No More Daily Insulin Injections? Once-Weekly Insulin Explained

By Dr. Moxit Shah, DM Endocrinology | Vishuddha Diabetes, Thyroid, Weight Loss Clinic, Ahmedabad

Can You Really Replace Daily Insulin With One Weekly Injection?

For selected adults with type 2 diabetes who need background (basal) insulin, a once-weekly option called insulin icodec (Awiqli) may reduce basal injections from about 365 to 52 per year. It does not cure diabetes or automatically replace mealtime insulin. Never change your insulin without medical supervision.

What Is Once-Weekly Insulin Icodec?

Insulin icodec is a long-acting basal insulin designed for dosing every seven days. Its reversible binding to albumin helps provide sustained insulin activity. It is not the same as weekly GLP-1 medicines such as semaglutide or tirzepatide, which are not insulin.

Who Might Benefit?

Selected adults with type 2 diabetes starting basal insulin or already taking a daily basal insulin may benefit from fewer injections. Suitability depends on HbA1c, fasting glucose, hypoglycaemia history, kidney function, concurrent medicines, affordability and local product availability. People who need rapid-acting insulin at meals may still require those injections.

What Do Clinical Trials Show?

The ONWARDS trials compared once-weekly insulin icodec with established daily basal insulins. ONWARDS 1 showed effective HbA1c lowering compared with daily glargine U100, while ONWARDS 3 showed effective glucose lowering compared with daily degludec. Clinically significant or severe hypoglycaemia was more frequent with icodec in some comparisons. Fewer injections should never be confused with zero risk.

Safety: What Patients Must Know

Low blood glucose can cause sweating, shaking, palpitations, hunger, dizziness and confusion. Severe episodes can cause loss of consciousness or seizures. Weight gain, injection-site reactions and allergy are also possible. Because a weekly dose has prolonged action, dose errors can be especially consequential. Patients need glucose monitoring, education about treating hypoglycaemia and an individualized titration plan.

How Does It Compare With Daily Basal Insulin?

Daily glargine or degludec generally requires one basal injection each day. Icodec is designed for one basal injection every week. Both aim to control background glucose and both require monitoring. Daily regimens may be more suitable when insulin requirements change rapidly or more dosing flexibility is needed. The choice should be individualized.

Can I Switch From Glargine or Degludec?

Possibly, but only under an endocrinologist’s supervision. Weekly insulin doses cannot be chosen simply by copying a daily dose. Conversion, initial dosing, weekly adjustments and missed-dose advice must follow the locally approved prescribing information. Never self-convert or combine regimens without clear instructions.

Is Awiqli Available in India?

Regulatory review, marketing authorization, commercial launch and pharmacy availability are different milestones. Patients in Ahmedabad should confirm current Indian approval details, approved indication, local stock and price before making treatment decisions. No unverified retail price is quoted here.

Frequently Asked Questions

Will I never need a daily insulin injection again?

Some people using basal insulin alone may switch to weekly basal injections. Those needing mealtime insulin may still require daily injections.

Is weekly insulin a tablet?

No. Icodec is an injectable insulin.

Does it cure diabetes?

No. It helps manage blood glucose.

Can I stop diabetes tablets?

Not automatically. Other medicines may still be needed.

Is weekly insulin safer?

Not necessarily. Hypoglycaemia remains an important risk and must be discussed with your clinician.

Consult a Diabetes Specialist in Ahmedabad

For individualized advice about insulin treatment, consult Dr. Moxit Shah, DM Endocrinology, Vishuddha Diabetes, Thyroid, Weight Loss Clinic, 104–105, Elite Magnum, Bhuyangdev Cross Road, Ghatlodiya, Ahmedabad – 380061, Gujarat, India. Appointments: +91 99799 92797.

References and Disclaimer

Rosenstock J et al. Once-weekly insulin icodec versus daily glargine U100, ONWARDS 1. New England Journal of Medicine, 2023.
Lingvay I et al. Once-weekly icodec versus daily degludec, ONWARDS 3. JAMA, 2023.
ONWARDS 6 trial: insulin icodec in type 1 diabetes.
Current local product prescribing information and regulatory notices should be consulted before prescribing.

Educational information only. Never start, stop or change insulin without medical supervision.