Dulaglutide

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Molecule Description

Dulaglutide is a medication used to help manage type 2 diabetes by lowering blood sugar levels. It belongs to a class of drugs called GLP-1 receptor agonists, which work by increasing insulin release from the pancreas when blood sugar is high, slowing down the movement of food from the stomach, and reducing sugar production by the liver. Dulaglutide is given as a once-weekly injection and helps improve blood sugar control along with diet and exercise. It may also help with weight management in some people with type 2 diabetes. Like all medications, it should be used under a doctor’s supervision, and patients should monitor for side effects such as nausea, vomiting, or low blood sugar, especially when taken with other diabetes medicines.

Uses

Treatment of diabetes mellitus.

Contraindications

When should one not use Dulaglutide

If you are allergic to Dulaglutide.
If you are suffering from hypoglycemia (low blood sugar level).

Side effects

Common side effects of this drug are:

Low blood sugar (Hypoglycaemia)
Lightheadedness
Dizziness
Anxiety
Nervousness
Tiredness
Feeling hungry
Visual disturbances
Headache
Shaking
Sweating
Pale skin
Skin rashes

Precautions and Warnings

Pregnancy

This medicine can be used during pregnancy if your doctor recommendsHowever, close monitoring of blood sugar levels is suggested as the dose requirements may change with each trimester of pregnancy.

Breast Feeding

You can use this while you are breastfeeding.

Driving

Dulaglutide is known to cause low blood sugar levels and these can lead to impairment in your driving abilityAlways keep sugar or a bar of chocolate in your car with you while drivingIn case you experience any of the symptoms of low blood glucose levels like dizziness, drowsiness, visual disturbances and sweating, stop driving immediately and have sugar/ juice.

Alcohol

It is advisable not to consume alcohol when you are taking this medicine as it interferes with the way insulin worksConsumption of alcohol may lead to an increased risk of both low blood glucose level and high blood glucose level Avoid excessive use of alcohol while taking insulin.

Other General Warnings

Talk to your doctor if

You have recurrent low blood sugar levels
Be very careful about symptoms of low blood sugar like sweating, anxiety, fast heartbeat, headache, intense hunger, restlessness, dizziness, irritability. If you experience these, immediately have sugar (Do not consume artificial sweeteners). Eat something as soon as possible. Do not take insulin in such a scenario. If still the symptoms persists, seek emergency medical help
You have frequent fever and infections
You have diseases related to liver and kidney
You have thyroid disorders
You are switching to different insulin medicine brand
You have pain, itching and swelling at the injection site, you should continuously change the site of injection
Avoid doing heavy exercise
You are planning to change your diet preferences
You should always carry sugar candy with you
You are taking insulin but not taking adequate meals, your blood glucose can drop drastically.

Mode of Action

How Does It Work?

Insulin is crucial to allow entry of blood glucose into each cell of the body
Inside the cell, this glucose is used as fuel
In type 1 diabetes mellitus, the body fails to produce adequate insulin
This leads to glucose accumulating in the blood and cause high blood glucose
This medicine lowers blood sugars by stimulating glucose uptake by cells, tissue and muscles, especially by skeletal muscles and fat and by inhibiting glucose production by the liver.

Interactions

Interactions with other medicines

You may have symptoms of low blood sugar if you are taking other medicines for diabetes, depression (fluoxetine), medicines for fever and pain (salicylates), ramipril, or lisinopril
You may have high blood sugar if you are taking oral contraceptives, thiazides, steroids, thyroxine, medicines used to treat severe diarrhoea and abnormal growth of body organs like octreotide, lanreotide.
If you are taking the medicine pioglitazone to treat diabetes, be cautious, as some cases of heart attack and heart failure have been reported
Some medicines block your body's response to low blood sugar, so you may not experience symptoms like headache, hunger pangs, sweating, or anxiety when your blood sugar drops. This can lead to a serious fall in blood sugar. Inform your doctor if you are on medicines like Betablockers (Metoprolol, Propranolol, Atenolol), Clonidine, Guanethidine, and Reserpine.

Interactions with food items

This medicine is to be taken 15 mins before meals or after meals
Maintaining a constant meal pattern is advisable when you are taking insulin
Avoid skipping or delaying meals when you are taking insulin.

Dosage

Overdose

Excess insulin will lead to low blood sugar levels, called hypoglycemia
Symptoms like dizziness, fainting, sweating and tremors may be seen
If you have the blood glucometer with you, test immediately and confirm
Whether or not you test your levels, it is important to take some glucose water/juice/eat sugar or chocolates immediately and then rush to your doctor.

Missed a Dose

Missed dose may lead to high blood sugar levels, which can cause symptoms like feeling thirsty, excessive urination, loss of appetite, drowsiness, fruity smell from breath, etc.
If you missed any dose of medicine, take it as soon as you remember
If it's time for your next dose, then skip the missed dose and continue with your regular dose schedule
Do not take a double dose of medicine to compensate the missed one as taking double dose can cause a drastic fall in blood glucose which can be dangerous.

Frequently Asked Questions (FAQs)

Avoid maida, white bread, noodles, corn flakes, poori, biryani, naan, fried rice, etc.Avoid seetaphal, mango, jack fruit, fruit salads with ice cream, fruit-based dessertsAvoid cheese, milkshakes, ice creams Try to avoid pork, beef, soft drinks, sugarcane juice, sweetened health drinks and beverages.

No, you can not stop taking your insulin without speaking with a doctor. It may lead to high blood sugar levels and may worsen your disease condition and land you in complications. If you experience side effects or discomfort, talk to your doctor. You may need dose adjustment.

Diet should include chapatis, multigrain bread, puffed rice with vegetables, sprouts, roasted grams, plain cooked daal, soups, steamed vegetables, cooked vegetables with less oil, Jamun, orange, guava, apple, watermelon, papaya, cow’s milk, curd, thin buttermilk, fish (grilled, baked or steamed), peanuts, cashew nuts and walnuts(handful).Limit sugar intakeBrisk walk daily for 30 minutesExercise regularlyMonitor your blood glucose regularlyTake your anti-diabetic medication on time.

Risk factors for developing low blood glucose levels include taking too much insulin, not taking adequate meals or missing meals, too much alcohol consumption, fever and too much exerciseSome medicines, when used with insulin can result in such episodes like other diabetes medicine glimepiride, medicines used for fever and pain (salicylates), ramipril, etc.Report to your doctor about these episodes. You may need a dose of adjustment.