For doctors · Dose calculator
Once-weekly basal insulin: starting dose, switching from daily basal, the one-time extra first-week dose, the 700-unit limit, weekly titration, missed doses, cost, and a card to print for the patient.
For registered medical practitioners. This calculator follows the European and US prescribing information and the ONWARDS trials. It supports clinical judgement and does not replace it, or the full prescribing information. Nothing you enter leaves your browser.
| Date | Dose | Before this dose |
|---|
Launch MRPs, July 2026: ₹2,611 for 700 units, ₹7,833 for 2,100 units (about ₹3.73 a unit either way). Prices change; treat these as indicative. The EU instructions ask for a 10-unit flow check before every injection, which is counted above. A pen in use is kept for up to 12 weeks, so a low weekly dose from a large pen wastes insulin. If a pen has less left than the dose, the dose can be split across two pens.
The label bases each change on the fasting glucose on the titration day and the two days before it. In the ONWARDS trials the dose moved by 20 units a week towards a fasting target of 80–130 mg/dL, using the mean of the three readings, or the lowest one if any was below target. Titrate once a week, on the injection day.
| Fasting readings (3 days) | Change |
|---|---|
| Any reading below 80 mg/dL (4.4 mmol/L) | Reduce by one step, based on the lowest reading |
| Any reading below 70 mg/dL, or any symptomatic low | Reduce, and review sulfonylurea, meals and mealtime insulin before the next dose |
| All 80 or more, mean 80–130 mg/dL | No change |
| All 80 or more, mean above 130 mg/dL (7.2 mmol/L) | Increase by one step |
A change takes two to four weeks to show fully because the insulin has a half-life of about a week. Resist changing by more than one step in a week. The label advises against dose changes for acute illness or short-term changes in diet or activity.
This page uses the EU rule, which the Indian abbreviated prescribing information follows. To keep the original day after a late dose, the EU label allows the gap between the next doses to be lengthened step by step.
In ONWARDS 6 (type 1, with mealtime insulin), clinically significant or severe hypoglycaemia ran at 19.9 events per patient-year on weekly icodec against 10.4 on daily degludec over 26 weeks, a rate ratio of about 1.9. HbA1c was non-inferior. In type 2 the rates were broadly comparable. In type 1 this is a considered choice, best made with a sensor and alarms on, and closer follow-up for the first two months. Safety is not established in newly diagnosed, insulin-naive type 1.
Good candidates: type 2 on basal insulin; people who forget daily basal; people whose injections are given by someone else; people refusing daily injections; shift workers and frequent travellers.
Think twice: type 1 with recurrent lows or reduced awareness; people who need fast dose changes; hospitalised or acutely ill patients; very high basal doses (cost, two injections a week); patients who cannot check fasting glucose or be followed up.
Not for: pregnancy or planned pregnancy (the EU label advises stopping); under 18 (not established).
No dose adjustment for age, renal or hepatic impairment. The label advises more frequent glucose monitoring in renal and hepatic impairment. In older people, hypoglycaemia risk and the ability to recognise lows matter more than the number.
No label gives a rule. One 2026 review suggests starting daily basal about a week after the last weekly dose (±3 days), at roughly the weekly dose divided by 7 (70 units a week to 10 units a day), with a further reduction in well-controlled patients and close monitoring. Treat this as expert opinion.
A weekly basal cannot be trimmed for the fasting hours the way a daily dose can. Trial data in Ramzan are limited. If the patient will fast, plan the transition well before the month, keep the fasting glucose target at the upper end, and review the sulfonylurea and mealtime insulin. See fasting with diabetes.
Found an error? Write to info@caspianhealthcare.in. For patients: what once-weekly insulin means for you.