What questions should I ask this patient on dulaglutide to assess functional status, energy level, appetite, gastrointestinal symptoms, unintended weight loss, hypoglycemia episodes, diet, recent changes in comorbidities, new medications or supplements, history of pancreatitis or gallbladder disease, diabetes care goals, preferences about the weekly injection, and advance‑care wishes?

Questions to Ask a Patient on Dulaglutide

Ask directly about gastrointestinal symptoms—particularly nausea, vomiting, diarrhea, and abdominal pain—as these are the most common adverse effects occurring in 15-20% of patients and are the primary reasons for treatment discontinuation. 1

Gastrointestinal Assessment (Priority)

Start with GI symptoms since these are most common and may signal serious complications:

• Current GI symptoms: Nausea, vomiting, diarrhea, abdominal pain (frequency, severity, timing relative to injection)
• Appetite changes: Decreased appetite is common (≥5% incidence) and contributes to weight loss 2
• Severe symptoms requiring attention: Persistent severe abdominal pain radiating to the back (pancreatitis warning), right upper quadrant pain (gallbladder disease) 2, 3, 4

The FDA label explicitly warns about severe gastrointestinal reactions, and dulaglutide is not recommended in patients with severe gastroparesis 2. Most GI symptoms are tolerable with dose titration and typically abate over several weeks to months 1.

Hypoglycemia Screening

Ask about any episodes of low blood sugar, including timing, frequency, severity, and whether the patient recognizes symptoms when they occur 5, 6:

• Symptomatic hypoglycemia episodes (shakiness, sweating, confusion, hunger)
• Asymptomatic hypoglycemia (detected only by monitoring)
• Severe hypoglycemia requiring assistance
• Hypoglycemia unawareness (inability to recognize symptoms)
• Concurrent use of insulin or sulfonylureas (which increase hypoglycemia risk) 1

While dulaglutide alone does not cause hypoglycemia, concomitant insulin or insulin secretagogue use significantly increases this risk 2. If hypoglycemia unawareness or severe episodes occur, treatment regimen re-evaluation is mandatory 5, 6.

Weight and Metabolic Changes

• Unintended weight loss: Quantify amount and rate (dulaglutide typically causes weight loss, but excessive loss warrants investigation)
• Weight trajectory: Expected vs. actual weight change since starting therapy
• Body composition concerns: Particularly in older adults where muscle loss may be problematic

Functional Status and Energy

• Energy level changes: Fatigue, ability to perform daily activities
• Exercise tolerance: Changes in physical activity capacity
• Cognitive function: Particularly important in older adults, as cognitive impairment increases hypoglycemia risk 5
• Falls or injuries: Especially relevant given potential orthostatic effects and hypoglycemia risk

Medication-Specific Safety Monitoring

Screen for contraindications and serious adverse events 2:

• Personal or family history of medullary thyroid carcinoma or MEN 2 (absolute contraindication)
• History of pancreatitis: Ask about any prior episodes, as dulaglutide has not been studied in patients with pancreatitis history 2
• Gallbladder disease history: Cholelithiasis or cholecystitis symptoms (dulaglutide increases acute gallbladder disease risk) 2, 7, 4
• Diabetic retinopathy: Monitor patients with pre-existing retinopathy, as complications have been reported in cardiovascular outcomes trials 2

Renal Function Context

• Kidney disease symptoms: Changes in urination, edema, fatigue
• Current kidney function status: Dulaglutide requires no dose adjustment for renal impairment, including ESRD, but monitor renal function in patients reporting severe GI reactions 2

Injection Technique and Adherence

• Injection site reactions: Pain, redness, swelling at injection sites (more common in pediatric patients) 2
• Administration timing: Confirm once-weekly dosing at any time of day with or without food 2
• Missed doses: If dose missed, can administer if ≥3 days (72 hours) until next scheduled dose 2
• Barriers to adherence: Cost, needle anxiety, complexity of regimen 8

Diabetes Management Context

• Current glycemic control: Recent blood glucose readings, A1C trends
• Other diabetes medications: Particularly insulin or sulfonylureas (may need dose reduction) 1, 2
• Diet patterns: Changes in eating habits, meal timing, carbohydrate intake
• Self-monitoring practices: Frequency and use of glucose data

Comorbidity Changes

• New cardiovascular symptoms: Dulaglutide reduces cardiovascular events in high-risk patients 9
• New medications or supplements: Dulaglutide delays gastric emptying and may affect absorption of oral medications 2
• Acute illnesses: Infections, dehydration (which may necessitate temporary treatment adjustments) 5

Patient Goals and Preferences

• Satisfaction with weekly injection: Convenience vs. burden
• Treatment goals: Glycemic targets, weight goals, cardiovascular risk reduction
• Advance care planning: Particularly in older adults or those with multiple comorbidities 10

Red Flags Requiring Immediate Action

Stop dulaglutide immediately and seek urgent evaluation if:

• Persistent severe abdominal pain (possible pancreatitis or gallbladder disease)
• Signs of thyroid mass or difficulty swallowing
• Anaphylaxis or angioedema symptoms
• Severe dehydration from GI symptoms
• Acute kidney injury symptoms in setting of severe GI reactions 2