Once-Weekly Insulin: Most Exciting Advance in Years?

What if you could take your basal insulin once a week instead of every day? Once-weekly basal insulin has arrived, offering a new approach that could make insulin therapy simpler while providing glucose control comparable to daily basal insulin.

In this episode, Dr. Steve Edelman is joined by Dr. Athena Philis-Tsimikas, a leading diabetes researcher who has been directly involved in clinical trials of once-weekly basal insulins. Together, they explain how these ultra-long-acting insulins work, how a single injection can provide steady background insulin throughout an entire week, and what studies have shown when once-weekly insulin is compared with traditional daily basal insulin.

The conversation gets practical with how once-weekly insulin is started, adjusted, and switched from daily basal insulin. Dr. Edelman and Dr. Philis-Tsimikas discuss the dosage differences with once-weekly basal insulin, how concentrated insulin keeps the actual injection volume small, and how fasting glucose can help guide dose adjustments. They also discuss what happens if you miss a dose and why reaching a steady state is an important part of understanding how these longer-acting insulins work.

They also dive into the clinical trial results, including A1C, time in range, and hypoglycemia. In studies of people living with type 2 diabetes, once-weekly basal insulin provided similar A1C lowering to daily basal insulin without an increase in hypoglycemia. They also explain why the story is different for people living with type 1 diabetes, where studies found higher rates of hypoglycemia with weekly basal insulin, and what that means for its use in the United States.

Finally, Dr. Edelman and Dr. Philis-Tsimikas look at how once-weekly insulin could make diabetes management easier. Going from seven basal injections a week to just one could help reduce some of the daily burden of diabetes and make it easier to consistently take your insulin. They also explore using weekly insulin alongside GLP-1 medications, potential combination therapies, cost and access, and what we still need to learn as these newer insulins move from clinical trials into everyday diabetes care.

Key Topics:

How once-weekly basal insulin worksOnce-weekly vs. daily basal insulinStarting, dosing, and adjusting weekly insulinWhy weekly insulin doses may look surprisingly largeA1C, time in range, and hypoglycemia resultsWhat to do if you miss a weekly doseOnce-weekly insulin in type 1 vs. type 2 diabetesWho may benef