#1714 Defining Diabetes: Total Daily Dose

Summary

Juicebox Podcast: Type 1 Diabetes

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

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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.

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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)

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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)

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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

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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.

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

Transcript

[A]

Here we are, back together again, friends, for another episode of the Juice Box Podcast. Managing diabetes is difficult, but trying to do it when you don't understand the lingo, that's almost impossible. The Defining Diabetes series began in 2019, and today we're adding to it. Go to juiceboxpodcast.com up in the menu, click on Defining Diabetes and you'll see a complete list of all the terms that we've defined so far. My Grand Rounds series was designed by listeners to tell doctors what they need, and it also helps you to understand what to ask for. There's a mental wellness series that addresses the emotional side of diabetes and practical ways to stay balanced. And when we talk about GLP medications, well, we'll break down what they are, how they may help you, and if they fit into your diabetes management plan. What do these three things have in common? They're all [e-mail] up in the menu. I know it can be hard to find these things in a podcast app, so we've collected them all for [e-mail] While you're listening, please remember that nothing you hear on the Juice Box Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. All right, we are going to define total daily dose of insulin. So what is that? Is that. Is TDI and TDD the same? Are people talking about the same thing?

[B]

Honestly, yeah. Tdd, tdi, Total daily insulin, Total daily dose, essentially. Right. And really it just means adding together what eubolis, both for food and correction, as well as the amount of basil that you're getting in a day. And you add them together, that's your total daily dose. And it may look a bit different day to day, especially with those who are using pumps. Right. Because we have these algorithms that titrate things up and down. So one day it might look like 42, and the next day it might look like 48, and the next day it might look like 39. And what's changing there? Basal, it's going up and down. They might eat a lot more one day than the other day. But when we aim to look at total daily dose from a perspective of adjusting some settings, which is what can be used for kind of going forward, we take an average, usually over the past seven days or the past 14 days to get an idea of what is typical.

[A]

Yeah, I was thinking that probably nowadays 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. Like this is your. You have to tell it on day one. Like, this is my total daily insulin.

[B]

Right.

[A]

That's why that's still coming up. Gosh, I don't really remember that being a big part of management for us back then. But yeah, I don't think about it much, honestly.

[B]

I think for kids it might be, or anybody going through a transitional time in life where their needs are changing, we pay attention. I do. Especially when I'm working with my kiddos, I pay attention to total daily insulin because as their needs change and we can see things fluxing and we need to make adjustments, 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. You know, little Susie has grown an inch in the past three months. This is why her insulin needs are this versus this. So it's helpful just to acknowledge that you're not crazy, that insulin needs are going up.

[A]

Right. So, you know, it's funny too because 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.

[B]

And really, you know, the pump that strives hard, which you know very well, having done all the Omnipod 5 episodes, that algorithm strives really hard to get somebody to about a 50, 50. But that's the algorithmic. That's how it was written, coded to do where with algorithm driven systems, especially in the DIY community, that 50 50, it can kind of get thrown out the window a bit because of the give and take of the system for the way that the algorithm is written to work for you.

[A]

Now, I'm glad you said it because I was thinking that that might be an old metric really, that you don't see much more of.

[B]

But you hear it. It's a great one to bring up because it's a metric that 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 basil 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.

[A]

Right. Okay. All right. Tdi. Also TDI or tdd. Why do people change things? Like, why did some, like whatever was first? Why did someone one day go, oh, it should be TDD or vice ver. Why do you got to make everything hard?

[B]

Just keep it.

[A]

Say the thing. All right, Right. Hey, kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juice Box Podcast. I know you're thinking Facebook, Scott, please. But no. Beautiful group, wonderful people, a fantastic community. Juice box podcast, type 1 diabetes on Facebook. Of course, if you have type 2, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of the Juice Box Podcast. Hey, I'm dropping in to tell you about a small change being made to the Juice Cruise 2026 schedule. This adjustment was made by Celebrity Cruise Lines, not by me. Anyway, we're still going out on the Celebrity beyond cruise ship, which is awesome. Check out the walkthrough [e-mail] JuiceCruise the ship is awesome. Still a seven night cruise. It still leaves out of Miami on June 21st. Actually, most of this is the same. We leave Miami June 21, head to CocoCay in the Bahamas, but then we're going to San Juan, Puerto rico instead of St. Thomas after that. Basteri. I think I'm saying that wrong. St. Kitts and Nevis. This place is gorgeous. Google it. I mean, you're probably gonna have to go to my link to get the correct spelling because my pronunciation is so bad. But once you get the St. Kitts and you Google it, you're gonna look and see a photo that says to you, oh, I want to go there. Come meet other people living with type 1 diabetes, from caregivers to children to adults. Last year we had a hundred people on our cruise and it was fabulous. You can see pictures again at my link juiceboxpodcast.com juicecruise you can see those pictures from last year there. The link also gives you an opportunity to register for the cruise or to contact Suzanne from Cruise Planners. She takes care of all the logistics. I'm just excited that I might see you there. It's a beautiful event for families, for singles. A wonderful opportunity to meet people, swap stories, make friendships and learn. Have a podcast. Want it to sound fantastic? Wrongwayrecording.com.