*Geek Box: TDID

*Geek Box: Total Daily Insulin Dose

Insulin doses are prescribed for the management of both type-1 diabetes and type-2 diabetes. On average, one unit dose of insulin can dispose of around 12-15g of carbohydrate, but this can range depending on individual insulin sensitivity. Insulin doses need to be titrated according to the individuals level of diabetic control.

Insulin is required for both basal insulin requirements for overnight and between meals, to maintain blood glucose homeostasis, and in response to meals to reduce blood glucose levels back into normal ranges. Thus, insulin doses reflect both of these factors: there is a ‘background’ dose for controlling overnight glucose levels and for suppressing hepatic glucose production [which normal insulin would do when the pancreas is functioning], and this represents around 50% of daily insulin requirements.

Then there are bolus daily doses required on top of the background dose, which is to cover the postprandial response to meals and snacks, and this represents the balance of daily insulin requirements. For T2D, it is possible – depending on the level of diabetes control – to have individuals require only a background dose, only the bolus doses, or both.

One distinction between the two, is that the background doses tend to use long-acting in the form of injections, while the bolus doses for meals tend to be rapid acting insulin drugs. However, the use of insulin pumps [infused under the skin] for the background dose tends to utilise fast-acting insulin.