Insulin Icodec for Adults With Type 2 Diabetes: Dosing and Monitoring Considerations With Rachael Sood, NP-C, CDCES

Adherence to basal insulin therapy remains a major barrier to optimal glycemic control in type 2 diabetes, particularly in primary care. Even when patients understand the importance of insulin, the requirement for daily injections can lead to missed doses, inconsistent timing, and eventual treatment fatigue. A once-weekly basal insulin such as insulin icodec (Awiqli) is designed to address this challenge by shifting from a daily routine to a single weekly decision point, potentially improving real-world adherence and persistence.

From a dosing standpoint, the once-weekly basal insulin differs substantially from traditional U-100 basal insulins. It is formulated as a highly concentrated U-700 insulin, and total weekly units may appear numerically higher than the daily doses clinicians are accustomed to prescribing. Primary care physicians should approach initiation and titration with the same clinical principles applied to other chronic therapies: start low, adjust gradually, and closely monitor glucose responses. Continuous glucose monitoring (CGM), where available, and structured finger-stick testing can be valuable for assessing the glycemic impact of a weekly basal dose and guiding titration decisions, especially early in therapy.

In the video discussion, Rachael Sood, RN, MSN, APRN, NP, CDCES, founder of The Diabetes Collective, acknowledges that the larger numeric dose (eg, 70 units weekly instead of 10 units daily of a traditional basal insulin) may initially feel uncomfortable to prescribers. She emphasizes that the pharmacokinetics of Awiqli are designed for slow absorption over the week and that careful patient and clinician education can mitigate concerns about dosing errors. Sood anticipates that the introduction of a once-weekly basal insulin will further normalize CGM use in primary care, as clinicians rely on richer glucose data to understand individual responses and to optimize weekly dosing safely.

References:

1. Novo Nordisk. FDA approves Novo Nordisk's Awiqli®, the first and only once-weekly basal insulin treatment for adults with type 2 diabetes. News release. March 26, 2026. Accessed March 27, 2026. https://www.prnewswire.com/news-releases/fda-approves-novo-nordisks-awiqli-the-first-and-only-once-weekly-basal-insulin-treatment-for-adults-with-type-2-diabetes-302726839.html