Awiqli: A Once-Weekly Insulin Injection for Type 2 Diabetes

Managing diabetes well means keeping your blood sugar levels steady and making treatment easier to follow. Daily insulin shots can be a hassle and may lead to missed doses. Awiqli (insulin icodec-abae) is a new option that changes this. It is the first and only long-acting insulin that can be taken once a week. This can make insulin treatment less stressful and help you stay on track more easily.

In this article, we’ll walk you through everything you need to know about Awiqli, how it works, who it’s for, possible side effects, proper dosing, and more.

What is Awiqli?

Awiqli (pronounced as “A-week-ly”) is a weekly insulin injection developed by Novo Nordisk. It contains insulin icodec, a long-acting form of insulin that stays in your body for about eight days. This extended action allows for just one injection each week.

This type of insulin binds more effectively to a protein in your blood called albumin. Albumin acts as a storage helper, holding onto the insulin and releasing it slowly. Because of this, the insulin stays in your body longer instead of being removed too quickly from your system.

Scientists also altered one of the insulin’s amino acids to slightly weaken the insulin’s ability to bind to insulin receptors. This slows down how fast the insulin is used, helping it stay active in your body for longer.

Who can use it?

Awiqli is a once-weekly insulin injection used to help manage blood sugar levels in adults with type 2 diabetes.

Awiqli may be sufficient on its own if your doctor believes it’s the right choice. However, in some cases, it may be used in conjunction with other diabetes medications to help control your blood sugar levels.

Is Awiqli safe and effective?

Researchers tested Awiqli in a large international study program called ONWARDS, which included people at different stages of diabetes. Some people had never used insulin before, some were already using daily long-acting insulin, and others were on a full insulin routine with both long-acting and mealtime insulin.

Across all five ONWARDS trials, Awiqli worked just as well, or better, than standard daily insulins, such as insulin glargine or insulin degludec, in lowering blood sugar. In several of the studies (ONWARDS 1, 3, and 5), it even performed better than other insulins.

In the ONWARDS 2 trial, Awiqli was compared to once-a-day insulin degludec in adults with type 2 diabetes. All of the study subjects were already using long-acting insulin (either once or twice a day), but their blood sugar levels were not well controlled.

Participants were randomly placed into two groups. One group switched to Awiqli, and the other group stayed on degludec. Everyone continued their other diabetes medications as usual.

Both groups started with average blood sugar levels (HbA1c) around 8.1%. After 26 weeks:

• • The Awiqli group lowered their HbA1c to 7.2%
  • The degludec group lowered theirs to 7.42%

This means that Awiqli not only matched degludec but actually worked slightly better at lowering blood sugar.

Hypoglycemia events were low in both groups, though Awiqli had slightly more. However, this difference wasn’t large enough to be considered statistically significant.

The ONWARDS 4 trial compared Awiqli to once-daily insulin glargine U100 in adults with long-term diabetes (on average, 17 years) who were already on intensive insulin treatment (one long-acting insulin dose plus 2 to 4 mealtime insulin injections each day).

Both groups started with an HbA1c level of around 8.3%. After 26 weeks:

• • The Awiqli group dropped their HbA1c by 1.16%
  • The glargine U100 group dropped theirs by 1.18%

This confirmed that Awiqli is non-inferior, or equally effective, even though it’s only taken once a week. Rates of hypoglycemia were also about the same for both treatments.

How to take Awiqli?

Awiqli is available in pre-filled FlexTouch pens that you inject once a week:

• • 3 mL prefilled pen (containing 2,100 units)
  • 1.5 mL prefilled pen (containing 1,050units)
  • 1 mL prefilled pen (containing 700 units)

It’s injected under the skin (not into muscle or veins), usually in your thigh, upper arm, or abdomen. Each dose can be adjusted in 10-unit steps and can go up to 700 units in a single shot.

Awiqli dosing guidelines

One unit of Awiqli equals one unit of regular human insulin. Your doctor will adjust the dose based on your blood sugar levels, how your body responds, and what your target goals are.

If you are not yet on insulin, the recommended starting dose is 70 units once a week.

If you’re switching from your once- or twice-daily basal insulin to Awiqli:

How to calculate your weekly Awiqli dose

Let’s say your current daily basal insulin dose is 47 units. Your one-time higher dose for the first week would be:

• 47 units × 7 × 1.5 = 493.5 units rounded to the nearest 10 = 490 units

Starting week 2, your regular weekly Awiqli dose would be:

• 47 units × 7 = 329 units rounded to the nearest 10 = 330 units

When the resulting dose exceeds the maximum dose of the FlexTouch pen (700 units), the dose may need to be split into two separate injections.

If you’re also using other diabetes medications, such as fast-acting insulin or pills, your doctor may adjust those as well.

Awiqli weekly dosages when switching from daily basal insulin therapy

What are the side effects of Awiqli?

As with all insulin therapies, hypoglycemia is the most common adverse effect of Awiqli. Other reactions reported in at least 2% of type 2 diabetic patients receiving Awiqli during the trials (ONWARDS 1-5):

• • diarrhea
  • nasopharyngitis
  • upper respiratory tract infection
  • back pain
  • headache
  • nausea
  • dizziness

Since Awiqli is given as a shot, it’s also possible to experience injection site reactions. These can include:

• • itching
  • redness
  • swelling
  • bruising
  • pain
  • a small lump under the skin
  • skin rash or sensitivity around the injection site

In clinical studies, about 1.6% of people using Awiqli reported these kinds of injection site reactions.

Another thing to be aware of is possible weight gain. This can happen with many types of insulin. In studies lasting 26 to 52 weeks, people with type 2 diabetes gained an average of 1.4 to 2.8 kg (about 3-6 lbs) with Awiqli. Weight gain varies from person to person and may depend on diet, activity level, and how your body responds to insulin.

Who shouldn’t use Awiqli?

Some people should avoid using Awiqli. These include:

• • Anyone allergic to insulin icodec, or any ingredients in Awiqli: In rare cases, Awiqli can cause serious allergic reactions that affect the whole body. These may include:

• • • • trouble breathing
      • swelling of the face or lips
      • skin rashes or hives
      • low blood pressure
      • shock

In clinical trials, about 0.4% of people using Awiqli experienced allergic reactions like swelling or hives.

• • Pregnant women: Awiqli is not recommended during pregnancy, as it hasn’t been well studied in pregnant individuals.

• • Breastfeeding mothers: It’s also advised not to use Awiqli while breastfeeding, as it’s unclear how it may affect the baby.

• • Children and teens: Awiqli has not been tested in pediatric patients, so its safety and effectiveness in this group are unknown.

How much does Awiqli cost?

Novo Nordisk has not yet released official US pricing for Awiqli. The drug was approved by the FDA in March 2026, but it’s not on the market yet.

As a reference, here’s the price Novo Nordisk proposed to Canadian health authorities when it got approved in Canada in 2024:

• • $78.05 for a 1.5 mL pen (contains 1,050 units of insulin icodec)
  • $156.10 for a pack of two pens totaling 3 mL (2 × 1,050 units = 2,100 units)

The estimated yearly cost of using Awiqli depends on how much insulin a person typically needs and their experience with insulin use:

• • $1,148/year for those new to insulin
  • $1,230/year for those already using basal insulin
  • $1,956/year for people using both basal and bolus insulin (more complex regimens requiring higher doses)

Actual retail prices may vary. Awiqli may be priced similarly to other long-acting insulins, though US pricing has not yet been announced.

Bottom line

Awiqli is a once-weekly insulin that helps manage blood sugar in adults with type 2 diabetes. It contains insulin icodec, which stays in the body longer by slowly releasing over time. Studies show Awiqli works just as well as daily insulins like degludec and glargine.

It comes in a pre-filled pen and is injected under the skin. Doses are customized based on your current insulin needs. Common side effects include hypoglycemia, weight gain, and mild injection site reactions. It offers a simpler and more convenient insulin option for many people living with diabetes.

Frequently Asked Questions

Sources

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Philis-Tsimikas, A., Asong, M., Franek, E., Jia, T., Rosenstock, J., Stachlewska, K., Watada, H., & Kellerer, M. (2023). Switching to once-weekly insulin icodec versus once-daily insulin degludec in individuals with basal insulin-treated type 2 diabetes (ONWARDS 2): a phase 3a, randomised, open label, multicentre, treat-to-target trial. The Lancet Diabetes & Endocrinology, 11(6), 414–425. https://doi.org/10.1016/s2213-8587(23)00093-1

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Mathieu, C., Ásbjörnsdóttir, B., Bajaj, H. S., Lane, W., Matos, A. L. S. A., Murthy, S., Stachlewska, K., & Rosenstock, J. (2023). Switching to once-weekly insulin icodec versus once-daily insulin glargine U100 in individuals with basal-bolus insulin-treated type 2 diabetes (ONWARDS 4): a phase 3a, randomised, open-label, multicentre, treat-to-target, non-inferiority trial. The Lancet, 401(10392), 1929–1940. https://doi.org/10.1016/s0140-6736(23)00520-2

PR Newswire. (2026). FDA approves Novo Nordisk’s Awiqli®, the first and only once-weekly basal insulin treatment for adults with type 2 diabetes. 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

FDA. (2026). HIGHLIGHTS OF PRESCRIBING INFORMATION OF AWIQLI. https://www.novo-pi.com/awiqli.pdf

Once-weekly Long-acting Insulin | Awiqli® (insulin icodec) injection 700 U/mL. (n.d.). https://www.awiqli.com/

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