Published: 13 July 2026 • Updated: 25 September 2026 • 8 minute read
The side effects to watch for with once-weekly Awiqli, which days need extra care, and when to get help.
The most common Awiqli insulin side effects are low blood sugar, mild reactions where you inject, itching or rash, some ankle swelling and a small weight gain. These are the same side effects seen with other long-acting insulins. The difference is that one weekly dose stays in your body for days, so a low can last longer and the dose cannot be reduced until your next shot.
Awiqli, or insulin icodec, is a background insulin you inject once a week instead of every day. Novo Nordisk launched it in India in July 2026 for adults with type 1 and type 2 diabetes, and India’s drug regulator, CDSCO, has asked that its Indian safety study include equal numbers of people with both types. If you want to know the cost first, see our guide to the Awiqli insulin price in India.
Quick Answer
- Most common: Low blood sugar, injection site reactions, itching, swelling and small weight gain.
- Timing: Lows may be more likely around days 2 to 4 after each shot, when the effect is strongest.
- Rare but serious: Severe low sugar, allergic reaction and low potassium.
- Biggest safety tip: Never mix up Awiqli with your old daily pen or another weekly injection.
How Awiqli Works Across the Week
Awiqli attaches to a protein in your blood and is released slowly, so one dose lasts about a week. Its effect is not perfectly even. Reviews by the US Food and Drug Administration found that it lowers sugar most strongly on days 2 to 4 after each injection, and that is also when lows are most likely.
How Awiqli Works Across the Week
Sugar-lowering effect after each weekly shot, once treatment is steady
Illustrative shape. The US FDA review found the strongest sugar-lowering effect on days 2 to 4 after each dose, which is also when lows are most likely.
It also takes about 3 to 4 weekly doses to reach a steady level in your body. So the first month is when your doctor will adjust the dose most closely, and when you should check your sugar more often.
Common Awiqli Insulin Side Effects
Low Blood Sugar: The One to Know Well
A low happens when there is more insulin than your body needs, for example after a skipped meal or extra exercise. Early signs include shaking, sweating, hunger, a fast heartbeat, headache and feeling irritable or confused. Knowing your usual numbers from our blood sugar chart by age helps you spot a drop early.
In type 2 diabetes trials, lows were more common with Awiqli than with daily insulin, but serious ones stayed uncommon. In one trial, clinically significant lows happened about 0.35 times per person per year on Awiqli against 0.12 on daily insulin, less than once a year in both groups.
Injection Site Changes
Injecting in exactly the same spot every week can cause thick or dented patches under the skin, which also affect how insulin is absorbed. Rotate between your tummy, thighs and upper arms.
Serious Awiqli Side Effects
Serious Awiqli insulin side effects are uncommon, but knowing them helps you act quickly if one happens.
Severe Low Blood Sugar
A severe low causes confusion, fainting or seizures, and the person needs help from someone else. Because a week of insulin is already in the body, a severe low can last longer or come back after treatment, so medical care is needed even if the person seems to recover.
Allergic Reactions
Hives, or swelling of the face and lips, were reported in about 0.4% of people in trials. A severe whole-body reaction, called anaphylaxis, is rare but possible with any insulin and needs emergency care.
Low Potassium
All insulins can lower potassium in the blood. Very low levels can cause weakness, cramps or an irregular heartbeat. Your doctor may check your potassium, especially if you take water tablets.
Fluid Build-Up With Pioglitazone
Taking insulin with diabetes tablets called TZDs, such as pioglitazone, can cause fluid retention and may bring on or worsen heart failure. Tell your doctor about swelling, sudden weight gain or breathlessness, which can be early signs of heart failure.
The Mix-Up Risk: Awiqli Is Not Your Daily Pen
Awiqli is packed at 700 units per millilitre, a much higher concentration than most insulins. According to the US prescribing information, serious lows needing hospital care have happened when people confused Awiqli with another insulin or another once-weekly diabetes injection, chose the wrong dose, or injected it too often.
If you also use a weekly injection such as semaglutide, read the label every time. Our guide to Mounjaro vs Ozempic explains how those weekly medicines differ from insulin. Never draw Awiqli into a syringe, and never share your pen.
Type 1 Diabetes Needs Extra Caution
In India, Awiqli is used for adults with type 1 and type 2 diabetes, and CDSCO has asked for its post-marketing safety study to include both groups. The US approval covers type 2 only. In the type 1 trial, clinically significant lows were 48% to 89% more common than with daily insulin, and they peaked on days 2 to 4. A US expert panel voted 7 to 4 against approving it for type 1 diabetes. European regulators advise using it in type 1 only when a clear benefit from weekly dosing is expected.
Who Should Not Use Awiqli?
- During a low: never inject it while your blood sugar is low.
- Allergy: anyone allergic to insulin icodec or any ingredient in the pen.
- Talk to your doctor first: if you have kidney or liver disease, often miss the warning signs of a low, are pregnant or breastfeeding, or are over 65.
Pregnancy, Driving and Daily Life
Pregnancy and breastfeeding: there is very little information on Awiqli in pregnancy, and it is not known whether it passes into breast milk. If you are pregnant, planning a pregnancy or breastfeeding, talk to your doctor before starting or continuing it.
Driving: a low can affect your judgement without much warning. Check your sugar before you drive, especially on days 2 to 4, and do not set off if it is low.
Illness and fasting: if you are unwell, eating very little or fasting for a religious reason, ask your doctor for a plan in advance, because a weekly dose cannot be reduced mid-week.
How to Lower Your Risk
- Follow your monitoring plan: check your sugar as your doctor advises, with extra attention in the first weeks and around days 2 to 4 when appropriate.
- Keep fast sugar with you: glucose tablets, juice or sweets.
- Eat regular meals: and plan ahead before long walks or fasting days.
- Missed a dose? Take it within 4 days, then go one week from that day. After 4 days, skip it and use your usual day. Our Awiqli dosage guide explains the rest.
- Store it right: keep new pens in the fridge at 2 to 8°C. A pen can stay below 30°C for up to 12 weeks. Never freeze it.
- Keep follow-ups: your doctor will track your HbA1c to see how well the dose is working.
When to Get Help
Illustrative Scenario
Composite example, not a specific patient.
Ramesh, 61, switched to Awiqli and took his shot every Sunday. On Tuesday evening, after a long walk and a light dinner, he felt shaky and sweaty. He took glucose tablets, rechecked his sugar and felt better. His doctor later lowered his dose slightly and told him to eat a snack before long walks early in the week.
Key Takeaways
- Learn the signs of a low, and keep fast sugar with you at all times.
- Take extra care on days 2 to 4 after each shot and in the first month.
- Check the label every time so you never mix Awiqli up with another pen.
- Report swelling, rash or repeated lows to your doctor early.
Frequently Asked Questions
What are the most common Awiqli insulin side effects?
Low blood sugar, injection site reactions, itching or rash, some swelling and a small weight gain. Most are mild.
Is Awiqli safe?
It has been studied in large trials in adults with type 2 diabetes and can be used safely when prescribed and monitored. Like all insulins, it can cause serious lows and other side effects.
When is low blood sugar most likely on Awiqli?
Lows may be more likely around days 2 to 4 after each weekly shot, when the sugar-lowering effect is strongest, and in the first weeks of treatment. Your own pattern can differ.
Can Awiqli side effects last for days?
A low can last longer or come back, because one dose stays active for about a week and cannot be reduced until the next shot.
Does Awiqli cause weight gain?
It can cause a small weight gain, similar to daily insulin. It is not a weight-loss medicine like Ozempic or Mounjaro.
Is Awiqli safe for type 1 diabetes?
It needs extra care. In trials, serious lows were more common than with daily insulin, so your doctor will decide if the weekly option is worth it for you.
How is Awiqli different from daily insulin?
It is injected once a week instead of daily. Sugar control is similar, but a dose cannot be adjusted mid-week. Our Awiqli vs daily insulin guide compares them.
What should I do if I miss a dose?
Take it within 4 days and your next dose one week later. If more than 4 days have passed, skip it and use your usual day.
References
- US Food and Drug Administration. Awiqli (insulin icodec-abae) prescribing information, 2026.
- Novo Nordisk. Awiqli important safety information, 2026.
- European Medicines Agency. Awiqli product information.
- US Food and Drug Administration. Advisory committee briefing document: insulin icodec, 2024.
- Pharmaceutical Technology. FDA review of insulin icodec in type 1 diabetes, 2024.
- Medaptly. Once-weekly insulin Awiqli: FDA approval and ONWARDS trial data, 2026.
- Awiqli. How to take Awiqli, missed doses and storage, 2026.
- CDSCO. Subject Expert Committee (Endocrinology and Metabolism) recommendations, including the Awiqli post-marketing study, 13 January 2026.
- Medical Dialogues. India gets once-weekly basal insulin Awiqli, July 2026.
Written By
Iraphan Khan, BSN, RN, D.Pharm, Public Health Researcher. Iraphan writes evidence-based patient guides that turn medical reports and research into plain language.
Medically Reviewed By
Dr Praveen Verma, MBBS, MD Pathology
Dr Himanshu Morya, MBBS, Medical Educator
First published: 13 July 2026. Updated and reviewed: 25 September 2026. Next scheduled review: March 2027.
Disclaimer: This article is for general education and does not replace advice from your own doctor, nurse or pharmacist. Do not start, stop or change any insulin dose on your own.