Converting Basal Insulin Patients to Insulin Icodec

Switching patients from daily basal insulin to once-weekly insulin icodec (Awiqli) requires a distinct dosing calculation clinicians have not previously had to apply, given the agent's extended half-life and slower time to steady state. Getting the conversion right matters for glycemic stability during the transition period.

On a recent episode of Diabetes Dialogue, hosts Diana Isaacs, PharmD, and Natalie Bellini, DNP, walked through the practical mechanics of switching patients from existing basal insulin regimens to icodec, the first once-weekly basal insulin approved for type 2 diabetes.

Watch the full episode discussing the commercial availability of Awiqli here.

The conversion begins with the patient's current total daily basal dose. Rather than simply multiplying by 7 to approximate a weekly equivalent, the initial dose calls for roughly 50% more, reached by multiplying the daily dose by 10.5, because the longer half-life delays time to steady state and a higher starting dose helps patients reach it faster. A patient taking 10 units of daily basal insulin would calculate to approximately 105 units, rounded to the nearest available increment of 100 or 110 units, before returning to a maintenance dose of 7 times the original daily amount, or 70 units weekly, for subsequent doses.

Titration will also depart from familiar basal insulin algorithms. Rather than adjusting every 3-4 days, once-weekly dosing limits adjustment frequency to ≤once per week, with clinicians reviewing 2-4 weeks of fasting and premeal glucose data before making changes, typically in 10% to 20% increments.

Hospital admission poses a separate practical question the hosts addressed directly. Because the average inpatient stay runs <3 days, well short of the weekly dosing interval, clinicians may often leave the icodec regimen untouched during a hospitalization and manage glucose with correction-dose insulin as needed, checking the timing of the patient's last dose. Isaacs and Bellini suggested inpatient glycemic control could ultimately prove more stable under a properly dosed weekly basal regimen, since it is not intended to cover meals or drive overnight drops the way rapid-acting or poorly matched basal doses can.

Patient education needs will differ by starting point. Insulin-naive patients are unlikely to be affected by the larger unit numbers involved, while patients transitioning from daily doses of 10 to 20 units to weekly doses of 70 units or more will need more deliberate counseling to avoid confusion or dosing errors.

Collectively, the hosts framed once-weekly dosing as a meaningful reduction in treatment burden, particularly for patients with caregiver support needs or a history of suboptimal adherence to daily injections, with anticipated gains in patient satisfaction expected to outweigh the learning curve required of both patients and prescribers.

Editors’ Note: Isaacs reports disclosures with Dexcom, Abbott, Lilly, Novo Nordisk, Medtronic, Insulet, and others. Bellini reports disclosures with Abbott Diabetes Care, MannKind, Povention Bio, and others.

References

1. Novo Nordisk. Novo Nordisk's Awiqli, the first once-weekly basal insulin for adults with type 2 diabetes, now available in the US. PR Newswire. August 11, 2026. Accessed August 12, 2026. https://www.prnewswire.com/news-releases/novo-nordisks-awiqli-the-first-once-weekly-basal-insulin-for-adults-with-type-2-diabetes-now-available-in-the-us-302847645.html