Once-Weekly Insulin Is Here. What Does It Mean for Your Patients?
What has felt like years in the making has finally arrived: a once-weekly insulin. This long-acting (basal) insulin, designed to be injected just once per week, has the potential to simplify long-term insulin therapy in a meaningful way.
At first glance, it may not seem like a major shift. But for individuals taking insulin, and for those supporting them, reducing the burden of daily injections can make a real difference in self-care routines, “adherence”, and ultimately long-term health outcomes.
So what does this mean for you and your patients? Who might be a good fit, and how should you counsel them on its use? Like any good diabetes care and education specialist, let’s dive into the package insert together.
What Is Once-Weekly Insulin?
Less than a week ago, the FDA approved Awiqli by Novo Nordisk, the first and only once-weekly basal insulin for adults with type 2 diabetes. Awiqli (insulin icodec) is designed as an alternative to daily basal insulin injections, reducing the burden from seven injections per week to just one. Basal insulin provides a steady, background level of insulin to meet the body’s needs, particularly overnight and between meals.
How Does Once-Weekly Insulin Work?
Awiqli works like other types of insulin by helping lower blood sugar. It moves glucose from the bloodstream into muscles and fat for energy.
What makes Awiqli different is how long it lasts. After injection, it binds to a protein in the blood (albumin), which allows it to be released slowly and steadily over time. This creates a consistent glucose-lowering effect that lasts an entire week.
It takes about 2 to 4 weeks for Awiqli to reach steady levels in the body. Once steady, it provides continuous insulin coverage without peaks. Awiqli stays in the body for about a week before being broken down, similar to natural insulin.
What Are the Dosage Forms and Strengths?
Awiqli comes in three different dosage options. Despite being seven times more concentrated (U-700), the pens look similar to standard once-daily basal insulin pens.
The FlexTouch pens are available as:
- 3 mL pen containing 2100 units
- 1.5 mL pen containing 1050 units
- 1 mL pen containing 700 units
Once opened or kept at room temperature, the pen can be used for up to 12 weeks.
How Is Once-Weekly Insulin Taken?
Awiqli is designed to be taken once weekly. Because it is seven times more concentrated, a single weekly dose provides coverage similar to a once-daily basal insulin over seven days. Like other long-acting insulins, it is injected subcutaneously into the thigh, upper arm, or abdomen.
The Awiqli FlexTouch pen can deliver doses ranging from 10 to 700 units in a single injection, in 10-unit increments.
If a dose is missed, it should be taken as soon as possible within 4 days. The weekly dosing schedule can then be resumed, with the next dose given one week after the missed dose is administered. If more than 4 days have passed, skip the missed dose and resume dosing on the regularly scheduled day.
How Should Clinicians Initiate and Adjust Once-Weekly Insulin?
Like all insulin, dosing should be individualized based on metabolic needs, blood glucose data, and glycemic goals. For insulin-naive patients, the prescribing information recommends a starting dose of 70 units of Awiqli administered once weekly.
When transitioning an individual from once-daily to once-weekly basal insulin, the dosing approach differs.Â
- The initial weekly dose is calculated as 7 times the daily basal dose, with an additional 50% added, then rounded to the nearest 10 units. For example, if an individual is taking 20 units of once-daily basal insulin, their first once-weekly dose would be 210 units.
- In week 2, the recommended dose is the prior total daily basal insulin dose multiplied by 7, then rounded to the nearest 10 units. For an individual was taking 20 units of once-daily basal insulin, their week 2 once-weekly dose would be 140 units.
- From week 3 onward, the Awiqli dose can be titrated based on the patient’s metabolic needs and glycemic goals. The first dose of Awiqli should be administered the day after the last dose of daily basal insulin.
Who Is a Good Candidate for Once-Weekly Insulin?
There are many who could benefit from once-weekly basal insulin, particularly those who struggle with adherence to daily injections. This includes individuals in long-term care settings with limited skilled nursing support, as well as busy professionals or anyone with demanding schedules. Reducing injection frequency from daily to weekly may simplify diabetes self-management, especially given how common missed doses can be.
At the same time, careful patient selection is important. Those with rapidly changing insulin needs, such as those with highly variable physical activity or inconsistent routines, may require closer monitoring.
Additional precautions include the risk of hypoglycemia with dosing changes, potential for medication mix-ups, and the need for close monitoring during transitions in therapy.
At this time, once-weekly insulin is not approved for use in children or during pregnancy.
Key Clinical Takeaways
Once-weekly basal insulin is a meaningful step forward in diabetes care and something many of us have been waiting for. For the right patient, it has the potential to simplify routines and improve adherence in a way that could translate to better long-term outcomes.
That said, it is not a set-it-and-forget-it option. Thoughtful patient selection, clear education, and close follow-up, especially during transitions and early titration, are key.
As diabetes care and education specialists, this is where we really add value, helping patients understand how to use it safely, integrating it into their daily lives, and adjusting along the way to meet their goals.
- https://www.novo-pi.com/awiqli.pdf
- Nordisk N. FDA approves Novo Nordisk’s Awiqli®, the first and only once-weekly basal insulin treatment for adults with type 2 diabetes. Accessed April 5, 2026. https://www.prnewswire.com/news-releases/fda-approves-novo-nordisks-awiqli-the-first-and-only-once-weekly-basal-insulin-treatment-for-adults-with-type-2-diabetes-302726839.html
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Let me help you develop patient-centered diabetes care and education that integrates seamlessly into clinical care. Book a discovery call to explore how we might work together.
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