HealthRX.com · Printable question sheet
Trulicity side effects questions for your prescriber
Use this sheet before or at a visit about Trulicity (dulaglutide) side effects, dose steps, low blood sugar with insulin or sulfonylureas, or kidney concerns. Fill it in by hand, bring it to your prescriber or pharmacist, and keep the diary going at home.
About me and my Trulicity
Write what you know now. Bring your current medicine list with you.
Name and date of birthFull name and birth date
Current Trulicity dose stepCopy the strength written on your pen or label
Date I started Trulicity
Date of my last dose step change
Other diabetes medicines I takeInclude insulin, glimepiride or other sulfonylureas
Pharmacy name and phone
Gather before the visit
Tick each item when it is done.
- Bring the Trulicity pen or box so the strength can be read
- List every medicine and supplement you take, including over the counter ones
- Write down your side effect diary for the past weeks
- Note any low blood sugar readings and what you were doing at the time
- Check with your pharmacist whether any new medicine interacts with Trulicity
- Note whether you have had vomiting, diarrhea or trouble drinking fluids
- Bring your recent kidney test results if you have them
- Confirm which clinic phone line to call if symptoms get worse
Questions to ask
- Which dose step am I on now, and what is the plan for the next step?
- How many weeks should I stay on my current dose before any change?
- Is the severity of my nausea or vomiting something you want to see again?
- Should my insulin or sulfonylurea dose be lowered while I use Trulicity?
- What low blood sugar signs should I watch for, and what should I write down?
- Does my kidney history change how you will watch my side effects?
- Are there signs of dehydration that mean I should call the clinic urgently?
- Does the label or your practice have any data on side effects for my age group?
Side effect and blood sugar diary
Write one row for each day you notice a reaction or a low reading. Leave blank days empty.
| Date | Dose step | Nausea or vomiting | Low sugar reading | Notes |
|---|---|---|---|---|
This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.