Awiqli
Awiqli, the brand name for insulin icodec-abae, is an ultra-long-acting insulin. It's used to manage blood sugar levels in adults with Type 2 diabetes. Awiqli (insulin icodec) comes as a FlexTouch pen containing 700 units of insulin/mL. It's the first insulin that's injected under the skin just once a week. Side effects include injection site reactions and low blood sugar (hypoglycemia). Awiqli (insulin icodec) is expected to be available in the second half of 2026.
What is Awiqli (insulin icodec)?
What is Awiqli (insulin icodec) used for?
- Type 2 diabetes in adults
How Awiqli (insulin icodec) works
Awiqli (insulin icodec) is an insulin. Insulin is a natural hormone your body makes to control blood glucose (sugar) levels. It helps your body absorb and store sugar from your blood. Insulin also stops your liver from making glucose.
In particular, Awiqli (insulin icodec) is called an ultra-long-acting insulin. It helps control blood sugar levels throughout the day. It's helpful for people with Type 2 diabetes who don't respond well to their natural insulin as they used to.
Drug facts
| Common Brands | Awiqli |
|---|---|
| Drug Class | Insulin |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | No lower-cost generic available |
| Availability | Prescription only |
Side effects of Awiqli (insulin icodec)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low blood sugar
Less Common Side Effects
- Injection site reaction (e.g., itching, bruising, redness, pain, swelling, hives)
- Swelling in the arm, leg, or ankle
- Weight gain
Awiqli (insulin icodec) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severely low blood sugar: dizziness, shakiness, feeling confused, feeling irritable or anxious, feeling faint, sweating, extreme hunger, can't think clearly
- Very low potassium: weakness, muscle cramps or twitches, constipation, abnormal heartbeat, tiredness, trouble breathing
- Severe allergic reaction: rash; hives; swelling of your face, tongue, or throat; trouble breathing; very low blood pressure
Pros and cons of Awiqli (insulin icodec)
Pros
- Injected once a week (fewer injections)
- More flexibility in daily routine
- Starts to work within a few hours of injecting
- Steady blood sugar control over a whole week with one injection
Cons
- Possible to cause low blood sugar levels
- Might cause some weight gain
- Can't mix with other insulins or use in an insulin pump
- Not approved for Type 1 diabetes
Pharmacist tips for Awiqli (insulin icodec)
- Inject Awiqli (insulin icodec) once a week. Choose a day of the week that's easy for you to remember and try to stick to the same day each week. This will help the medication work consistently for you. Ask your care team what to do if you want to change the day of the week you inject.
- If you miss a dose of Awiqli (insulin icodec): If it's within 4 days of your usual day, inject the medication as soon as you remember. Then, your next injection will be one week from the day you took your missed dose. If more than 4 days have passed, skip the missed dose and take your next dose on your usual day. Check your blood sugar more often when you miss a dose.
- Ask your prescriber how often you should check your blood sugar while taking Awiqli (insulin icodec). Write down your blood sugar readings and bring your log to your appointments. This helps you and your prescriber see how well the medication is working and if you need dose adjustments.
- Awiqli (insulin icodec) can sometimes cause low blood sugar. It's important for you and the people around you to know how to spot and treat low blood sugar. Watch for symptoms like shakiness, lightheadedness, anxiety, sweating, or hunger. Always carry fast-acting sugars so you can bring your blood sugar up if it gets too low. Very low blood sugar can be dangerous and needs to be treated right away.
- You can use Awiqli (insulin icodec) with other types of insulin, like mealtime insulin. Before each injection, double check that you're using the right insulin at the right dose and time. This helps prevent dosing mistakes that could cause your blood sugar to drop too low if you accidentally use too much insulin.
- How to store Awiqli (insulin icodec): Store unopened pens in the fridge. They can also be kept at room temperature (up to 86°F). Keep any opened pens (those that you've started using) either in the fridge or at room temperature. Unopened and opened pens kept at room temperature are both good for 12 weeks. So, be sure to write down the date it will expire (in 12 weeks) so you don't use it after that.
How to use and how to inject Awiqli (insulin icodec):
- Your care team will teach you how to use and inject Awiqli (insulin icodec). Carefully read the the Instructions for Use. Ask your care team if you have any questions.
- Before you inject Awiqli (insulin icodec): Check that you're using the right insulin at the right time. Make sure the insulin in the pen is clear and colorless without any particles (solid chunks). If it isn't, don't use the pen and ask your pharmacist for a replacement.
- Always use a new needle for each Awiqli (insulin icodec) injection. This helps prevent infections and blocked needles. Don't reuse or share your needles with others to avoid spreading infections.
- Attach a new needle onto the Awiqli (insulin icodec) pen: Tear off the paper tab, push the needle straight onto the pen, and twist it on tightly. Put the needle on the pen only when you're ready for your injection. Remove both caps on the needle for the injection.
- Check the pen flow before each Awiqli (insulin icodec) injection: Turn the dose selector so the pointer lines up with the 10-units mark (the first dash line). Hold the pen with the needle up. Then, press and hold the dose button until the dose counter goes to "0." You should see a drop of insulin at the tip. Checking the flow makes sure the pen is working and you get your full dose.
- Where to inject Awiqli (insulin icodec): Inject the medication under the skin into the fatty tissue. You can inject into your stomach area (2 inches away from your belly button), thigh, or the back of your upper arm. You can inject into the same body area each week, but don't use the exact same spot as last time.
- How to inject Awiqli (insulin icodec): Turn the dose selector to your prescribed number of units. Clean the area of skin with an alcohol wipe and let it dry. Then, insert the needle straight into your skin and hold down the dose button. After the dose counter reaches "0," keep pressing the button with the needle in your skin and slowly count to 6. Then, pull the needle straight out and take it off from the pen.
- Throw away used needles and empty Awiqli (insulin icodec) pens: Throw away all used needles and pens in a sharps container. You can also use a heavy-duty container, like an empty milk carton or laundry detergent bottle. This helps keep you and others safe from needle sticks. Don't throw away needles and pens in your regular trash can.
Risks and warnings for Awiqli (insulin icodec)
Awiqli (insulin icodec) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of infections with pen sharing
Never share Awiqli (insulin icodec) pens with anyone, even after you change the needle. Sharing pens can spread serious infections and is dangerous for both people.
Risk of too high or too low blood sugar with changes to your insulin regimen
Changing your insulin or insulin routine can affect your blood sugar levels. This includes where you inject Awiqli (insulin icodec), the insulin brand name you use, or your dose. Depending on the change, it can make your blood sugar get too high or too low. Also, injecting insulin into thickened or pitted areas of skin too often can make your body absorb less insulin. This can make your blood sugar higher.
Don't make changes to your Awiqli (insulin icodec) dose or routine without talking to your diabetes care team. If they tell you to make changes, be sure to check your blood sugar more often. This helps you see how the changes affect your blood sugar.
Low blood sugar levels (hypoglycemia)
- Risk factors: Changes to diet, meal patterns, or exercise routine | Drinking alcohol | Taking other diabetes medications at the same time | Liver or kidney problems
Awiqli (insulin icodec) can cause low blood sugar, or hypoglycemia. Sometimes, it can drop dangerously low and can be life-threatening if not treated in time.
Check your blood sugar regularly to make sure it's in a safe range. Also tell your care team if you change your diet, meal patterns, other medications, or exercise routine. These can affect your blood sugar and your care team might need to adjust your treatment plan to keep you safe.
Be familiar with symptoms of hypoglycemia. This includes feeling shaky, nervous, anxious, or very hungry. You also might be sweaty or have body chills. Keep fast-acting sugars, such as glucose tablets, with you at all times. This can help you treat hypoglycemia quickly if needed. If your blood sugar doesn't improve, get medical help right away.
Low potassium levels
- Risk factors: Taking other medications that lower potassium
Awiqli (insulin icodec) can lower your potassium levels, which can sometimes be dangerous. The risk is greater if you also take other medications that lower potassium, such as some diuretics. If needed, your prescriber might check your potassium with blood tests.
It's a good idea to know the signs and symptoms of low potassium. These include weakness, muscle cramps or twitches, constipation, or a racing heart. If you have these symptoms while using Awiqli (insulin icodec), call a healthcare professional.
Swelling and risk of heart failure when used with certain diabetes medications
- Risk factors: Taking glitazones together with Awiqli (insulin icodec) | History of heart failure
Be careful when taking Awiqli (insulin icodec) with diabetes medications called glitazones, like pioglitazone (Actos). It can make your body hold onto extra fluid. This can put stress on your heart and can lead to or worsen heart failure. It can cause symptoms such as trouble breathing or feeling more tired when you try to exercise.
Tell your prescriber if you have heart failure before starting Awiqli (insulin icodec). Also let them know about all the diabetes medications you take so they can check your risk. Your prescriber can make sure Awiqli (insulin icodec) is safe for you.
Call your care team if you notice unusual sudden weight gain, swelling, or trouble breathing while using Awiqli (insulin icodec). These can be signs of fluid buildup or heart failure.
Allergic reactions
In rare cases, Awiqli (insulin icodec) can cause a serious, life-threatening allergic reaction. This can include anaphylaxis. Get medical help right away if you have an allergic reaction. Look out for any swelling in your face, lips, or tongue; rash; or trouble breathing.
Awiqli (insulin icodec) dosage
Typical dosage for Awiqli (insulin icodec)
Your prescriber will work with you to find the dose that works best for you. Your dose depends on your blood sugar levels and how you respond to the medication.
Awiqli (insulin icodec) is injected under the skin into the thigh, upper arm, or stomach. It's injected once a week.
- First time using insulin: The typical starting dose is 70 units injected under the skin once a week.
- Switching from another long-acting insulin to Awiqli (insulin icodec): Your care team will help figure out your starting dose for Awiqli (insulin icodec). This is based on the dose of the long-acting insulin you were using before.
Note: Awiqli contains 700 units of insulin/mL. This is different than the typical amount in most other insulins.
Awiqli (insulin icodec) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Awiqli (insulin icodec) will not be safe for you to take.
- Using during episodes of low blood sugar (hypoglycemia)
