Juicebox Podcast: Type 1 Diabetes

Episode #1714 – Defining Diabetes: Total Daily Dose
Host: Scott Benner
Date: December 20, 2025

Episode Overview

This episode of the Juicebox Podcast continues the ongoing “Defining Diabetes” series with a focus on the term “Total Daily Dose” (TDD or TDI) of insulin. Host Scott Benner and his guest break down what TDD means in the context of diabetes management, why it matters, how it’s used (especially during transitions in therapy), and clarify common misconceptions around insulin ratios. The episode aims to equip listeners with practical knowledge, helping them communicate effectively with healthcare professionals and make informed decisions about insulin management.

Key Discussion Points & Insights

1. Defining Total Daily Dose (TDD/TDI)

• What is TDD/TDI?

  • TDD (Total Daily Dose) and TDI (Total Daily Insulin) are interchangeable terms.
  • TDD comprises the sum of all insulin a person gets in a day: both bolus (for food and corrections) and basal insulin.
  • Quote:
    • "Honestly, yeah. TDD, TDI, Total daily insulin, Total daily dose, essentially. Right. And really, it just means adding together what you bolus, both for food and correction, as well as the amount of basal that you're getting in a day." (B, 01:42)

• Why does it vary?

  • TDD can change daily, especially for those on insulin pumps due to algorithmic adjustments.
  • Tracking averages over 7 or 14 days helps understand what’s typical for a person.

2. When Is TDD Important?

• Transitioning to Pumps or Automated Systems

  • When moving from Multiple Daily Injections (MDI) to a pump, users often need to provide an estimated TDD to set up the device (e.g., Omnipod 5).
  • Quote:
    • "...one of the places this still comes up. Right. Is people who are getting off of MDI and going into a pump or going into an automated system, especially like Omnipod 5. Right. Like they really want you to start with like a number." (A, 02:47)

• Changing Needs – Children & Life Transitions

  • TDD is especially monitored during growth spurts in children or any significant life change affecting insulin needs.
  • Quote:
    • "I do. Especially when I'm working with my kiddos, I pay attention to total daily insulin because as their needs change ... tracking their total daily insulin can be helpful to explain. This is why you're seeing a higher blood sugar, we're needing to increase." (B, 03:17)

3. Debunking the 50/50 Basal-Bolus Myth

• Old guidelines suggested a 50% basal to 50% bolus ratio.

  • This is now seen as outdated, particularly with pump algorithms or individualized management.
  • Algorithms may strive for that 50/50 split, but real-world patterns often differ based on the person’s life and system used.
  • Quote:
    • "People sometimes talk about that, like, know your insulin should be 50% basil and 50% bolus. I don't, I don't really prescribe to that. Really. I don't see that being the case some days." (A, 03:59)
    • "...that's the algorithmic. That's how it was written ... with algorithm driven systems, especially in the DIY community, that 50/50, it can kind of get thrown out the window a bit..." (B, 04:16)

• Medical professionals may still cite this ratio, but it’s not always applicable.

  • Quote:
    • "...a lot of doctors still are hard lined in looking at and they're like, no, no, something's gotta be off. We have to throw in more basal here. Cause you know, you're only getting 30% when you should be getting a 50, 50 split. And it's like, then cleanup work on my part, teaching somebody, it's kind of old school information." (B, 04:55)

4. TDD, TDI, TDD... Why So Many Terms?

• Interchangeable, just use what works.
  • The hosts acknowledge the confusion but affirm that they’re the same thing, just different abbreviations.
  • Quote:
    • "TDI. Also TDI or TDD. Why do people change things? ... Just keep it. Say the thing." (A/B, 05:19-05:33)

Notable Quotes & Memorable Moments

• On TDD Calculation:
  • "...you add them together, that's your total daily dose. And it may look a bit different day to day..." (B, 01:42)
• On Average TDD:
  • "When we aim to look at total daily dose from a perspective of adjusting some settings, ... we take an average, usually over the past seven days or the past 14 days to get an idea of what is typical." (B, 01:42)
• On Real Life Changing Needs:
  • "Little Susie has grown an inch in the past three months. This is why her insulin needs are this versus this." (B, 03:17)
• Challenging Old School Ratios:
  • "...that 50/50, it can kind of get thrown out the window a bit because of the give and take of the system..." (B, 04:16)
  • "...then cleanup work on my part, teaching somebody, it's kind of old school information." (B, 04:55)

Important Timestamps

• [01:42] – Clear definition and discussion of Total Daily Dose/TDI
• [02:47] – Importance of TDD when transitioning to new insulin delivery systems
• [03:17] – Role of TDD in children’s diabetes management and times of life change
• [03:59–04:49] – Discussion and debunking of the 50/50 basal/bolus insulin split
• [05:19–05:33] – TDD/TDI terminology confusion and simplification

Conclusion

This episode demystifies a fundamental diabetes management term—Total Daily Dose—making it accessible and approachable. The hosts emphasize practical strategies for tracking insulin needs, challenge outdated conventions like rigid ratio splits, and offer reassurance to those managing diabetes through periods of change. The tone is friendly, clear, and supportive, inviting listeners to “be bold with insulin” and to keep learning.

For more resources and past definitions, listeners are directed to juiceboxpodcast.com’s Defining Diabetes section.