Awiqli

Awiqli (insulin icodec) is a once-weekly basal insulin used for adults and children 10 years of age and older with type 2 diabetes to improve blood sugar control without the need for daily basal injections. It should be used together with diet and exercise.

Awiqli is injected under the skin once a week on the same day each week using the FlexTouch pen. This once-weekly insulin option may help simplify basal insulin treatment for adults and children 10 years of age and older who are managing type 2 diabetes.

Novo Nordisk announced the nationwide launch of Awiqli (insulin icodec-abae) on August 11, 2026. In October 2026, the approved use was expanded to include children 10 years of age and older with type 2 diabetes. The pediatric approval is supported by the adult clinical trials together with a pharmacokinetic study in children 10 years of age and older. Awiqli has not been studied in children younger than 10.

In a 52-week trial, once-weekly Awiqli lowered average blood sugar (A1C) slightly more than daily insulin glargine U-100 in adults with type 2 diabetes who were new to insulin (Trial A, NCT04460885). People taking Awiqli also spent about 4% more time in the target blood sugar range of 70 to 180 mg/dL during the last 4 weeks of the trial, which works out to roughly one extra hour per day.

A separate 26-week trial (Trial D, NCT04880850) looked at people already taking both a daily basal insulin and mealtime insulin. In that trial, blood sugar control with once-weekly Awiqli was comparable to daily insulin glargine U-100 when both were used alongside mealtime insulin aspart.

• Read the Instructions for Use that come with your Awiqli FlexTouch pen before starting treatment.
• Your healthcare provider should show you how to use the pen properly before your first dose.
• Use Awiqli exactly as prescribed. Do not convert your dose, because the dose counter shows the correct dose in units.
• Make sure you know the type and strength of insulin you are using. Do not switch insulins unless your healthcare provider tells you to.
• Awiqli is once-weekly insulin for type 2 diabetes; it should be injected once a week on the same day each week.
• If you need to change your dosing day, you can do so as long as at least 4 days have passed since your last dose.
• Check your blood sugar as directed by your healthcare provider, and ask what your target levels should be, and when to test them.
• Inject Awiqli only under the skin, not into a vein or muscle, and do not use it in an insulin pump.
• Never use a syringe to remove Awiqli from the FlexTouch pen.
• Never dilute or mix Awiqli with any other insulin or solution.
• Awiqli can be injected under the skin of the thighs, upper arms, or abdomen.
• Rotate your injection site with each dose to help reduce the risk of skin changes such as thickened skin, pits, or lumps.
• Do not inject into the exact same spot every time.
• Do not inject into skin that is thickened, pitted, lumpy, tender, bruised, scaly, hard, scarred, or damaged.

Awiqli carries some serious risks, including side effects that may be life-threatening and safety issues around how the pen is used. Talk to your healthcare provider about these before you start treatment, and about what to watch for once you do.

Low blood sugar from medication mistakes or accidental overdose:Taking the wrong insulin or diabetes medicine by mistake can cause dangerously low blood sugar. Always check the label before each injection to make sure you are using Awiqli and not a different insulin or injectable diabetes medication. Never remove Awiqli from the FlexTouch pen with a syringe, because this can lead to taking too much insulin and may cause severe low blood sugar.

Low blood sugar (hypoglycemia):Low blood sugar can be serious and may become life-threatening. Your risk may increase if your insulin dose changes, if you take other diabetes medicines, change your eating habits, become more or less active, or if you have kidney or liver problems. Some people may also have trouble noticing the warning signs of low blood sugar, so careful blood sugar monitoring is important.

High or low blood sugar when changing insulin treatment:Switching to a different insulin, changing your dose, changing how you take it, or even using a different injection site can affect your blood sugar levels. These changes should only be made under close medical supervision, with more frequent blood sugar checks.

Serious allergic reactions:Awiqli can cause severe allergic reactions that may be life-threatening, including anaphylaxis. Stop using Awiqli and get medical help right away if you develop symptoms of an allergic reaction such as rash, hives, itching skin, swelling of face, lips or eyes, trouble breathing, or a fast or weak pulse (heartbeat).

Low potassium levels:Awiqli may cause low potassium levels in the blood (hypokalemia), which can be serious. Your healthcare provider may monitor this if you are at risk.

Do not share your pen:Never share your Awiqli FlexTouch pen with anyone else, even if the needle has been changed. Sharing the pen can spread serious infections.

Heart failure risk with certain diabetes medicines:If Awiqli is used together with diabetes medicines called TZDs (thiazolidinediones), it may increase the risk of fluid retention and heart failure. Contact your healthcare provider if you notice symptoms such as shortness of breath, swelling in your feet or ankles, or sudden weight gain.

Do not take Awiqli if you:

• are having an episode of low blood sugar (hypoglycemia)
• have an allergy to Awiqli (icodec-abae) or any of the inactive ingredients.

Before starting Awiqli, tell your healthcare provider about all of your medical conditions, including if you:

• have liver or kidney problems.
• take other medicines, especially TZDs (thiazolidinediones)
• have heart failure or other heart problems. If you have heart failure, it may get worse while you take TZDs with Awiqli
• are pregnant, planning to become pregnant, or breastfeeding.

Before using Awiqli, talk with your healthcare provider about low blood sugar, including how to recognize it and how to manage it safely.

Common Awiqli side effects

The most common Awiqli side effects are low blood sugar levels (hypoglycemia), serious allergic reactions (whole body reactions), reactions at the injection site, skin thickening or pits at the injection site (lipodystrophy), itching, rash, swelling of your hands and feet, and weight gain.

Serious side effects

This medicine may cause serious side effects that can lead to death, including:

Low blood sugar (hypoglycemia). Signs and symptoms that may indicate low blood sugar include:

• dizziness or light-headedness
• blurred vision
• anxiety, irritability, or mood changes
• sweating
• slurred speech
• hunger
• confusion
• shakiness
• headache
• fast heartbeat

Severe allergic reaction (whole body reaction). Stop using Awiqli and get medical help right away if you have any of these signs or symptoms of a severe allergic reaction including difficulty breathing, swelling of the face, lips, eyes, throat or tongue, widespread hives or itching, dizziness, and stomach pain with vomiting

Low potassium in your blood (hypokalemia).

Heart failure. Taking certain diabetes pills called thiazolidinediones or “TZDs” with Awiqli may cause heart failure in some people. This can happen even if you have never had heart failure or heart problems before. If you already have heart failure, it may get worse while you take TZDs with Awiqli. Your healthcare provider should monitor you closely while you are taking TZDs with Awiqli. Tell your healthcare provider if you have any new or worse symptoms of heart failure, including shortness of breath, tiredness, swelling of your ankles or feet, and sudden weight gain. Treatment with TZDs and Awiqli may need to be adjusted or stopped by your healthcare provider if you have new or worse heart failure.

These are not all the possible side effects of Awiqli. Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Inject Awiqli subcutaneously once weekly on the same day each week.

Individualize and titrate the dose of Awiqli based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goal. The recommended starting dose and titration approach are the same for adults and for children 10 years of age and older; the prescribing information does not give a separate pediatric dose.

Due to the long half-life of Awiqli, adjustment of dose is not advised during acute illness, nor if patients make short-term changes in their physical activity level or usual diet. In these situations, consider other applicable adjustments, e.g., glucose intake or changes to other glucose-lowering medication

Recommended Dosage in Insulin Naïve Patients

The recommended weekly starting dose of Awiqli in insulin-naïve patients is 70 units administered subcutaneously once weekly on the same day each week.

Switching to Awiqli from Daily Basal Insulin Therapy

Administer the first dose of Awiqli on the day after the last dose of daily basal insulin.

• Week 1 dosage: The recommended one-time starting dosage of Awiqli FlexTouch is 1.5 times the total daily basal dosage multiplied by 7, rounded to the nearest 10 units.
• Week 2 dosage: The recommended dosage is the previous total daily basal insulin dose multiplied by 7 and then rounded to the nearest 10 units. See Prescribing Information for tables.
• Week 3 dosage and beyond: The recommended dosage of Awiqli can be titrated from the previous dosage based on the patient’s metabolic needs, blood glucose monitoring results, and glycemic control goal.
• When switching from daily basal insulin to once-weekly Awiqli, close glucose monitoring is recommended. Doses and timing of concurrent rapid-acting or short-acting insulin products or other concomitant antidiabetic treatment may need to be adjusted.

Dose modifications

Your Awiqli dose may need to change if your kidney or liver function changes, or if you become unwell, to lower the risk of blood sugar going too low (hypoglycemia) or too high (hyperglycemia).

Because Awiqli stays in your body for about a week, your dose is not usually adjusted for a short-term illness, or for a temporary change in how active you are or what you are eating. In those situations, your healthcare provider will look at other options instead, such as adjusting how much carbohydrate you take in or changing the doses of your other diabetes medicines.

Missed doses

• If you miss a dose, take it as soon as possible within 4 days, then continue your once-weekly schedule 1 week after taking the missed dose.
• If more than 4 days have passed, skip the missed dose and take your next dose on your regular scheduled day.

Formulations

The Awiqli FlexTouch pen (700 units/mL)

• 3 mL single-patient-use FlexTouch prefilled pen (containing 2,100 units)
• 1.5 mL single-patient-use FlexTouch prefilled pen (containing 1,050 units)
• 1 mL single-patient-use FlexTouch prefilled pen (containing 700 units)

• While taking Awiqli, do not drive or operate heavy machinery until you know how Awiqli affects you.
• Do not drink alcohol or use prescription or over-the-counter medicines that contain alcohol.

Many medicines can affect how Awiqli works, including prescription medicines, over-the-counter products, vitamins, and herbal supplements. Tell your healthcare provider and pharmacist about everything you take, and check with them before starting or stopping anything.

Medicines that may raise your risk of low blood sugar (hypoglycemia) when taken with Awiqli

These can add to the blood sugar-lowering effect of Awiqli:

• other diabetes medicines, including GLP-1 receptor agonists, DPP-4 inhibitors, SGLT-2 inhibitors, and pramlintide
• ACE inhibitors and angiotensin II receptor blockers (blood pressure medicines)
• fibrates (cholesterol medicines)
• fluoxetine and monoamine oxidase inhibitors (antidepressants)
• salicylates, such as aspirin
• sulfonamide antibiotics
• disopyramide (a heart rhythm medicine)
• pentoxifylline (a blood flow medicine)
• somatostatin analogs, such as octreotide

Medicines that may make Awiqli less effective

These medicines may cause high blood sugar (hyperglycemia) when used with Awiqli:

• corticosteroids, such as prednisone
• atypical antipsychotics
• diuretics (water tablets)
• estrogens, oral contraceptives, and progestogens
• thyroid hormones
• somatropin (growth hormone)
• glucagon
• niacin
• danazol
• isoniazid (a tuberculosis medicine)
• phenothiazines
• protease inhibitors (HIV medicines)
• sympathomimetics, such as albuterol, epinephrine, and terbutaline

Medicines that may raise your risk of low blood sugar (hypoglycemia) when taken with Awiqli

The effect of these is less predictable, so your provider may ask you to check your blood sugar more often:

• alcohol
• beta blockers
• clonidine
• lithium
• pentamidine

Medicines that may hide the warning signs of low blood sugar

These can mask the symptoms you would normally feel when your blood sugar drops, such as a fast heartbeat or shakiness. That makes a low harder to catch early:

• beta blockers
• clonidine
• guanethidine
• reserpine

Awiqli taken with a TZD (eg pioglitazone or rosiglitazone) can cause fluid retention and heart failure. See Warnings for details."

This is not a complete list of everything that can interact with Awiqli.

The price you pay for Awiqli depends on your insurance and on which savings program you qualify for, and it is not the same as the list price. Novo Nordisk currently offers three cost programs, and eligible people pay between $35 and $55 for a one month supply through them.

Eligibility rules and restrictions apply to each of these, so check the program terms before you assume a price.

Awiqli cost with private or commercial insurance

If you have insurance through an employer or bought your own plan, the Awiqli Savings Offer is a copay card that may lower what you pay at the pharmacy. Eligible people pay as little as $35 and no more than $55 for each 1-month prescription. Copay cards like this one usually exclude people with government insurance, so read the eligibility terms.

Awiqli cost with Medicare

If you have a Medicare Part D plan that covers Awiqli, your monthly cost is capped at $35 or less. This cap applies to covered insulin products under Part D, so the first thing to confirm is whether your specific plan lists Awiqli on its formulary.

Awiqli cost without insurance

If you do not have insurance, the MyInsulinRx program may let you pay $55 for a 1 month supply, and the offer can be used each month within a calendar year. Money you spend through this program does not count toward any insurance deductible.

Other help with Awiqli costs

Novo Nordisk runs NovoCare, which brings its affordability programs together in one place and helps you find the one that fits your insurance situation. Your prescriber's office and your pharmacist can also point you toward assistance, and your pharmacist is usually the fastest way to get an accurate number for your own prescription.

What changes the price you pay

Several things move the final number:

• whether your plan covers Awiqli at all, and on which formulary tier
• how much of your deductible you have already met
• which pharmacy you fill at
• your prescribed weekly dose, since that determines which pen size and how many pens you need
• whether you qualify for a savings program

Because Awiqli is dosed once weekly rather than daily, a single pen lasts differently than it would with a daily basal insulin. Ask your pharmacist how many pens your prescription works out to per month before comparing costs against your current insulin.

Storage Conditions for 3 mL, 1.5 mL, and 1 mL Single-patient-use Awiqli FlexTouch Pen

Note: The total time at room temperature must not exceed 12 weeks, including time while the pen is in use.

Do not store in the freezer or directly adjacent to the refrigerator cooling element. Do not freeze. Do not use Awiqli if it has been frozen.

Manufactured by: Novo Nordisk Inc. 800 Scudders Mill Road Plainsboro, NJ 08536

Active Ingredient: insulin icodec-abae

Inactive Ingredients: Glycerin; metacresol; phenol; sodium chloride; zinc acetate and water for injection. Hydrochloric acid or sodium hydroxide may be added to adjust pH.