Weekly Insulin Injections Coming Soon to Israel for Diabetes Patients

Israel is set to introduce weekly insulin injections for type 2 diabetes patients, with Novo Nordisk's Awiqli expected to arrive in November. This follows the U.S. Food and Drug Administration's (FDA) approval of Awiqli in March 2026 and its earlier clearance in the European Union approximately two years ago. Eli Lilly's similar long-acting insulin, Onswik, has also received FDA certification and was licensed on September 24. Onswik is intended as a weekly addition to diet and exercise for adults with type 2 diabetes, potentially reducing yearly injections by over 300. The arrival date for Onswik in Israel is not yet known.

Weekly injections replace basal insulin, which maintains stable hormone levels throughout the day, but not short-acting insulin taken before meals. Type 2 diabetes, affecting about 95% of diabetes cases, involves insulin resistance and insufficient production, leading to elevated blood sugar. In Israel, 7.4% of the population, or approximately 696,000 people over age two, had diabetes in 2023, with the rate rising to one in three for those over 65. Treatment typically begins with lifestyle changes and oral medications, progressing to injectables like Ozempic or Mounjaro, and finally insulin if needed.

Onswik's FDA approval was based on four studies involving over 3,400 adults with type 2 diabetes. These studies demonstrated that Onswik was as effective as daily basal insulins, such as Glargine or Degludec, in controlling blood sugar levels, measured by glycated hemoglobin (HbA1c). The time spent within the normal blood sugar range was also comparable. The most common side effect was hypoglycemia, or low blood sugar, with severe cases being rare. Other reported side effects included allergic reactions, weight gain, and skin changes at the injection site. The drug carries warnings about dosage errors, potential potassium reduction, and fluid retention, and is not recommended for pregnant or breastfeeding women.

Awiqli, containing insulin icodec, works by binding to albumin in the blood, creating a reservoir for slow release over the week. Eli Lilly's Onswik utilizes a different mechanism, attaching to a fragment of a human antibody, which prolongs its half-life to 15-16 days. Both weekly insulins are more concentrated than daily formulations, with Awiqli at 700 units/ml and Onswik available in 500 and 1000 units/ml concentrations.