The U.S. Food and Drug Administration has approved insulin icodec (Awiqli), marking a major shift in how people with type 2 diabetes manage their blood sugar. This is the first and only once-weekly long-acting basal insulin approved for adults with type 2 diabetes, offering an alternative to daily injections that have been the standard treatment for over 20 years .

Why Does Injection Frequency Matter So Much for Diabetes Management?

For many people with type 2 diabetes, the daily routine of managing the condition can feel overwhelming. Beyond monitoring blood sugar levels and taking medications, the physical act of injecting insulin seven days a week adds another layer of complexity to an already demanding regimen. Research shows that weekly injectable medications are associated with improved patient adherence, meaning people are more likely to stick with their treatment plan when they don't have to inject themselves every single day .

The mental and emotional burden of diabetes management is real. People with type 2 diabetes often experience burnout from juggling hundreds of daily decisions about food, medication schedules, glucose monitoring, and health concerns . When treatment itself becomes a source of stress, some people begin to neglect their care entirely, which can lead to serious complications. Reducing the frequency of injections from daily to weekly could help ease this burden and make staying on track feel more manageable.

How Does Insulin Icodec Work Differently Than Daily Insulin?

Insulin icodec is a long-acting basal insulin, which means it provides steady blood sugar control throughout the day and night, similar to how a healthy pancreas naturally releases insulin. The key difference is that instead of injecting every morning or evening, people using Awiqli inject just once per week. The medication is designed to work in combination with diet and exercise, and can be used alongside other diabetes medications or GLP-1 receptor agonists (a class of drugs that help regulate blood sugar and appetite) .

The approval is based on results from the ONWARDS clinical trial program, which included approximately 2,680 adults with uncontrolled type 2 diabetes . These randomized, controlled trials compared once-weekly insulin icodec to daily basal insulin and demonstrated that the new medication was effective at reducing A1C levels, a key measure of average blood sugar control over three months. The safety profile was consistent with other long-acting basal insulins, though common side effects include low blood sugar (hypoglycemia), injection site reactions, and weight gain .

Ways to Ease the Burden of Diabetes Management

Whether you're considering insulin icodec or managing type 2 diabetes with your current treatment plan, experts recommend several strategies to reduce the emotional and physical toll of daily diabetes care:

• Simplify Meal Preparation: When energy is low, preparing elaborate healthy meals can feel impossible. Use shortcuts like precut vegetables, frozen shrimp, canned tuna, or rotisserie chicken to make meal prep easier. Batch cooking and freezing meals for later can also reduce daily cooking stress.
• Use the Diabetes Plate Method: The American Diabetes Association recommends filling half your plate with nonstarchy vegetables, a quarter with lean protein, and the remaining quarter with complex carbohydrates. This framework removes guesswork from meal planning and helps stabilize blood sugar throughout the day.
• Set Phone Reminders for Medications and Glucose Checks: Managing diabetes requires remembering multiple tasks daily. Setting timers and phone reminders for medication doses and blood sugar monitoring can free up mental energy and reduce the stress of trying to remember everything.
• Explore Adjustments to Your Treatment Plan: If your current routine feels unsustainable, talk with your doctor about modifications. This might mean switching to a continuous glucose monitor instead of finger-stick testing, or breaking up exercise routines into shorter sessions rather than one long workout.
• Practice Stress Management Techniques: Meditation, mindfulness, deep breathing, gentle movement like yoga or tai chi, journaling, and engaging in hobbies can help reduce the anxiety and overwhelm that often accompany diabetes management.

Diabetes self-management education and support (DSMES) programs can also provide personalized strategies tailored to your life. Ask your doctor if there's a local program available, or search for one through the Association of Diabetes Care and Education Specialists .

"Diabetes care is a journey, not a test of perfection. Even small steps, like one healthy meal, one walk, or one glucose check, are meaningful progress," said Barbara Eichorst, vice president of health programs at the American Diabetes Association.

Barbara Eichorst, RD, CDCES, Vice President of Health Programs at the American Diabetes Association

What Should You Know About Fatigue and Diabetes?

Many people with type 2 diabetes experience chronic fatigue that goes beyond normal tiredness. This exhaustion stems from several interconnected factors. Insulin resistance, the hallmark of type 2 diabetes, prevents the body from efficiently converting glucose into energy, causing blood sugar to accumulate in the bloodstream instead of fueling cells . Additionally, increased urination, a common diabetes symptom, can interrupt sleep and create metabolic stress. Chronic inflammation, sleep apnea, and medication side effects can all contribute to persistent exhaustion .

Managing blood sugar levels is the most important first step toward reducing diabetes-related fatigue. Testing blood glucose in the morning can help identify high morning blood sugar, a phenomenon called the "dawn phenomenon" that occurs between 3 and 4 a.m. and 8 a.m. due to natural hormone release . Eating a balanced breakfast with protein, carbohydrates, and healthy fats helps stabilize blood sugar and energy levels throughout the day, preventing the energy crashes that come from skipping meals .

"Managing blood sugar is the most important first step toward managing type 2 diabetes fatigue," explained Fady Hannah-Shmouni, an endocrinologist in Vancouver and medical director of Eli Health.

Fady Hannah-Shmouni, MD, Endocrinologist and Medical Director of Eli Health

If sleep apnea is affecting your rest, talk to your doctor about treatment options like a CPAP (continuous positive airway pressure) machine, which can promote more restful sleep and reduce fatigue . Staying hydrated throughout the day is also important, as dehydration can worsen exhaustion. The exact amount of water you need depends on factors like activity level, age, and weight, so ask your care team for personalized guidance .

The approval of insulin icodec represents a meaningful step forward for people with type 2 diabetes who struggle with the daily demands of insulin therapy. By reducing injections from seven per week to just one, this new medication may help people stay more consistent with their treatment and reduce one source of stress in an already complex disease management routine. As always, talk with your healthcare provider about whether insulin icodec might be right for your individual situation .