Lucknow: India’s first once-weekly long-acting insulin, Awiqli (insulin icodec) was launched in Lucknow on Saturday and is expected to be available at leading pharmacies within a week.Guiding people on insulin about the drug, assistant professor Avivar Awasthi, faculty member in the Endocrinology Department at RMLIMS, said the insulin is not suitable for all people with diabetes and should only be started after medical evaluation.Who is the ideal patient?‘Awiqli’ is best suited for adults with Type 2 diabetes who need only basal (long-acting) insulin to control blood sugar and do not require high doses of mealtime (bolus) insulin. It is not meant for patients who need significant mealtime insulin to manage post-meal blood sugar spikes.Who should not use it?The insulin is not recommended for children with Type 1 diabetes. For people with Type 1 diabetes, it should be used with caution. Those with a history of recurrent hypoglycaemia (low blood sugar), women who are pregnant, planning a pregnancy, or breastfeeding, and anyone allergic to its ingredients should avoid it.Can patients switch from daily insulin?Yes, but only under medical supervision. Patients already on basal insulin can switch through a planned schedule, starting with a higher dose in the first week, followed by a lower dose and further adjustments based on blood sugar levels. For first-time insulin users, the usual starting dose is 70 units once a week, with subsequent dose adjustments based on glucose readings.Can it replace all insulin injections?No. The once-weekly injection replaces only basal (long-acting) insulin. Patients who also need mealtime (bolus) insulin will still require those injections.Will it help patients take insulin more regularly?It depends on the patient. For people who need only basal insulin, switching to a once-weekly injection can reduce the number of injections and may improve convenience and treatment adherence.What are the risks?Like all insulin, the most important side effect is hypoglycaemia (low blood sugar). Patients should also be aware of the possibility of an allergic reaction to ingredients in the medicine, although such reactions are uncommon.How much does it cost?A 70-unit weekly dose costs around Rs 265. It is broadly comparable to daily long-acting insulin, though it may be slightly more expensive.Will this become the preferred insulin?Probably not. The weekly insulin should be viewed as another option in the doctor’s toolkit rather than a replacement for existing insulin therapies.What should patients remember? What is the biggest misconception?Once-weekly insulin is not a ‘magic’ treatment and is suitable only for selected patients. It replaces only long-acting (basal) insulin in eligible individuals. Patients may still need other diabetes medicines or mealtime insulin and should never change their treatment without consulting their endocrinologist.If a patient misses their scheduled weekly insulin dose, what should they do?If the dose is missed, it should be taken as soon as possible within four days of the scheduled dose. The next dose should then be taken exactly seven days after the missed dose is administered. For example, if a patient was scheduled to take the dose on Sunday but missed it and took it on Wednesday instead, all future doses should be taken on Wednesdays. If more than four days have passed since the missed dose, the patient should skip the missed dose and take the usual dose on the next scheduled administration date.Can patients inject the weekly insulin themselves at home, like daily insulin?Yes. It is administered in the same way as daily insulin using an insulin pen. The only difference is that it is taken once a week instead of once a day.How long does one weekly injection remain effective in the body?The half-life (T½) of insulin icodec is approximately eight days, allowing it to remain active in the bloodstream for an entire week.How often should patients monitor their blood sugar after switching from daily to weekly insulin?Monitoring should continue as previously advised. If any changes are required, the patient’s physician, internal medicine specialist, or endocrinologist will provide specific guidance.
