Dosing with Awiqli® (insulin icodec-abae).
Awiqli® uses a familiar basal insulin titration approach, which can be adjusted for each patient's glucose goal, for adults with type 2 diabetes (T2D).1
For illustrative purposes only.
Awiqli® is available in a single-pen package:
one 1.5 mL FlexTouch® pen containing 1050 units
Inject Awiqli® subcutaneously once weekly on any day of the week 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.
Dose adjustments may be needed with changes in renal or hepatic function or during illness to minimize the risk of hypoglycemia or hyperglycemia. 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, eg, glucose intake or changes to other glucose-lowering medication.
Start with your patient’s treatment pathway
Review dosing guidance based on where your adult patients with T2D are starting their treatment.
Administer the first dose of Awiqli® on the day after the last dose of daily basal insulin
Week 1
One-time starting dose: previous total daily basal insulin dose x 7, then x 1.5, rounded to the nearest 10 units
Week 2
Previous total daily basal insulin dose x 7 and then rounded to the nearest 10 units
Week 3
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.
A one-time additional 50% dose with the first Awiqli® injection helps establish steady state exposure faster.1 Insulin icodec-abae concentration reached steady state levels after 2 to 3 weeks of Awiqli® administration with a one-time 50% additional dose for the first dose and after 3 to 4 weeks when initiating Awiqli® without a one-time additional dose.
Titration approach
- Uses a familiar basal insulin titration approach personalized to each patient's metabolic needs
- Guided by blood glucose monitoring results
Dosing conversion
Transition patients from daily basal insulin using a structured once‑weekly conversion with an initial loading dose followed by weekly maintenance dosing.
For complete dosing guidance, including a dosing chart when switching from daily basal insulin, please see the Prescribing Information.
Calculate the Awiqli® recommended dose for your adult patients with type 2 diabetes switching to once-weekly Awiqli® based on their current daily basal insulin dose.1
For illustrative purposes only.
Titration approach
- Uses a familiar basal insulin titration approach personalized to each patient's metabolic needs
- Guided by blood glucose monitoring results
Recommended treatment initiation
The recommended starting dose for insulin-naïve adults is 70 units administered once weekly on the same day each week.1 Following initiation, individualize and titrate the weekly dose based on the patient's metabolic needs, blood glucose monitoring results, and glycemic goals.1
Guidance for managing missed doses
Patients have a 4-day window to administer a missed dose before resuming their once-weekly dosing schedule.1
Within 4 days of missed dose
Administer the missed dose as soon as possible within 4 days
Resume once-weekly dosing, 1 week after the missed dose was administered1
More than 4 days since missed dose
Skip the missed dose
Administer the next dose on the regularly scheduled day1
Monitoring
Increase blood glucose monitoring when doses are missed1
The Awiqli® FlexTouch® 700 units/mL (U-700) pen
Awiqli® is administered using the single-patient-use FlexTouch® 700 units/mL (U-700) 1.5 mL pen containing 1050 units. The FlexTouch® 700 units/mL (U-700) pen can deliver up to 700 units in a single injection and doses are delivered in 10-unit increments.1 Do not dial the maximum single dose (700 units) of Awiqli® unless this is the prescribed dose.
For illustrative purposes only.
Store unopened Awiqli® pens in the refrigerator (36 ºF to 46 ºF [2 ºC to 8 ºC]) until the expiration date. Once opened, the pen may be stored for up to 12 weeks either at room temperature (below 86 °F [30 °C]) or in the refrigerator (36 °F to 46 °F [2 °C to 8 °C]). Do not freeze or use a pen that has been frozen. Keep the pen in its original carton and follow the Instructions for Use.
For step-by-step visual administration instructions, see the Prescribing Information.
Awiqli® samples
Awiqli® samples are available through novoMEDLINKTM
See the clinical data
Explore efficacy and safety results for Awiqli®.
Support for you and your patients
Access savings, support, and educational resources.
Important Safety Information for Awiqli®
Contraindications
- Awiqli® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to insulin icodec-abae or any of the excipients in Awiqli® FlexTouch®. Serious hypersensitivity reactions have included anaphylaxis.
Warnings and Precautions
- Hypoglycemia Due to Medication Errors and Accidental Overdose: Serious hypoglycemia requiring hospitalization has occurred due to accidental mix-ups between Awiqli® and other insulin products or once-weekly injectable antidiabetic medicines, incorrect dose selection, and dosing frequency errors.
To avoid dosing errors when switching patients from daily basal insulin to Awiqli®, follow the dosage recommendations as detailed in the prescribing information. Administer Awiqli® once weekly only.
Advise patients to always check the product label before each injection to confirm they are using Awiqli® and not another insulin or injectable antidiabetic medicine. Prior to initiation, train patients and their caregiver(s) on how to select their weekly Awiqli® dosage. Advise patients using other injectable medications for glycemic control that the dosage selection of Awiqli® differs. Instruct patients to visually verify the dialed units on the dose counter of the Awiqli® FlexTouch® prefilled pen before each injection to avoid dosing errors. Do not dial the maximum single dose (700 units) of Awiqli® unless this is the prescribed dose. Do not use a syringe to remove Awiqli® from the Awiqli® FlexTouch® disposable insulin prefilled pen.
Monitor patients for signs and symptoms of hypoglycemia, particularly during the first several weeks after initiation or dose escalation of Awiqli®. Ensure patients understand how to recognize and manage hypoglycemia. - Hypoglycemia: Hypoglycemia is the most common adverse reaction of insulin, including Awiqli®. Severe hypoglycemia can cause seizures, may be life-threatening or cause death. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g., driving or operating other machinery). Awiqli®, or any insulin, should not be used during episodes of hypoglycemia.
Hypoglycemia can happen suddenly and symptoms may differ in each individual and change over time in the same individual. Symptomatic awareness of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications that block the sympathetic nervous system (e.g., betablockers) or in patients who experience recurrent hypoglycemia. The longacting effect of Awiqli® may delay recovery from hypoglycemia compared to shorter-acting insulins.
Risk Factors for Hypoglycemia: The risk of hypoglycemia generally increases with intensity of glycemic control. The risk of hypoglycemia after an injection is related to the duration of action of the insulin and, in general, is highest when the glucose lowering effect of the insulin is maximal. As with all insulins, the glucose lowering effect over time of Awiqli® may vary among different individuals or at different times in the same individual and depends on many conditions, including the area of injection as well as the injection site blood supply and temperature.
Other factors which may increase the risk of hypoglycemia include changes in meal pattern (e.g., macronutrient content or timing of meals), changes in level of physical activity, or changes to co-administered medications. Patients with renal or hepatic impairment may be at higher risk of hypoglycemia.
Educate patients and caregivers to recognize and manage hypoglycemia. In patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia, increased frequency of blood glucose monitoring is recommended. - Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in an insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) may affect glycemic control and predispose to hypoglycemia or hyperglycemia. Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to an unaffected area) has been reported to result in hypoglycemia.
Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring. Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change the injection site to unaffected areas and closely monitor for hypoglycemia. Adjustments in concomitant anti-diabetic treatment may be needed. - Hypersensitivity Reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulins, including Awiqli®. If hypersensitivity reactions occur, discontinue Awiqli®; treat per standard of care and monitor until symptoms and signs resolve.
- Hypokalemia: All insulins, including Awiqli®, cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Monitor potassium levels in patients at risk for hypokalemia and treat if indicated.
- Never Share an Awiqli® FlexTouch® Pen or Needle Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens.
- Fluid Retention and Congestive Heart Failure with Concomitant Use of PPAR Gamma Agonists: Fluid retention and heart failure can occur with concomitant use of thiazolidinediones (TZDs), which are PPAR-gamma agonists, and insulin, including Awiqli®. Patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of the TZD must be considered.
Adverse Reactions
- Adverse reactions commonly associated with Awiqli® are: hypoglycemia, hypersensitivity reactions (e.g. urticaria, swelling face and lips), injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain
Drug Interactions
- There are certain drugs that may cause clinically significant drug interactions with Awiqli®:
- Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE
inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog (e.g., octreotide), sulfonamide antibiotics, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors - Drugs that may decrease the blood glucose lowering effect: atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones
- Drugs that may increase or decrease the blood glucose lowering effect: alcohol, beta-blockers, clonidine, lithium salts, and pentamidine
- Drugs that may blunt the signs and symptoms of hypoglycemia: beta-blockers, clonidine, guanethidine, and reserpine
- Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE
Please click here for Awiqli® Prescribing Information.
Important Safety Information for Awiqli®
Contraindications
- Awiqli® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to insulin icodec-abae or any of the excipients in Awiqli® FlexTouch®. Serious hypersensitivity reactions have included anaphylaxis.
Warnings and Precautions
- Hypoglycemia Due to Medication Errors and Accidental Overdose: Serious hypoglycemia requiring hospitalization has occurred due to accidental mix-ups between Awiqli® and other insulin products or once-weekly injectable antidiabetic medicines, incorrect dose selection, and dosing frequency errors.
To avoid dosing errors when switching patients from daily basal insulin to Awiqli®, follow the dosage recommendations as detailed in the prescribing information. Administer Awiqli® once weekly only.
Advise patients to always check the product label before each injection to confirm they are using Awiqli® and not another insulin or injectable antidiabetic medicine. Prior to initiation, train patients and their caregiver(s) on how to select their weekly Awiqli® dosage. Advise patients using other injectable medications for glycemic control that the dosage selection of Awiqli® differs. Instruct patients to visually verify the dialed units on the dose counter of the Awiqli® FlexTouch® prefilled pen before each injection to avoid dosing errors. Do not dial the maximum single dose (700 units) of Awiqli® unless this is the prescribed dose. Do not use a syringe to remove Awiqli® from the Awiqli® FlexTouch® disposable insulin prefilled pen.
Monitor patients for signs and symptoms of hypoglycemia, particularly during the first several weeks after initiation or dose escalation of Awiqli®. Ensure patients understand how to recognize and manage hypoglycemia. - Hypoglycemia: Hypoglycemia is the most common adverse reaction of insulin, including Awiqli®. Severe hypoglycemia can cause seizures, may be life-threatening or cause death. Hypoglycemia can impair concentration ability and reaction time; this may place an individual and others at risk in situations where these abilities are important (e.g., driving or operating other machinery). Awiqli®, or any insulin, should not be used during episodes of hypoglycemia.
Hypoglycemia can happen suddenly and symptoms may differ in each individual and change over time in the same individual. Symptomatic awareness of hypoglycemia may be less pronounced in patients with longstanding diabetes, in patients with diabetic nerve disease, in patients using medications that block the sympathetic nervous system (e.g., betablockers) or in patients who experience recurrent hypoglycemia. The longacting effect of Awiqli® may delay recovery from hypoglycemia compared to shorter-acting insulins.
Risk Factors for Hypoglycemia: The risk of hypoglycemia generally increases with intensity of glycemic control. The risk of hypoglycemia after an injection is related to the duration of action of the insulin and, in general, is highest when the glucose lowering effect of the insulin is maximal. As with all insulins, the glucose lowering effect over time of Awiqli® may vary among different individuals or at different times in the same individual and depends on many conditions, including the area of injection as well as the injection site blood supply and temperature.
Other factors which may increase the risk of hypoglycemia include changes in meal pattern (e.g., macronutrient content or timing of meals), changes in level of physical activity, or changes to co-administered medications. Patients with renal or hepatic impairment may be at higher risk of hypoglycemia.
Educate patients and caregivers to recognize and manage hypoglycemia. In patients at higher risk for hypoglycemia and patients who have reduced symptomatic awareness of hypoglycemia, increased frequency of blood glucose monitoring is recommended. - Hyperglycemia or Hypoglycemia with Changes in Insulin Regimen: Changes in an insulin regimen (e.g., insulin strength, manufacturer, type, injection site or method of administration) may affect glycemic control and predispose to hypoglycemia or hyperglycemia. Repeated insulin injections into areas of lipodystrophy or localized cutaneous amyloidosis have been reported to result in hyperglycemia; and a sudden change in the injection site (to an unaffected area) has been reported to result in hypoglycemia.
Make any changes to a patient’s insulin regimen under close medical supervision with increased frequency of blood glucose monitoring. Advise patients who have repeatedly injected into areas of lipodystrophy or localized cutaneous amyloidosis to change the injection site to unaffected areas and closely monitor for hypoglycemia. Adjustments in concomitant anti-diabetic treatment may be needed. - Hypersensitivity Reactions: Severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulins, including Awiqli®. If hypersensitivity reactions occur, discontinue Awiqli®; treat per standard of care and monitor until symptoms and signs resolve.
- Hypokalemia: All insulins, including Awiqli®, cause a shift in potassium from the extracellular to intracellular space, possibly leading to hypokalemia. Untreated hypokalemia may cause respiratory paralysis, ventricular arrhythmia, and death. Monitor potassium levels in patients at risk for hypokalemia and treat if indicated.
- Never Share an Awiqli® FlexTouch® Pen or Needle Between Patients, even if the needle is changed. Sharing poses a risk for transmission of blood-borne pathogens.
- Fluid Retention and Congestive Heart Failure with Concomitant Use of PPAR Gamma Agonists: Fluid retention and heart failure can occur with concomitant use of thiazolidinediones (TZDs), which are PPAR-gamma agonists, and insulin, including Awiqli®. Patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of the TZD must be considered.
Adverse Reactions
- Adverse reactions commonly associated with Awiqli® are: hypoglycemia, hypersensitivity reactions (e.g. urticaria, swelling face and lips), injection site reactions, lipodystrophy, pruritus, rash, edema, and weight gain
Drug Interactions
- There are certain drugs that may cause clinically significant drug interactions with Awiqli®:
- Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE
inhibitors, angiotensin II receptor blocking agents, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, pramlintide, salicylates, somatostatin analog (e.g., octreotide), sulfonamide antibiotics, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors - Drugs that may decrease the blood glucose lowering effect: atypical antipsychotics (e.g., olanzapine and clozapine), corticosteroids, danazol, diuretics, estrogens, glucagon, isoniazid, niacin, oral contraceptives, phenothiazines, progestogens (e.g., in oral contraceptives), protease inhibitors, somatropin, sympathomimetic agents (e.g., albuterol, epinephrine, terbutaline), and thyroid hormones
- Drugs that may increase or decrease the blood glucose lowering effect: alcohol, beta-blockers, clonidine, lithium salts, and pentamidine
- Drugs that may blunt the signs and symptoms of hypoglycemia: beta-blockers, clonidine, guanethidine, and reserpine
- Drugs that may increase the risk of hypoglycemia: antidiabetic agents, ACE
Please click here for Awiqli® Prescribing Information.
References
- Awiqli [package insert]. Plainsboro, NJ: Novo Nordisk Inc.
- Bajaj HS, Bergenstal RM, Christofferson A, et al. Switching to once-weekly insulin icodec versus once-daily insulin glargine U100 in type 2 diabetes inadequately controlled on daily basal insulin: a phase 2 randomized controlled trial. Diabetes Care. 2021;44(7):1586-1594.