Awiqli (insulin icodec) is the first once-weekly basal insulin available in the United States, FDA approved in March 2026 for adults with type 2 diabetes. One injection covers a full week of background insulin, which for a daily-basal patient means going from 365 shots a year to 52. The catch you won’t see in the headline: it’s approved for type 2 diabetes only, not type 1.
Dr. Van Dyke here, board certified endocrinologist. Hot off the presses: there’s a new long-acting, or basal, insulin on the market, and it’s a real change in how often patients inject. It’s called Awiqli, the molecule is insulin icodec, it comes from Novo Nordisk, and the headline feature is right in the schedule. It’s once a week. Let’s talk about what it is, who it helps, and the honest limitations, because a couple of them matter.
Key Takeaways
- Awiqli (insulin icodec) is the first and only once-weekly basal insulin in the US, FDA approved in March 2026.
- One injection covers a full week, moving a daily-basal patient from 365 injections a year to 52.
- It works by binding reversibly to albumin in your blood, creating a slow-release reservoir that keeps insulin steady across the week.
- It’s approved for type 2 diabetes only. It’s not approved for type 1, largely over low-blood-sugar risk.
- Because a weekly dose is committed for the week, switching is a planned, supervised transition, not a same-day swap.
What is Awiqli (insulin icodec)?
Basal insulin is the background insulin. It’s the steady, all-day baseline your body needs whether or not you’re eating, as opposed to the fast-acting mealtime insulin you take with food. Up to now, basal insulins have been daily injections.
Awiqli changes the schedule from daily to weekly. One injection covers a full week of background insulin. For a patient who was taking a basal shot every single day, that’s a move from 365 injections a year to 52.
How is a once-weekly insulin even possible?
Fair question, because it sounds like it shouldn’t work. Insulin icodec is engineered to bind reversibly to albumin, a protein that circulates in your blood. That binding creates a slow-release reservoir: the insulin is held and released gradually over the week, keeping a steady level in your system instead of a daily peak-and-fade.
To this point, my go-to long-acting insulin has been insulin degludec, known as Tresiba, precisely because it’s so long-acting and so stable. It lasts well beyond 24 hours, gives you good overlap between doses, and produces a flat, predictable curve. Icodec takes that same design goal, stability and overlap, and stretches it to a full week.
Who is Awiqli approved for?
Here’s the single most important line in this article, and it’s the one your headline probably didn’t tell you.
Awiqli is approved for type 2 diabetes only. It’s not approved for type 1 diabetes.
I want to be clear about that, because I know how a “new insulin” headline reads to a type 1 family. In the approval process, concerns came up about the risk of low blood sugar in people with type 1 specifically, and the once-weekly design makes that risk harder to manage in that group, because you can’t pull a week’s worth of insulin back out once it’s in. So for now, this is a type 2 diabetes medication. The type 1 question isn’t settled, and I’m not going to pretend it is.
Within type 2 diabetes, Awiqli is indicated as an add-on to diet and exercise for adults, and it was studied across a large phase 3 program covering thousands of patients, where once-weekly icodec matched or outperformed daily basal insulin on blood sugar control.
How does Awiqli compare to Tresiba (insulin degludec)?
Both are long-acting, stable basal insulins. The headline difference is the schedule.
| Feature | Awiqli (insulin icodec) | Tresiba (insulin degludec) |
|---|---|---|
| Class | Long-acting basal insulin | Long-acting basal insulin |
| Frequency | Once weekly | Once daily |
| Duration | Full week | Beyond 24 hours |
| Curve | Flat, steady | Flat, steady |
| Approved for | Type 2 diabetes | Type 1 and type 2 diabetes |
For the right type 2 patient, the appeal of Awiqli is obvious: fewer injections, fewer things to remember, less daily friction. For a patient who needs the flexibility of daily titration, or who has type 1, a daily basal like Tresiba is still the tool.
What are the risks of a once-weekly insulin?
The main one to understand is timing. With any insulin, the risk is low blood sugar. With a weekly insulin, the dose is committed for the week. That’s the convenience, and it’s also the caution: dose adjustments take effect more slowly, and if something changes in your routine, illness, a big change in eating, new medications, you and your care team have to think a week ahead, not a day ahead.
That’s exactly why a switch to weekly insulin is a supervised transition, not a same-day swap at the pharmacy counter. The starting dose and the move from your current basal have to be planned, and the first few weeks should be watched closely.
How we handle an insulin transition
Changing a basal insulin isn’t the kind of thing you should do and then wait six months to see how it went. For my diabetes patients, we will watch this transition closely, maybe reviewing CGM patterns once every couple weeks.
The takeaway
Awiqli, insulin icodec, is a real milestone: the first once-weekly basal insulin, approved for type 2 diabetes, engineered for the same stability as the best daily long-acting insulins with a fraction of the injections. It’s not for type 1 diabetes yet, and the switch has to be planned and monitored because a weekly dose is committed for the week. For the right type 2 patient, going from a daily shot to a weekly one is a genuine quality-of-life change. Whether you’re that patient is a conversation with your endocrinologist.
Frequently asked questions
What is Awiqli?
Awiqli (insulin icodec) is the first once-weekly basal, or long-acting, insulin approved in the United States. It’s made by Novo Nordisk and was FDA approved in March 2026 for adults with type 2 diabetes.
Is once-weekly insulin approved for type 1 diabetes?
No. Awiqli is approved for type 2 diabetes only. Concerns about low blood sugar in type 1 diabetes kept it from approval in that group for now.
How does once-weekly insulin work?
Insulin icodec binds reversibly to albumin, a blood protein, creating a slow-release reservoir that keeps insulin levels steady across a full week from a single injection.
Awiqli vs Tresiba, what’s the difference?
Both are stable long-acting insulins. Awiqli is once weekly and approved for type 2 diabetes. Tresiba (insulin degludec) is once daily and approved for both type 1 and type 2 diabetes.
Can I switch to weekly insulin on my own?
No. Moving to a once-weekly insulin should be a planned, supervised transition with close monitoring in the first weeks, because a weekly dose is committed for the whole week and adjustments take effect more slowly.
Wondering whether once-weekly insulin fits your diabetes plan? Book a visit at the Advanced Institute for Diabetes & Endocrinology. We see patients in Mansfield, Texas in the office and remotely across seven states.
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Sources: Novo Nordisk: FDA approves Awiqli · HCPLive: FDA Approves Insulin Icodec (Awiqli) · AJMC: FDA Approves Novel Weekly Basal Insulin