For decades, people using basal insulin have usually needed daily injections. Once-weekly insulin changes this routine by providing background insulin coverage for seven days with a single injection.
The best-known once-weekly basal insulin is insulin Icodec, marketed as Awiqli. It can reduce basal insulin injections from around 365 per year to 52.
However, weekly insulin is not suitable for everyone. It still requires accurate dosing, regular glucose monitoring and proper medical supervision.
What Is Weekly Insulin?
Weekly insulin is an ultra-long-acting basal insulin. Basal insulin provides steady background insulin between meals and during sleep.
Insulin icodec binds to albumin in the bloodstream and is slowly released over seven days. It is injected under the skin once a week, preferably on the same day.
Weekly insulin is not mealtime insulin. People who need insulin around meals may still require rapid-acting insulin separately.
How Effective Is Weekly Insulin?
Clinical studies have compared once-weekly insulin icodec with daily basal insulins such as insulin glargine and insulin degludec.
In adults with type 2 diabetes starting insulin, weekly insulin provided glucose control that was comparable to daily basal insulin. Some studies also showed a slightly greater improvement in HbA1c.
Its effectiveness depends on:
- The starting glucose level
- Insulin sensitivity
- Kidney and liver function
- Diet and physical activity
- Other diabetes medicines
- Correct weekly dosing
Main Benefits
Fewer Injections
One injection per week can significantly reduce the physical and emotional burden of daily insulin therapy.
This may help people who delay insulin because of needle fear, busy schedules, travel or difficulty remembering daily doses.
Better Treatment Adherence
Weekly dosing may reduce the number of missed injections.
However, missing one weekly dose may have a greater impact than missing one daily dose. Patients still need reminders and a consistent routine.
Easier Insulin Initiation
Many people with type 2 diabetes hesitate to start insulin because daily injections feel complicated. Weekly insulin may make the decision less intimidating.
Steady Background Coverage
Insulin icodec is designed to provide continuous basal insulin activity throughout the week.
Is Weekly Insulin Safe?
Weekly insulin can be safe when prescribed and monitored correctly. Its main risk is hypoglycaemia, or low blood glucose.
Hypoglycaemia
Low glucose may occur when:
- The weekly dose is too high
- Meals are skipped
- Physical activity increases
- Alcohol is consumed
- Kidney or liver function declines
- Other glucose-lowering medicines are used
Because weekly insulin remains active for several days, the risk of hypoglycaemia may continue longer than with shorter-acting insulin.
Patients should recognise symptoms such as sweating, trembling, hunger, weakness, dizziness and confusion.
Risk of Dosing Errors
Insulin icodec is a highly concentrated insulin. Confusing it with daily insulin or injecting it more than once a week could cause a serious overdose.
Patients should always:
- Check the insulin name
- Confirm the prescribed weekly dose
- Use it only once every seven days
- Never withdraw insulin from the pen using a syringe
- Never share the insulin pen
Injection-Site Reactions
Some patients may experience redness, itching, swelling or discomfort at the injection site. Injection areas should be rotated.
Weight Gain
As with other insulin treatments, some people may gain weight. Diet, physical activity and overall diabetes treatment should be reviewed regularly.
Weekly Insulin in Type 1 Diabetes
Weekly insulin requires greater caution in type 1 diabetes.
Where approved, it must be combined with rapid-acting mealtime insulin. Weekly insulin cannot control the glucose rise after meals.
Some studies reported a higher risk of clinically significant hypoglycaemia in people with type 1 diabetes compared with daily basal insulin.
For this reason, weekly insulin may currently be more suitable for selected adults with type 2 diabetes.
Who May Benefit Most?
Weekly insulin may be considered for adults who:
- Need basal insulin
- Find daily injections difficult
- Frequently forget daily basal insulin
- Can monitor glucose regularly
- Understand the difference between weekly and daily insulin
- Have reliable medical follow-up
Extra caution may be needed in people who:
- Frequently experience severe hypoglycaemia
- Have irregular food intake
- Have major changes in activity levels
- Have kidney or liver impairment
- Cannot follow dosing instructions reliably
- Cannot monitor glucose consistently
Can Weekly Insulin Replace All Injections?
No.
Weekly insulin replaces basal insulin injections, not all diabetes injections.
People who require mealtime insulin may still need rapid-acting insulin before meals. Other diabetes medicines may also continue.
It should therefore be described as once-weekly basal insulin, not as a complete replacement for diabetes treatment.
What Happens If a Dose Is Missed?
Patients should not guess the dose or take an extra injection without advice.
Instructions may differ depending on the product and the time since the missed dose. Patients should follow the product leaflet and contact their diabetes-care team.
Because the medicine remains active for an entire week, changing the schedule without medical guidance may cause unstable glucose or hypoglycaemia.
Final Verdict
Weekly insulin is an important development in diabetes treatment.
It can reduce injection frequency, simplify basal insulin therapy and provide glucose control comparable to daily basal insulin for many adults with type 2 diabetes.
However, convenience does not remove risk. A weekly injection contains several days of insulin, so dosing mistakes may be more serious and harder to correct.
For the right patient, once-weekly insulin may significantly reduce the burden of treatment. Proper patient selection, glucose monitoring and specialist supervision remain essential.
Medical Disclaimer
This article is intended for general educational purposes only. It does not provide medical advice, diagnosis or an individual treatment recommendation.
Weekly insulin is a prescription medicine that may cause severe or prolonged hypoglycaemia. Do not start, stop, switch or adjust insulin without consulting a qualified diabetologist or endocrinologist. Approved uses and availability may differ between countries.