From the Guidelines
For a patient with hyperglycemia (BG 230-250 mg/dL) prior to starting Trulicity, I recommend initiating basal insulin with or without correction doses, as this patient falls into the moderate hyperglycaemia category with a BG range of 201-300 mg/dL, according to the management guidelines for non-critically ill patients with diabetes 1.
Treatment Plan Details
- The patient's blood glucose range of 230-250 mg/dL indicates moderate hyperglycaemia, which suggests the need for basal insulin with or without correction doses, considering the patient is insulin naive and has type 2 diabetes 1.
- The initial dose of basal insulin could be started at 0.2-0.3 U/kg per day, with correction doses of rapid-acting insulin given before meals or every 6 hours as needed, to achieve a target fasting glucose of 80-130 mg/dL and postprandial glucose below 180 mg/dL.
- Lifestyle modifications, including dietary changes, regular physical activity, and weight management, are essential components of the treatment plan to improve insulin sensitivity and overall glycemic control.
- Regular blood glucose monitoring is crucial to adjust the insulin doses and to assess the effectiveness of the treatment plan.
- Once the patient's blood glucose levels are adequately controlled, Trulicity (dulaglutide) can be initiated at 0.75 mg subcutaneously once weekly, potentially increasing to 1.5 mg weekly if needed, to enhance glucose-dependent insulin secretion, reduce glucagon secretion, slow gastric emptying, and promote satiety, making it an effective second-line agent for type 2 diabetes management.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Plan for Hyperglycemia Prior to Starting Trulicity
The patient's blood glucose (BG) range prior to taking Trulicity was 230-250 mg/dL, indicating hyperglycemia.
- The treatment plan for a patient with this condition prior to starting Trulicity (Dulaglutide) is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that dulaglutide is effective in reducing blood glucose levels in patients with type 2 diabetes 3, 4, 5, 6.
- According to the study 3, dulaglutide achieved a reduction in glucose levels within 24 hours of the first injection, and the improvement in blood glucose levels remained stable for a week in a hospitalized clinical setting.
- Another study 4 states that dulaglutide is approved as an adjunct to diet and exercise for the treatment of adults with type 2 diabetes, and it has been shown to be effective in reducing blood glucose levels in clinical trials and real-world settings.
Blood Glucose Monitoring
- The study 2 recommends monitoring blood glucose levels in patients with pre-diabetes prior to and after each infusion of teprotumumab to determine patients at a greater risk for adverse hyperglycemic outcomes.
- Although this study is not directly related to dulaglutide, it highlights the importance of blood glucose monitoring in patients with hyperglycemia.