Awiqli (insulin icodec) is a long-acting insulin used along with diet and exercise to help manage blood sugar in people with type 2 diabetes. It is injected under the skin once a week.
Like all insulin products, Awiqli can cause side effects and may interact with other medicines.
Keep reading to learn about potential Awiqli side effects, how to manage them, and which medicines may interact with Awiqli.
This article does not include all possible side effects or interactions. Tell your health care provider about any symptoms that concern you or do not improve.
Awiqli Side Effects
The most common side effects reported with Awiqli include:
- Low blood sugar (hypoglycemia)
- Injection site reactions, such as irritation or pain where you inject Awiqli
- Skin changes at the injection site
- Rash or itching
- Swelling in the hands or feet due to fluid retention
- Weight gain
While less common, potentially serious side effects of Awiqli include:
- Severe low blood sugar
- Severe allergic reactions, including trouble breathing, hives, or throat swelling
- Low potassium levels
If you have symptoms that feel serious or life-threatening, seek medical care right away.
How to Manage Awiqli Side Effects
While not a complete guide, the following tips can help you prevent or manage common side effects of Awiqli.
Low blood sugar
Low blood sugar (hypoglycemia) is the most common side effect of Awiqli. Possible symptoms include dizziness, sweating, shakiness, hunger, confusion, and a fast heartbeat.
Hypoglycemia can range from mild to severe. In studies of Awiqli, about 9%-51% of people had mild episodes of low blood sugar, and up to 1.4% of people had severely low blood sugar. These episodes were more common in people who were also using mealtime insulin.
Mild episodes can often be treated by consuming a quick-acting source of sugar, such as glucose tablets or juice. Without prompt treatment, hypoglycemia can become serious or even life-threatening. Talk with your prescriber about how to recognize and treat hypoglycemia.
To help reduce your risk of having severely low blood sugar:
- Talk with your health care provider before making major, long-term changes to your diet or exercise routines.
- Test your blood sugar regularly at home or consider using a continuous glucose monitor (CGM).
- Carry a source of fast-acting sugar with you.
Tell your health care provider if low blood sugar happens often. They may adjust your dose or treatment plan.
Injection site reactions
Some people have skin reactions at or around the area where Awiqli is injected. In studies, around 2% of people had injection site reactions.
Symptoms may include redness, itching, bruising, swelling, or discomfort. These reactions are usually mild and go away on their own. If needed, you can place a cool compress on the skin for a few minutes after your injection to help ease discomfort or irritation.
Repeated injections in the same area can also cause skin thickening or pitting. These changes can affect how well your insulin works.
To help reduce the risk of having injection site reactions:
- Rotate injection sites each week.
- Use a new needle for each injection.
- Avoid injecting into areas that are bruised, thickened, or scarred.
- Use proper injection technique, and follow the instructions that come with your prescription. Review these steps with your health care team if needed.
Weight gain
Modest weight gain can happen with insulin treatment. In studies of Awiqli, people gained about 3-6 pounds (1.4-2.8 kg) over 6-12 months.
To help prevent weight gain, follow a balanced eating plan and stay physically active. For personalized guidance, consider meeting with a registered dietitian or certified personal trainer.
If weight gain becomes a concern, your health care provider may adjust your treatment plan.
Fluid retention
Awiqli can cause the body to hold onto fluid, which may lead to swelling, especially in the hands, lower legs, or feet. In studies, around 1% of people experienced swelling from fluid retention (edema).
To help manage edema:
- Avoid excess salt intake.
- Elevate your legs when sitting, or ask your health care provider if compression socks may be helpful for you.
- Monitor for sudden weight gain.
Tell your health care provider if you have sudden weight gain or swelling that is unusual, worsening, or bothersome. They may adjust your Awiqli dose or recommend other ways to manage edema.
Awiqli Interactions
Awiqli can interact with other medicines that affect blood sugar levels. Some interactions may increase the risk of having low blood sugar, while others may make Awiqli less effective.
This is not a full list of drug interactions, but the following interactions are important to be aware of while taking Awiqli.
Medicines that increase the risk for low blood sugar
Some Awiqli interactions may increase the risk of having low blood sugar (hypoglycemia).
Examples include:
- Other insulins
- Other diabetes medicines, such as canagliflozin, empagliflozin, linagliptin, or semaglutide
- Certain blood pressure medicines, such as lisinopril or valsartan
- Some antidepressants, such as fluoxetine, and monoamine oxidase inhibitors (MAOIs), such as selegiline
- Certain antibiotics that contain sulfa medicines, such as sulfamethoxazole
Your health care provider may recommend closer monitoring or dose changes if you take these together.
Medicines that raise blood sugar
Some medicines can increase blood sugar levels. This can make Awiqli less effective.
Examples include:
- Corticosteroids, such as prednisone
- Some mental health medicines, such as clozapine and olanzapine
- Diuretics (“water pills”), such as chlorthalidone or hydrochlorothiazide
- Hormonal medicines such as birth control pills
- Somatropin (growth hormone)
Your dose of Awiqli may need to be adjusted if you take these medicines. You may also need to check your blood sugar more often. Always check with your health care provider before changing your dose.
Medicines that lower potassium
All insulins, including Awiqli, can lower potassium levels in your blood. This happens because insulin moves potassium from the bloodstream into your cells.
For most people, this is not a problem. However, the risk may be higher if you already have low potassium levels or if you take other medicines that can lower potassium levels.
Examples of such medicines include:
- Water pills (diuretics), such as furosemide and thiazides
- Potassium-binding medicines, such as sodium polystyrene sulfonate (SPS) or patiromer
- Corticosteroids, such as prednisone
Your health care provider may need to check your potassium levels regularly. Keep all appointments to have blood tests done while using Awiqli.
Medicines that can mask low blood sugar symptoms
Some medicines can make it harder to recognize the symptoms of low blood sugar (hypoglycemia). This can delay treatment and increase the risk of having more serious symptoms.
Examples include certain blood pressure medicines, such as beta-blockers and clonidine.
These medicines may reduce warning signs such as a fast heartbeat or shakiness. As a result, you may not notice having a low blood sugar level until it becomes more severe.
If you take one of these medicines, your health care provider may recommend checking your blood sugar more often. It is also important to learn other signs of low blood sugar (such as sweating or confusion) and keep a source of fast-acting sugar nearby.
Pioglitazone
Pioglitazone is a type of diabetes medicine that belongs to a class called thiazolidinediones (TZDs). It can increase the risk of having fluid retention when used with insulins, including Awiqli.
The combination may cause the body to hold onto extra fluid. This can lead to swelling in the hands, legs, or feet. In some people (especially those with a history of heart problems), this may worsen or lead to congestive heart failure.
Your health care provider may monitor you more closely if you take both medicines. Tell your provider right away if you notice symptoms such as:
- Shortness of breath
- Swelling in your legs or feet
- Sudden weight gain
If you experience new or worsening heart failure, your health care provider may adjust your treatment plan.
Alcohol
Alcohol can make blood sugar levels less predictable when you are using Awiqli or other insulins. It may increase the risk of having low blood sugar (hypoglycemia); it can also lead to high blood sugar.
For this reason, it is best to avoid alcohol while using Awiqli. Drinking can also make it harder to tell if you’re having symptoms of low blood sugar, such as confusion or drowsiness, which can be dangerous.
If you choose to drink alcohol, do so cautiously and only after discussing safe limits with your health care provider.
Reducing Your Risk for Awiqli Side Effects and Interactions
You can reduce your risk of having side effects and interactions by using Awiqli exactly as prescribed and following all the instructions on how to use it.
- Check the label before each injection, monitor your blood sugar regularly, and rotate injection sites.
- Keep track of any new or changing symptoms, and share them with your health care provider, especially if symptoms affect your daily routines.
- Tell your health care provider about all medicines, vitamins, and supplements you take. Some products can affect how Awiqli works or increase your risk of having low or high blood sugar.
- Your health care provider can review your full treatment plan and make adjustments, if needed, to help control your blood sugar and reduce risks.
With the right support and monitoring, Awiqli can be a convenient, safe, and effective part of a diabetes care plan.
