Most People With Type 1 Aren't on an Insulin Pump
Two Doors
Most people with type 1 are on injections, not a pump. Two pieces of technology, two very different stories about which doors open — and what we quietly read into where people land.
If you only knew type 1 diabetes from the way it gets talked about, you'd think everyone was wearing a pump that talks to a sensor and runs quietly in the background. That's what the announcements are about, what the conferences sell, what the loudest corners of the community get excited about.
It's not how most people with type 1 actually live.
About have type 1. By industry estimates, somewhere around — and claims data on younger and lower-income patients runs lower. Whichever number you trust, you land in the same place: most people with type 1 in this country are on injections. The pump is the loud part of the story. It's also the smaller part. And being on injections isn't a lesser version of this — it's the version most people are living.
How people with type 1 take their insulin
Roughly four in ten on a pump, the rest on injections. The quieter option is the common one.
Pump share is an industry estimate; population from the CDC. Tap the chart to read the numbers.
Now hold that next to the other piece of technology, because the comparison is worth understanding.
The sensor went the other way. CGM use among people with type 1 climbed from in under a decade, and it has kept climbing since. It reached far more people, far faster, than the pump ever did — and most of them are wearing it on injections, not a pump. Same condition, same years, same country. Two pieces of technology. One door swung wide open. The other stayed narrow.
Adoption over time
The sensor climbed steeply and pulled most people through. The pump moved slowly and stayed lower.
CGM figures from commercially insured claims data (Clinical Diabetes, 2024); pump shown for comparison and is approximate. Tap a line to read more.
I don't think that's a story about good guys and bad guys. The companies making these devices didn't decide who walks through which door — by the time anyone is choosing a pump, the choosing has already been shaped by what insurance covers, what a clinic stocks, what a family can carry, and a hundred small moments upstream of the device itself.
What's worth understanding is that the narrow door doesn't stay narrow evenly.
If pump use came down to preference, you'd expect the split to land about the same across different groups. It doesn't. A national study of young adults found pump use of across White, Hispanic, and Black participants. Adjusting for income and insurance shrank the gap but didn't close it. Researchers have also found something quieter at work: in the moment, people get for a device, and that read can track things that have nothing to do with how well they'd do. CGM carries its own version of this, though in some data it runs gentler, and in a few places it even flips.
Device use by race and ethnicity
Young adults with type 1, by group. Notice the pump gap is the wider one — and for Black participants, the sensor reached more people than the pump did.
YARDD young-adult study, six T1D Exchange clinics. Tap a bar to read the study.
So you've got two doors to roughly the same room. One opened fast and pulled most people through, injections and all. The other opened slowly, stayed narrow, and who got through it had as much to do with their zip code and their insurance and how a stranger sized them up as it did with what would actually help them.
And here's the part that's bigger than diabetes. It's a very human thing to look at where someone landed — on a pump, on shots, numbers tight, numbers struggling — and quietly build a story about the person from it. Their effort. Their seriousness. Their readiness. The two doors are a reminder of how often that story is really about the doors, not the person. Most of the time we can't see the doors at all. We just see where someone ended up.
So when I look at the injection majority, I try to start from understanding rather than assumption. Somebody on shots running good numbers is doing real, skilled diabetes management. Somebody on shots and struggling may be carrying a load I can't see from here. Neither of those is told to me by the hardware.
That's the whole piece, really. Not a verdict on anyone. Just a nudge to notice the doors before we draw conclusions about the people standing on either side of them — and to extend the more generous read, because more often than not, it's also the more accurate one.
