The main Awiqli side effect is low blood sugar, the same risk as any insulin. The twist is that a weekly dose cannot be taken back once it is in you.
A weekly shot sounds simpler than a daily one. Most people still want one answer first. Is it safe?
Evidence based patient guide by RealMedVision | 10 to 12 minute read
Key takeaways
- The most common Awiqli side effects are low blood sugar (hypoglycemia), mild reactions where you inject, and a small amount of weight gain (Reviews in Endocrine and Metabolic Disorders, 2025).
- In type 2 diabetes, serious low blood sugar was no more common with Awiqli than with daily insulin (Diabetes, Obesity and Metabolism, 2024).
- Severe lows were rare. Across five type 2 trials, the Awiqli group had just 8 severe episodes in total (Journal of Clinical Endocrinology and Metabolism, 2025).
- Type 1 diabetes is the exception. Awiqli caused 50 to 80 percent more serious low blood sugar than daily degludec at one year (FDA advisory committee briefing, 2024).
- A rare but serious allergic reaction (anaphylaxis) can occur, as with any insulin, and needs emergency care (Awiqli prescribing information, FDA, 2026).
- India approved Awiqli for type 1 and type 2 diabetes. The United States approved it for type 2 only (Novo Nordisk, 2024 and 2026).
Introduction
Awiqli insulin side effects are mostly mild, and the main one is low blood sugar. This is the same risk that comes with every insulin, so it is well understood.
Awiqli is a brand of insulin called insulin icodec. It is a long-acting insulin you inject once a week instead of once a day. Novo Nordisk launched it in India in July 2026, making India the seventh country to offer it (Business Today, 2026). Curious what it costs first? See our guide to the Awiqli insulin price in India.
One shot a week sounds easier than seven, and it is. But the medicine works like other insulins, so its side effects are the familiar ones. The difference that matters: a week of insulin is already in your body, and you cannot dial it down before a long walk or a skipped meal the way you can with a daily pen. This guide walks through the Awiqli insulin side effects, who is most at risk, and what to do about each one.
Quick answer
Awiqli insulin side effects are mostly mild. The main one is low blood sugar. Some people get redness at the injection site or gain a little weight. In type 2 diabetes trials, serious low blood sugar was no more common than with daily insulin (Diabetes, Obesity and Metabolism, 2024).
Table of contents
- What is Awiqli insulin?
- How does it work?
- Awiqli vs daily insulin
- Approved uses
- Who should not use it?
- Common Awiqli insulin side effects
- Serious Awiqli insulin side effects
- Risk factors
- Warnings and precautions
- Drug interactions
- Pregnancy and breastfeeding
- Storage instructions
- Missed dose
- How to reduce side effects
- When to contact a doctor
- Emergency warning signs
- Bottom line
- Frequently asked questions
What is Awiqli insulin?
Awiqli is background insulin, also called basal insulin (long-acting insulin). Basal insulin covers the slow, steady insulin your body needs between meals and overnight. The medicine inside the pen is insulin icodec.
What makes Awiqli stand out is the schedule. One injection lasts a full week, cutting basal insulin shots from about 365 a year to 52 (Business Today, 2026). It comes in a prefilled FlexTouch pen holding 700 units in each millilitre.
| Detail | Information |
|---|---|
| Generic name | Insulin icodec (insulin icodec-abae) |
| Brand name | Awiqli |
| Drug class | Long-acting (basal) insulin analog |
| Manufacturer | Novo Nordisk |
| Approved uses | Adults with type 2 diabetes (India also approves type 1) |
| Dosage form | Prefilled FlexTouch pen, 700 units per millilitre |
| Approval status | US FDA approved 2026 (type 2); India approved 2026 (type 1 and type 2) |
How does it work?
Insulin icodec sticks to a blood protein called albumin. While stuck, it stays inactive, then lets go slowly across seven days (Reviews in Endocrine and Metabolic Disorders, 2025). That slow release is how one shot covers the whole week.
The effect is not perfectly even. It is strongest about 2 to 4 days after the injection, then eases off (Awiqli product information, 2026). So a low is a little more likely during those middle days, mainly at the start.
Awiqli vs daily insulin
The biggest difference is how often you inject. A daily basal insulin means about 365 shots a year. Awiqli means 52 (Business Today, 2026). For someone who dreads the needle, that alone can be the reason to finally start.
Blood sugar control is about the same. In trials, Awiqli lowered long-term blood sugar (HbA1c) as well as daily insulin, and in some studies kept blood sugar in range for a few more hours a day (Diabetes, Obesity and Metabolism, 2024).
The trade-off is flexibility. With a daily pen you can lower tomorrow’s dose before a big day, but with a week of insulin already in you, you cannot. And to be clear, Awiqli is insulin, not a weight-loss injection like Mounjaro or Ozempic.
Approved uses
In India, Awiqli is approved for adults with type 1 and type 2 diabetes (Business Today, 2026). In the United States, it is approved only for adults with type 2 diabetes, used along with diet and exercise (Novo Nordisk, 2026).
It is used as basal insulin. In type 2 diabetes, it can go with tablets, a GLP-1 medicine (such as Ozempic), or mealtime insulin. In type 1 diabetes, it replaces only the background insulin. It has not been studied in children.
Who should not use it?
Awiqli is not for everyone. Do not use it if you have ever had an allergic reaction to insulin icodec or any ingredient in the pen (Awiqli prescribing information, FDA, 2026). It should also not be injected while your blood sugar is already low.
People with kidney or liver problems, or those who often have lows or cannot feel them coming, need closer monitoring. For type 1 diabetes, the evidence is weaker, so it should be used only when a weekly insulin clearly helps (European Medicines Agency, 2024). Your doctor decides if Awiqli fits you.
Common Awiqli insulin side effects
The most common Awiqli insulin side effects are low blood sugar, a reaction where you inject, and a small rise in weight. They are the same three seen with almost any insulin (Reviews in Endocrine and Metabolic Disorders, 2025).
Low blood sugar
Low blood sugar, or hypoglycaemia, is the one to learn first. It happens when there is more insulin than your blood sugar needs. Early signs are shaking, sweating, a fast heartbeat, hunger, and feeling dizzy or irritable. Knowing your normal blood sugar levels makes an early low easier to catch. In type 2 diabetes, Awiqli caused more mild lows than daily insulin but not more serious ones (Diabetes, Obesity and Metabolism, 2024).
Injection site reactions
Some people get mild redness, itching, or a small bump where they inject. In the Awiqli trials, these reactions were reported in about 1.8 percent of people (Awiqli prescribing information, FDA, 2026). Injecting a little away from last week’s spot lowers the chance of dents or lumps under the skin.
Weight gain
A small weight gain is common with most insulins. In the early trials, people gained about 0.6 to 1.5 kg, close to what daily glargine caused (Insulin Icodec Weekly review, 2023). Healthy eating and activity help keep it in check.
Serious Awiqli insulin side effects
Serious Awiqli insulin side effects are uncommon, but they are worth knowing so you can act fast. The main ones are a severe low, a serious allergic reaction, and low potassium.
Severe low blood sugar
A severe low can bring confusion, a seizure, or fainting, and it needs help from another person. It was rare in the trials: across all five type 2 studies the Awiqli group had only 8 severe episodes in total, and among people 65 and over there was 1 severe low on Awiqli against 6 on daily insulin (Journal of Clinical Endocrinology and Metabolism, 2025).
Serious allergic reactions
Rarely, Awiqli can set off a serious, whole-body allergic reaction, including anaphylaxis (severe allergic reaction). In the trials, such reactions, like hives and swelling of the face or lips, were reported in about 0.4 percent of people (Awiqli prescribing information, FDA, 2026). See the emergency signs below.
Low potassium
Like all insulins, Awiqli can move potassium out of the blood and lower its level (hypokalemia). A very low level can affect the heart and muscles (Awiqli prescribing information, FDA, 2026). Your doctor may check your potassium, mainly if you take other medicines that lower it.
| Side effect | Frequency | Symptoms | What patients should do |
|---|---|---|---|
| Low blood sugar | Common | Shaking, sweating, hunger, dizziness | Eat fast sugar, recheck in 15 minutes |
| Injection site reaction | About 1.8 percent | Redness, itching, a small bump | Rotate the injection spot each week |
| Weight gain | Common, modest | Slow rise of about 0.6 to 1.5 kg | Healthy eating and activity |
| Serious allergic reaction | About 0.4 percent, rare | Hives, face or lip swelling, trouble breathing | Stop, get emergency care |
| Severe low blood sugar | Rare | Confusion, seizure, fainting | Emergency help, glucagon if available |
| Low potassium | Uncommon | Weakness, cramps, uneven heartbeat | Doctor checks potassium level |
Risk factors
Some people are more likely to have a low on Awiqli. The risk goes up with other blood-sugar-lowering medicines, skipped or smaller meals, extra exercise, drinking alcohol without food, and kidney or liver problems (Reviews in Endocrine and Metabolic Disorders, 2025).
Older adults face more danger from a low, since the warning signs are harder to feel. The first weeks carry more risk too, because Awiqli does not reach a steady level until the second or third week, so your doctor starts with a larger dose and watches you closely (CMAJ, 2025).
| Risk factor | Why it matters | Warning signs | Recommended action |
|---|---|---|---|
| Other glucose-lowering medicines | Their effect adds to the insulin | Frequent lows | Tell your doctor, doses may change |
| Skipped meals or fasting | Less sugar is coming in | Shaking, sweating | Eat regular meals, carry fast sugar |
| Extra exercise | Muscles use more sugar | Lows during or after activity | Check before and after, plan ahead |
| Kidney or liver problems | Insulin clears more slowly | Longer or repeated lows | More frequent monitoring |
| TZD tablets like pioglitazone | Fluid buildup when used with insulin | Swelling, breathlessness | Report swelling, doctor reviews |
| Older age | A low is harder to feel | Missed warning signs | Gentler dosing, closer checks |
Warnings and precautions
A few cautions matter. Awiqli is seven times stronger than most insulins at 700 units in each millilitre, so mixing this pen up with an ordinary one can cause a dangerous overdose (Awiqli prescribing information, FDA, 2026). Always check the label before each injection, never draw Awiqli into a syringe, and never share your pen.
Because the dose stays in your body for days, a low can last longer and cannot be trimmed until the next weekly shot (European Medicines Agency, 2024).
Drug interactions
Tell your doctor about every medicine and supplement you take, since some change how Awiqli affects your blood sugar.
Other diabetes medicines that lower blood sugar, such as another insulin or a sulfonylurea, add to Awiqli’s effect and raise the risk of a low, so doses may need to change (Awiqli prescribing information, FDA, 2026). A group of diabetes tablets called thiazolidinediones, or TZDs, can make the body hold fluid when taken with insulin, which may bring on or worsen heart failure (Awiqli prescribing information, FDA, 2026). Some medicines lower potassium, and since Awiqli can lower it too, your doctor may check your level more often (Awiqli prescribing information, FDA, 2026).
| Medicine | What can happen | What to do |
|---|---|---|
| Other insulin or a sulfonylurea | Adds to the effect, more risk of a low | Doctor may lower doses |
| TZD tablets like pioglitazone | Fluid buildup, may worsen heart failure | Report swelling or breathlessness |
| Potassium-lowering medicines | Can drop potassium too low | Doctor checks potassium level |
| A GLP-1 or other diabetes medicine | Blood sugar may go too low | Adjust doses with your doctor |
Pregnancy and breastfeeding
There is little human data on Awiqli in pregnancy. In animal studies, no harm to the developing baby was seen at doses close to human levels (Awiqli prescribing information, FDA, 2026). Blood sugar control matters greatly in pregnancy, and insulin is often preferred, but whether Awiqli is the right choice should be decided with your doctor.
It is not known whether insulin icodec passes into breast milk (Awiqli prescribing information, FDA, 2026). Talk to your doctor before using Awiqli while pregnant or breastfeeding.
Storage instructions
Keep unopened Awiqli pens in the fridge, at 36 to 46 F (2 to 8 C), until the expiry date, or at room temperature below 86 F (30 C) for up to 12 weeks (Awiqli prescribing information, FDA, 2026).
Once opened, keep the pen in the fridge or at room temperature and use it within 12 weeks. Do not freeze Awiqli, or use a pen that has been frozen. Keep it away from heat and light.
Missed dose
If you miss your weekly dose, take it as soon as you can, as long as 4 days or less have passed. Then take your next dose one week from that day (Awiqli prescribing information, FDA, 2026).
If more than 4 days have passed, skip it and take your next one on your usual day. Never take two doses to make up. Check your blood sugar more often afterward, and keep at least 4 days between doses.
How to reduce side effects
You have real control over most Awiqli insulin side effects. A few simple habits do the heavy lifting:
Learn the early signs of a low and keep fast sugar within reach, such as glucose tablets, juice, or hard candy.
Eat your meals at regular times, above all in the first few weeks.
Check your blood sugar as often as your doctor advises, and more often when you are ill, fasting, or changing your routine.
Inject on the same day each week, and shift the spot a little each time.
Check your blood sugar before you drive, and do not set off if it is low.
Wear a diabetes ID or carry a card so others can help in an emergency.
Show a family member how to spot a severe low and what to do.
When to contact a doctor
Book an appointment within a few days if you have lows often, keep getting redness or lumps where you inject, are gaining weight fast, or feel your doses have stopped working.
Also call if you are unwell, planning surgery, or eating very little, since weekly insulin needs a plan for those days.
Emergency warning signs
Call your local emergency number now if a person with diabetes faints, has a seizure, cannot be woken, is too confused to eat or drink safely, or has a low that will not lift after eating sugar. That is severe hypoglycemia and needs treatment now.
Also get emergency help for signs of a serious allergic reaction soon after an injection: a spreading rash or hives, swelling of the face, lips, or throat, trouble breathing, or a fast heartbeat with dizziness.
Bottom line
Awiqli brings real convenience, one insulin shot a week in place of daily jabs (Business Today, 2026). For most adults with type 2 diabetes, the Awiqli insulin side effects are mild and much like any basal insulin, with low blood sugar the one to watch, and severe lows were rare in the trials (Journal of Clinical Endocrinology and Metabolism, 2025).
Type 1 diabetes is the honest exception, and that group needs closer guidance. Learn the warning signs, respect the strength of the pen, keep fast sugar close, and stay in touch with your care team. Do that, and Awiqli can fit your week rather than run it.
Frequently asked questions
What are the most common Awiqli insulin side effects?
The three seen most often are low blood sugar, mild reactions at the injection site, and a small amount of weight gain (Reviews in Endocrine and Metabolic Disorders, 2025). Most are mild and settle with regular meals and moving the injection spot each week.
Is Awiqli safe?
For most adults with type 2 diabetes, yes. In large trials its safety matched daily basal insulins, most side effects were mild, and severe lows were rare (Journal of Clinical Endocrinology and Metabolism, 2025). People with type 1 diabetes need individual advice.
Can Awiqli cause low blood sugar?
Yes. Too much insulin for your food can push blood sugar too low. Weekly icodec caused slightly more mild lows than daily insulin, but not more serious ones in type 2 diabetes (Diabetes, Obesity and Metabolism, 2024).
Can Awiqli side effects last for several days?
They can. Because one dose stays in your body for days and cannot be lowered until the next injection, a low can last longer or return before the dose fades (European Medicines Agency, 2024). Report repeated lows to your doctor.
Is Awiqli safe for type 1 diabetes?
This needs care. In type 1 diabetes, Awiqli caused 50 to 80 percent more serious low blood sugar than daily degludec, and a US FDA panel voted 7 to 4 against it for that group (FDA advisory committee, 2024). India cleared it for both types, the US for type 2 only.
Does Awiqli cause weight gain?
It can, usually a small amount. In the early trials people gained about 0.6 to 1.5 kg, close to daily glargine (Insulin Icodec Weekly Review, 2023). Healthy eating and activity help keep it in check.
What should I do if I miss a dose?
Take it as soon as you can if 4 days or less have passed, then take your next dose a week later. If more than 4 days have passed, skip it and use your next dose on your usual day (Awiqli prescribing information, FDA, 2026). Never double up.
How do I store Awiqli?
Keep unopened pens in the fridge, or at room temperature below 86 F (30 C) for up to 12 weeks. Once opened, use within 12 weeks (Awiqli prescribing information, FDA, 2026). Never freeze it, and do not use a pen that has been frozen.
Is Awiqli the same as Ozempic or Mounjaro?
No. Awiqli is insulin, taken once a week to control blood sugar. Ozempic and Mounjaro are different medicines that also aid weight loss. Awiqli is not a weight-loss drug, and insulin tends to cause a small weight gain, not loss.
Can I take Awiqli with other diabetes medicines?
Often, yes. In type 2 diabetes it is used with tablets, a GLP-1 medicine, or mealtime insulin. But other medicines that lower blood sugar can raise the risk of a low, so your doctor may adjust the doses (Awiqli prescribing information, FDA, 2026).
More questions about Awiqli
Does Awiqli make you sleepy?
Awiqli does not usually cause sleepiness by itself. But a low blood sugar can leave you feeling weak or drowsy, so sudden tiredness after a dose is worth a quick blood sugar check.
Can Awiqli cause a headache?
Headache is not a common direct effect, but it is a listed sign of low blood sugar with Awiqli (Awiqli prescribing information, FDA, 2026). If a headache comes with shaking or sweating, check your blood sugar and treat a low quickly.
Can Awiqli cause nausea?
Nausea is not a common Awiqli side effect. It is more linked to GLP-1 medicines like Ozempic. Feeling sick alongside signs of a low is still worth a blood sugar check.
Can Awiqli cause weight loss?
No. Awiqli is insulin, and insulin tends to cause a small weight gain, not loss. For a diabetes medicine that can help with weight, ask your doctor about other options.
Medical disclaimer
This article is for general education only. It does not replace advice from your own doctor, nurse, or pharmacist. Do not start, stop, or change any medicine based on this page. Always talk to a qualified health professional about your own health, your medicines, and what suits you best.
References and sources
- US Food and Drug Administration. Awiqli (insulin icodec-abae) prescribing information. 2026. fda.gov
- European Medicines Agency. Awiqli (insulin icodec) product information. 2024. ema.europa.eu
- Reviews in Endocrine and Metabolic Disorders. Insulin icodec: a once-weekly formulation for type 1 and type 2 diabetes mellitus. 2025. springer.com
- Diabetes, Obesity and Metabolism. Efficacy and safety of once-weekly insulin icodec in type 2 diabetes: a meta-analysis of ONWARDS phase 3 trials. 2024. wiley.com
- Journal of Clinical Endocrinology and Metabolism. Efficacy and hypoglycaemia profile of once-weekly insulin icodec versus once-daily comparators across subgroups. 2025. oup.com
- Diabetes Therapy. Efficacy and safety of once-weekly insulin icodec in Indian participants with diabetes (ONWARDS 1, 4 and 6). 2025. ncbi.nlm.nih.gov
- The Lancet. ONWARDS 6: once-weekly insulin icodec versus once-daily insulin degludec in type 1 diabetes. 2023. thelancet.com
- CNN Health. FDA advisers weigh benefits of weekly insulin for people with diabetes. 2024. cnn.com
- BioSpace. Novo Nordisk’s once-weekly insulin loses FDA advisory committee vote for type 1 diabetes. 2024. biospace.com
- CMAJ. Weekly injectable insulin icodec for adults with diabetes. 2025. cmaj.ca
- Insulin Icodec Weekly: a basal insulin analogue for type 2 diabetes. PMC. 2023. ncbi.nlm.nih.gov
- Business Today. Novo Nordisk launches once-weekly insulin Awiqli in India at Rs 261 a week. 2026. businesstoday.in
Medically reviewed by
This guide was checked for medical accuracy by our review board before publishing.
Dr Praveen Verma, MBBS, MD (Pathology), Pathologist and Clinical Laboratory Specialist.
Dr Himanshu Morya, MBBS, Medical Educator.
Kalpna Singh Shekhawat, BSN, RN
About the author
Iraphan Khan, BSN, RN, D.Pharm, is the founder of RealMedVision and a Public Health Researcher who creates evidence-based health content from trusted medical sources.
This article is for education and does not replace advice from your own doctor.