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HealthRX.com · Printable surgery planning sheet

Trulicity procedure note for the surgical and anesthesia teams

Fill this in when a procedure is booked and bring it to the pre-anesthesia visit: your exact last injection, any recent dose change or stomach symptoms, who decided to hold or continue Trulicity, and how your blood sugar will be covered if the dose is skipped.

Companion to “Trulicity Pre-Surgery Hold Window: When to Stop Dulaglutide Before an Operation” · healthrx.com/dulaglutide-trulicity-v2/pre-surgery-window · Facts checked 2026-10-19

The procedure

Procedure, date and place
Anesthesia plannedgeneral, deep or moderate sedation, neuraxial block, local only
Elective or urgent
Surgery team and anesthesia contacts

My Trulicity details

Write the date you injected, not the date the pen was dispensed.

Strength on my pen0.75, 1.5, 3 or 4.5 mg
Usual injection day
Date of my last injection
Last dose increase, if within the past few months
This week: nausea, vomiting, bloating, stomach pain or constipation?
Other diabetes medicinesinsulin, sulfonylurea, metformin, others

What the label and the anesthesia guidance say

  • Trulicity label: tell your healthcare providers before any planned surgery or procedure; rare cases of aspiration under general anesthesia or deep sedation have been reported with GLP-1 medicines despite fasting.[1]
  • Trulicity label: there are not enough data to say whether changing fasting rules or pausing Trulicity lowers the chance of food left in the stomach.[1]
  • ASA 2023, for elective procedures: with weekly GLP-1 medicines, consider holding the dose for the week before.[2]
  • ASA 2023: if a GLP-1 medicine prescribed for diabetes is held longer than its dosing schedule, consider asking an endocrinologist to bridge diabetes treatment and avoid high blood sugar.[2]
  • Multi-society guidance, affirmed by ASA in May 2024: the medicine may be continued in people without raised risk of delayed stomach emptying; a hold should be weighed against the risk of high blood sugar.[3]

The plan we agreed

Hold or continue Trulicityand who decided: name and role
Injection to skip, if holdingdate
Blood sugar plan while it is heldhow often to check, other medicines, who to call
Diet instructions before the procedurefor example a clear liquid diet, and from when
Restart date and dose

After the procedure

  • Once back on Trulicity, severe pain in your stomach area that will not go away, with or without nausea or vomiting: stop it and call your healthcare provider right away.[1]
  • Nausea, vomiting or diarrhea that does not go away: tell your healthcare provider right away.[1]
Sources for the facts on this sheet
  1. Eli Lilly and Company, via DailyMed. Trulicity (dulaglutide) injection, for subcutaneous use: prescribing information and Medication Guide. Effective 2026-06-16. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=463050bd-2b1c-40f5-b3c3-0a04bb433309
  2. American Society of Anesthesiologists. American Society of Anesthesiologists Consensus-Based Guidance on Preoperative Management of Patients (Adults and Children) on Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists. Accessed 2026-10-19. https://www.asahq.org/about-asa/newsroom/news-releases/2023/06/american-society-of-anesthesiologists-consensus-based-guidance-on-preoperative
  3. Kindel TL, Wang AY, Wadhwa A, et al. Multi-society clinical practice guidance for the safe use of glucagon-like peptide-1 receptor agonists in the perioperative period. Surg Endosc 2025. PMID 39370500. https://pubmed.ncbi.nlm.nih.gov/39370500/

This sheet records information for a conversation with your prescriber or pharmacist. It does not replace their instructions or the medication's prescribing information.