The FDA has officially approved the first once-weekly basal insulin—Awiqli (icodec)—from Novo Nordisk for adults with type 2 diabetes. Instead of taking a basal insulin every single day, this option could mean just one injection per week—which is a pretty dramatic shift in how insulin therapy can look and feel in real life.
This isn’t brand new globally. It’s already approved in places like Europe, Canada, and Japan. But in the U.S., the process hit some speed bumps—mainly around safety concerns for people with type 1 diabetes. Ultimately, the FDA said no for T1D (due to hypoglycemia concerns), but yes for T2D, where the data looked solid.
Those decisions were based on several large clinical trials (the ONWARDS program), where weekly icodec performed just as well—and sometimes better—than traditional daily basal insulin at lowering blood sugar. So from a pure efficacy standpoint, it checks the box.
But diabetes management isn’t just about averages—it’s about day-to-day life.
And that’s where this gets more complicated.
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Your insulin needs aren’t static. They shift constantly based on things like activity, stress, hormones, illness, sleep, and even something as simple as taking a long walk or having a more active weekend. With daily insulin, you at least have the ability to adjust more frequently. With a once-weekly insulin, you’re essentially “locking in” a dose that has to carry you through all those variables.
That doesn’t mean it’s a bad option—it just means it’s not a flexible one.
Some of the trial data did show slightly higher rates of hypoglycemia with icodec, though not significantly higher. Still, in the real world—where people aren’t being closely monitored like they are in a study—that risk could play out differently.
On the flip side, adherence is a very real challenge. Missing daily injections is common, and for some people, a once-weekly option could dramatically improve consistency and overall outcomes.
So who is this great for? Likely people with more predictable routines, higher A1C levels, or those who struggle to stick with daily injections.
Who might need to be more cautious? People with highly variable schedules, frequent activity changes, or tighter glucose targets.
Bottom line: this is a meaningful step forward—but it’s not a magic solution. It’s another tool, and like any diabetes tool, it has to be matched to the right person.
If you’re starting something like this, education is everything—especially around hypoglycemia—and using a CGM would make a huge difference in staying safe.
Awiqli is expected to be available in the U.S. soon. And not surprisingly, Eli Lilly is right behind them, developing their own once-weekly basal insulin, efsitora alfa.
Ginger Vieira has lived with type 1 diabetes since 1999 along with a few other chronic illnesses! She is the Cofounder of the Diabetes Nerd Network and the Diabetes Nerd Marketing agency. Ginger has authored hundreds of articles and several books, including Exercise with Type 1 Diabetes, Pregnancy with Type 1 Diabetes, Dealing with Diabetes Burnout, and Stop Overeating During Lows. Over her 20-year career (so far) in diabetes, she’s produced hundreds of articles and videos about life with diabetes. Her background includes a Bachelor of Science in professional writing and certifications in coaching, personal training, powerlifting, and Ashtanga yoga. Find Ginger’s YOUTUBE, PODCAST, INSTAGRAM, and LINKEDIN.