Darling

For millions of people managing type 2 diabetes, mornings begin the same way — a needle, a dose, and a quiet mental note to do it all again tomorrow.

That routine just changed.

On March 26, 2026, the U.S. Food and Drug Administration approved Awiqli (insulin icodec-abae), developed by Novo Nordisk, as the first and only once-weekly basal insulin ever approved for adults with type 2 diabetes in the United States.

This is not a minor update to an existing drug.

It is the first entirely new class of basal insulin to reach U.S. patients in more than two decades.

Instead of injecting insulin every single day, people with type 2 diabetes using Awiqli will only need one shot per week, on the same day, every week.

That means reducing from 365 injections a year down to just 52.

For anyone who has ever felt the weight of that daily ritual — the anxiety of forgetting, the physical discomfort, the constant reminder that their body needs help — this approval represents something much bigger than a dosing schedule.

It represents relief.

How the Drug Actually Works

Understanding why this injection lasts a full week requires a quick look inside the body.

Most traditional basal insulins are absorbed into the bloodstream and begin breaking down within 24 hours, which is why patients need a fresh dose every day to maintain stable blood sugar levels.

Awiqli works differently.

Its active ingredient, insulin icodec-abae, is engineered to loosely attach to a blood protein called albumin, which is found naturally and abundantly in the bloodstream.

This attachment creates a slow-release reservoir.

Instead of flooding the system and fading fast, the insulin releases gradually and consistently over an entire seven-day period, keeping blood sugar in a healthy range around the clock...

The FDA reviewed and ultimately declined to approve it for people with type 1 diabetes, citing concerns about a modestly increased risk of hypoglycemia in that population specifically.

Some regulatory agencies in other countries, including the European Union, Canada, Australia, and Japan, have approved Awiqli for both type 1 and type 2 diabetes, but for now the U.S. approval is limited to type 2...

What Comes Next

Awiqli is not standing alone in this space for long.

Eli Lilly is developing its own once-weekly basal insulin, called efsitora alfa, which is currently in late-stage clinical trials.

If that drug also earns FDA approval, it would give patients and doctors two once-weekly options to choose from, allowing for personalized decisions based on a patient’s health profile, insurance coverage, and individual response.

The broader direction of travel in diabetes care is unmistakable.

Fewer injections, smarter formulations, and better integration with digital tools like continuous glucose monitors and insulin-tracking apps are all converging toward a future where managing diabetes requires less daily mental effort without becoming any less medically precise...

A Small Shot With Large Implications

It is easy to look at a once-weekly injection and see only a scheduling change.

But the science behind Awiqli, the scale of the ONWARDS trials, and the consistent satisfaction reported by patients all point toward something that matters far more than convenience.

Diabetes management has always asked a lot of people.

It asks for daily vigilance, daily discipline, and a daily willingness to confront one’s own condition, sometimes in uncomfortable or inconvenient circumstances.

Anything that reduces that load, without reducing the quality of care, is worth taking seriously.

For the more than 37 million Americans living with diabetes, and the hundreds of millions more around the world, a simpler weekly routine could mean the difference between a treatment plan that works on paper and one that actually works in a person’s life.

That is the real significance of what the FDA approved on March 26, 2026.

Not just a new drug.

A new way of keeping people healthy, one week at a time.

music taste

There are real labor problems here. Base pay is often insulting. Customer tips carry too much of the burden. Workers need better protections, more transparent algorithms, protection from arbitrary deactivation, and actual recourse when the app or a customer screws them over. Car-dependent delivery is also an environmental and infrastructural problem, though in a denser city I’d still be doing this work; I’d just be doing it by bike.

But when people talk about delivery work, I rarely see them talk to actual delivery workers. I see a lot of abstract arguments about convenience, consumer decadence, “hustle culture,” and internalized neoliberalism. Meanwhile, when I’m out working and waiting in restaurants for orders, the other Dashers I meet are usually people who only speak Spanish, people who read as neurodivergent, visibly physically disabled people, or some combination of the above.

I have not met this mythical Disco Elysium poor ultraliberal hustlegrinder-wannabe people seem to be arguing with. Maybe that archetype exists somewhere. If it exists among any kind of gig worker, it would probably be rideshare drivers. But most of what I see looks less like “rise and grind” and more like “this is one of the few forms of work available to people who need flexibility, low barriers to entry, limited managerial surveillance, or a way to work around language barriers, disability, burnout, chronic illnesses and injuries with symptoms that come and go unpredictably, caregiving, résumé gaps, or discrimination.”

That does not make the current system good. It means the current system is filling a real gap that a lot of supposedly better systems do not even acknowledge.

As a disabled person who is burnout-prone and demand-sensitive, contracting as a delivery driver has given me an unprecedented level of financial flexibility. I can work when I have capacity. I can stop when I’m deteriorating. I can build my day around my actual body instead of being trapped under a manager who thinks “reliable” means “able to perform the same way every day no matter what.” That matters. It does not cancel out the exploitation, but it is also not fake just because it is politically inconvenient.

And delivery itself is not some inherently decadent evil. Sometimes people live alone. Sometimes they are sick. Sometimes they are disabled, exhausted, overwhelmed, grieving, overloaded, or recovering from something else - perhaps the stress and fatigue induced by their own job. Sometimes they need medicine, groceries, or a meal that will actually unplug their sinuses instead of whatever generic community-care slop someone thinks they should be grateful for. Humans are allowed to need specificity. “Food” is not the same as “the food I can actually eat right now.”

A serious labor critique would ask how to make delivery work safer, better-paid, less tip-dependent, less car-dependent, less algorithmically punitive, and less precarious. It would ask what kinds of flexible, accessible work should exist for people who cannot thrive in conventional employment. It would ask how cities could support bike delivery, worker cooperatives, public infrastructure, and real protections without simply replacing one bad system with a moral sermon about how nobody should ever want takeout.

But a lot of the discourse does not do that. It treats convenience itself as suspicious. It treats wanting flexible work as false consciousness. It treats the needs of disabled people, immigrants, and other people who can't fit into traditional employment structures as details to be swept aside in favor of a cleaner political image.

The Loose Ends Project matches crafters with a project that is unfinished because of death or disability. They offer help with a spectrum of textile mediums in over 80 countries. One project I find particularly lovely: “My mom was making this octopus for me. She was 67 years old when she passed away from COPD. She was hospitalized for pulmonary rehab several times and would always take it to work on while she was there and loved to talk about it with people."

THE COMPOSITION

THE BALANCE