduled dose taken at the usual time. Do not double up.

📘 About

• Always check the BNF for latest prescribing advice.
• Dulaglutide is a long-acting GLP-1 receptor agonist given once weekly by subcutaneous injection.
• Used in type 2 diabetes mellitus (T2DM), either alone if metformin is inappropriate, or in combination with other antidiabetic drugs (including insulin).
• Also promotes weight reduction through appetite suppression and delayed gastric emptying.

⚙️ Mode of Action

• Mimics the incretin hormone GLP-1.
• Enhances glucose-dependent insulin secretion from pancreatic β-cells.
• Suppresses inappropriate glucagon secretion.
• Delays gastric emptying → promotes satiety and weight loss.

💊 Indication & Example Doses

🔄 Interactions

• See BNF for full list.
• Risk of DKA if insulin doses are reduced too rapidly when switching/adding dulaglutide.
• Can delay absorption of oral medicines (monitor drugs with narrow therapeutic index).

⚠️ Cautions

• Monitor renal function, particularly if severe GI side effects occur (risk of dehydration).
• Caution in patients with history of pancreatitis.
• Consider retinopathy risk with rapid glucose lowering (rare, but noted in some GLP-1 studies).

🚫 Contraindications

• Personal/family history of medullary thyroid carcinoma (based on animal studies of GLP-1 class).
• Severe gastrointestinal disease, e.g., diabetic gastroparesis.
• Advanced congestive heart failure (CHF).

💥 Side Effects

• GI: Nausea, vomiting, diarrhoea, constipation, abdominal discomfort.
• Reduced appetite and earlier satiety (can be beneficial for weight loss).
• Hypoglycaemia (especially if combined with insulin or sulfonylurea).
• Injection site pain or reactions.
• Cardiovascular: Sinus tachycardia (uncommon).
• Rare: Pancreatitis, gallbladder disease.

📖 References

• BNF – Dulaglutide
• NICE NG28: Type 2 Diabetes in adults: management

📝 Revisions

• September 2025 – Expanded with UK NICE context, safety notes, and teaching points.