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Diabetes affects millions of people worldwide, and for many, daily injections can be a barrier to starting insulin therapy or staying on it. A weekly schedule reduces the number of injections from 365 to 52 each year, which may improve adherence and quality of life.

In 2026, the US Food and Drug Administration approved Awiqli (pronounced “uh-WEE-klee”), a once-weekly basal insulin, for adults with type 2 diabetes. It comes prefilled in a FlexTouch pen and dispenses doses in 10-unit increments and can deliver up to 700 units in a single injection.

In trials, the average reduction in A1C in the Awiqli group was 1.55%, while the insulin glargine group was 1.35%. The time spent in the target glucose range (70-180 mg/dL) was also higher with Awiqli. Although rates of significant or severe low blood sugar were slightly higher with the weekly insulin. These results show that Awiqli can be effective when used correctly, but requires a careful dosing schedule.

Below, we’ll guide you through Awiqli’s dosing schedule, how to switch from daily insulin, and what to do if you miss a dose.

Key Takeaways

  • Awiqli delivers a full week of basal insulin in a single injection. The pen releases insulin slowly over seven days, so you only need to inject once a week.
  • Insulin-naïve adults start at 70 units once weekly. Dose adjustments generally occur in 10- or 20-unit increments based on fasting blood sugar.
  • When switching from a daily basal insulin, inject Awiqli the day after your last daily dose. The Week 1 dose equals 1.5× your total daily basal insulin dose × 7, while the Week 2 dose equals 7× the daily dose. Week 3 dose and onwards is titrated based on your glucose readings.
  • If you miss a dose, take it within four days, otherwise skip it. Maintain at least four days between injections.
  • Store unopened pens in the refrigerator and use opened pens within 12 weeks at room temperature or refrigerated.
  • Monitor blood sugar regularly. Hypoglycemia is the most common side effect, and rates were slightly higher than with daily insulin in clinical trials.

Awiqli starting dose for insulin-naïve patients

If you have never used a basal insulin, the recommended weekly starting dose is 70 units administered once weekly on the same day each week. This starting dose corresponds to about 10 units per day, which is comparable to the starting dose for many daily basal insulins.

After the initial dose, weekly titration begins based on your fasting blood glucose readings. A review of the ONWARDS trials noted that adjustments are typically made in 20-unit increments depending on fasting glucose results in the last 3 days before the next injection.

If your readings are consistently above your target range (>130 mg/dL), your doctor may increase the weekly dose by 20 units. If readings are below the target (<80 mg/dL), the dose may be reduced by 20 units.

For some people at higher risk of low blood sugar, clinicians may choose smaller 10-unit adjustments. Always follow the titration plan provided by your healthcare team.

Switching from daily basal insulin

If you’re already using a daily basal insulin and plan to switch to Awiqli, it requires careful planning to avoid high or low blood sugar. According to the prescribing information, you should inject the first dose of Awiqli on the day after your last dose of daily basal insulin.

For the first and second weekly doses, your doctor will calculate the dose based on your current daily basal insulin. The calculations are as follows:

    • Week 1 (first injection) – Multiply your current total daily basal insulin dose by seven (to convert to a weekly dose) and then multiply by 1.5. Round to the nearest 10 units. This larger dose helps the new insulin reach a steady state more quickly. For example, if you currently take 20 units of a daily basal insulin, your Week 1 dose of Awiqli would be 20 × 7 × 1.5 = 210 units.
    • Week 2 – Multiply your previous total daily basal dose by seven and round to the nearest 10 units. Using the same example, 20 units per day × 7 = 140 units for Week 2.
    • Week 3 and beyond – After Week 2, the weekly dose may be titrated up or down based on blood glucose monitoring and your glycemic goals. Doses are typically adjusted in 10- or 20-unit increments as described above.

The table below offers example conversions from daily to weekly insulin doses. Doses are rounded to the nearest 10 units, and Week 1 includes the 1.5× loading factor. Talk with your healthcare provider to determine your specific dose.

Previous Daily Basal Dose (units)

 Week 1 Awiqli Dose (units)

Week 2 Awiqli Dose (units)

10

 110

70

11

120

80

12

130

80

13

140

90

14

150

100

15

160

110

16

170

110

17

180

120

18

190

130

19

200

130

20

210

140

21

220

150

22

 230

150

23

 240

160

24

 250

170

25

 260

180

26

 270

180

27

 280 190
28 290

200

29

 300 200

30

 320

210
31 330

220

32

 340 220
33 350

230

34

 360 240
35 370

250

36

 380 250
37 390

260

38

 400 270
39 410

270

40

 420 280
41 430

290

42

 440 290
43 450

300

44

 460 310
45 470

320

46

 480 320
47 490

330

48

 500 340
49 510

340

50

 530 350
100 1,050

700

Why does Awiqli need a loading dose?

Awiqli has a long half-life, so it accumulates over several weeks. A one-time additional 50% of the weekly dose speeds up reaching the steady state. An expert review of the ONWARDS program explains that the Week 1 dose is 1.5 × (daily dose × 7) and the Week 2 dose returns to 7 × the daily dose. Without the larger first dose, it could take several weeks for your blood levels to reach their goal.

Adjusting mealtime insulin and other medications

When switching, remember that Awiqli replaces your previous basal insulin only. If you use rapid-acting insulin with meals, you will generally continue your usual mealtime doses. However, you may need to adjust the timing or amount of mealtime insulin, as the once-weekly insulin could change your fasting and premeal glucose levels.

Titration after switching

After the second injection, your Awiqli dose is fine-tuned based on fasting blood glucose and your overall glycemic goals. Titration usually begins in Week 3. The general approach is:

    • Check fasting blood glucose on the two days before and on the day of your next injection. Some clinicians use three readings.
    • If all readings are above the upper limit of your target range (often 130 mg/dL), increase the weekly dose by 20 units.
    • If any reading is below the lower limit (often 80 mg/dL), decrease the weekly dose by 20 units.
    • If readings are within target, keep the dose the same.

These are general guidelines. Your doctor may recommend smaller 10-unit adjustments if you have a history of low blood sugar or are otherwise at risk. Because the insulin acts for a full week, dose changes will not take full effect until several weeks later. Patience and consistent monitoring are important.

What if you miss a dose?

Here’s what to do if you miss a dose:

    • If less than 4 days have passed since your scheduled dose, inject the missed dose as soon as possible and then resume the weekly schedule one week later. For example, if you usually inject on Monday but remember on Wednesday (two days late), take the injection on Wednesday and then take the next one the following Wednesday.
    • If more than 4 days have passed, skip the missed dose entirely and take your next dose on your usual day. This prevents the doses from overlapping too closely.
    • Monitor your blood sugar more often if you miss a dose. You may need to temporarily adjust rapid-acting insulin or other medications. Contact your healthcare team if you experience high or low blood sugar after a missed injection.

The patient guide offers similar advice, noting that you can keep taking your dose on your regular day as long as there are four days between injections and advising users to mark their calendar to reduce missed doses.

How to inject Awiqli?

Awiqli is injected under the skin (subcutaneously) into the thigh, upper arm, or abdomen, avoiding areas with scar tissue or lipodystrophy. You can inject at any time of the day, but you must take the dose on the same day each week.

Before each injection, confirm that you are using the correct pen and that the solution looks clear.

  • Prepare pen – Wash your hands, then check that the insulin is clear and colorless. Attach a new needle and remove both caps.
  • Check flow (prime) – With Awiqli, you should check the flow before every injection. Dial 10 units, then hold the pen upright and press the button. Look for a drop at the needle tip. If no drop appears, repeat up to 3 times or change the needle.
  • Set dose – Turn the dose selector to your prescribed units. Check that the correct dose lines up with the pointer.
  • Choose injection site – Select stomach, thigh, or upper arm. Rotate sites each time. Clean the area with alcohol and let it dry.
  • Inject dose – Insert the needle straight into the skin. Press and hold the dose button until the counter shows 0. Keep holding and count slowly to 6 before removing the needle.
  • After injection – Remove the needle and dispose of it in a sharps container. Do not store the pen with a needle attached. Replace the pen cap.

Use a new needle for each injection and rotate injection sites to reduce the risk of lumps or skin changes. Do not mix Awiqli with other insulins or dilute it, and do not use it in insulin pumps.

Storage and handling

Awiqli must be stored properly to maintain potency. Unopened pens should be kept in the refrigerator between 36 °F and 46 °F (2 °C to 8 °C). Do not freeze the pens or expose them to light.

Once in use, the pen can be stored at room temperature (below 86 °F or 30 °C) or in the refrigerator for up to 12 weeks. Always keep the cap on to protect the medicine from light. Do not use the pen beyond the expiration date printed on the label.

Dispose of used needles in a sharps container. Do not throw pens or needles into household trash or recycling. Your pharmacist can advise you on disposal. Keep the medicine out of reach of children.

Safety considerations

Awiqli carries the same risks as other insulins. The most common side effect is hypoglycemia (low blood sugar). Symptoms may include shakiness, sweating, hunger, dizziness, or confusion. Severe hypoglycemia can lead to loss of consciousness or seizures.

Always have a source of fast-acting carbohydrate, such as glucose tablets or fruit juice, and teach family members how to help in an emergency. Monitoring blood sugar regularly and following the titration schedule can reduce the risk of low blood sugar.

Other possible side effects include allergic reactions, injection site reactions, swelling (edema), and weight gain. Serious hypersensitivity reactions are rare but can be life-threatening. Seek immediate medical attention if you have difficulty breathing, swelling of the face or lips, or a rash that spreads. Do not use Awiqli if you are allergic to insulin icodec, or any component of the pen.

Bottom line

The dosing regimen of Awiqli requires careful calculation, especially during the first two weeks and when adjusting doses. Following the recommended schedule, monitoring blood sugar closely, and communicating with your healthcare provider are essential to using Awiqli safely and effectively.

If you are considering Awiqli, discuss it with your doctor. Together you can determine whether a weekly insulin works for your situation, how to calculate your starting dose, and how to adjust it over time. Once-weekly insulin can be a valuable tool in the ongoing effort to manage diabetes and maintain a healthy lifestyle.

Frequently Asked Questions

Most long-acting insulins, such as insulin glargine or insulin degludec, are injected once daily and are available at 100 units/mL or 200 units/mL concentrations. Awiqli has a concentration of 700 units/mL and is injected once a week. Its unique formulation allows the insulin to release slowly over seven days. Because it is highly concentrated, the injection volume is similar to daily insulins despite the large unit dose. A weekly injection can reduce injection fatigue and improve adherence.

Yes. Awiqli can be used with other glucose-lowering medications, including metformin, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors. However, some drugs may increase the risk of low blood sugar or require dose adjustments. Your healthcare provider will create your treatment plan.

A healthy lifestyle remains important. Continue to follow your meal plan and engage in regular physical activity. Because Awiqli works all week, avoid changing your diet or exercise drastically without consulting your healthcare team. Sudden increases in activity or reductions in carbohydrate intake can cause low blood sugar. If you become ill, have surgery, or change your diet, speak with your provider rather than adjusting your insulin dose yourself.

Contact your healthcare provider if you have repeated episodes of low blood sugar, injection site reactions, or signs of an allergic reaction. For severe symptoms such as difficulty breathing or swelling of the face and throat, seek emergency care immediately.

Keep unused pens refrigerated. When traveling, you can keep the pen at room temperature for up to 12 weeks, but avoid exposing it to temperatures above 86 °F (30 °C). Use an insulated bag with a cold pack if needed. Always carry spare needles and, if flying, keep your insulin and diabetes supplies in your carry-on bag. Time zone changes will alter the day you take your weekly dose. Consult your doctor about adjusting injection days.

Related Articles

Sources

Rosenstock, J., Bain, S. C., Gowda, A., Jódar, E., Liang, B., Lingvay, I., Nishida, T., Trevisan, R., & Mosenzon, O. (2023). Weekly Icodec versus Daily Glargine U100 in Type 2 Diabetes without Previous Insulin. New England Journal of Medicine, 389(4), 297–308. https://doi.org/10.1056/nejmoa2303208

Bajaj HS, Goldenberg RM. Insulin Icodec Weekly: A Basal Insulin Analogue for Type 2 Diabetes. touchREV Endocrinol. 2023 May;19(1):4-6. doi: 10.17925/EE.2023.19.1.4. Epub 2023 Mar 16. PMID: 37313230; PMCID: PMC10258611.

HIGHLIGHTS OF PRESCRIBING INFORMATION OF AWIQLI. https://www.novo-pi.com/awiqli.pdf

Awiqli (insulin icodec) dosing, indications, interactions, adverse effects, and more. (n.d.). https://reference.medscape.com/drug/awiqli-insulin-icodec-4000417