Sebastián is a global advocate with T1International, living in Montevideo, Uruguay who participated in T1International’s New Advocate Speakers Bureau in January 2026.

In Uruguay, access to insulin pump therapy for adults with type 1 diabetes is now frequently resolved through judicial mechanisms rather than standard healthcare coverage pathways.

Official data from Uruguay’s National Resources Fund (FNR) illustrate the scale of this trend. Uruguay, a country of approximately 3.5 million inhabitants, registered 22 legal appeals (recursos de amparo) related to insulin pump access during 2025. Twenty resulted in favorable rulings, while only two were denied — an approval rate approaching 91%.

These figures are not isolated legal outcomes. They reflect a recurring institutional pattern in which courts repeatedly grant access to technologies sought by adults living with a lifelong condition.

The Coverage Boundary at Age 21

Since 2019, Uruguay’s public coverage framework has guaranteed access to insulin pump therapy. Coverage was originally limited to patients up to age 15, with eligibility later extended to age 21. Continuous glucose monitoring systems (CGMs) were formally incorporated into public coverage in 2024, also restricted to patients aged 21 or under. Beyond that threshold, standard coverage does not apply to adults.

Type 1 diabetes, however, does not change at 21. The physiological demands remain constant, clinical risks continue throughout adulthood, and the management burden remains lifelong, yet eligibility frameworks introduce an age-based discontinuity.

The legal data highlights the practical consequences of this structure. None of the individuals initiating insulin pump appeals in 2025 were under 21 (the population already covered by policy). Claimants ranged from 25 to 70 years old, reflecting a systemic coverage boundary.

Continuity of a Longer-Term Trend

The 2025 surge builds upon an already established trajectory. Between 2021 and 2024, FNR data show that at least 18 individuals, including myself, accessed insulin pump therapy via favorable judicial rulings.

In 2024 alone, 17 appeals were filed (the highest number recorded at the time) with 15 favorable decisions. By 2025, the pattern had clearly intensified.

Judicial rulings granting access therefore appear not as exceptional events, but as a recurring mechanism through which adults obtain technologies not routinely covered beyond age-based criteria.

Age-Based Disparities in Access

While Uruguay maintains broad access to insulin and essential diabetes medications, the restriction of insulin pump coverage beyond age 21 introduces a clear age-based disparity in access to advanced diabetes technology.

Individuals living with the same lifelong condition encounter materially different access frameworks based solely on age thresholds rather than clinical need.

The judiciary’s repeated validation of appeals further underscores this disparity.

When courts consistently rule in favor of patients seeking insulin pump therapy, an implicit institutional signal emerges: clinical justification frequently exists even where coverage does not.

A Personal Experience Within the System

My own experience unfolded within this broader context. The first concrete step toward accessing pump therapy began on April 30, 2024, when I contacted a lawyer to explore whether a legal appeal was even possible. Until that point, an insulin pump had never truly existed as a realistic option in my life. The cost alone made the idea feel distant, almost theoretical.

What followed was a process marked by uncertainty. Legal documents, medical reports, waiting periods — and the persistent awareness that the outcome was far from guaranteed. Like many people living with type 1 diabetes, I had spent decades adapting to what was available rather than what might have been clinically optimal.

On August 1, 2024, at age 44, I received a favorable judicial ruling.

The decision did not simply authorize a device. It altered the daily mechanics of managing a lifelong condition. After more than 30 years of insulin injections, glucose checks, and constant manual adjustments, access to pump therapy introduced a fundamentally different treatment experience.

The months between initiating the appeal and receiving the ruling were defined less by legal complexity than by something more difficult to quantify: the psychological weight of waiting. Waiting to learn whether a medically relevant treatment would become accessible, or remain permanently out of reach.

While individual timelines vary, this experience reflects a broader reality faced by many adults. Access, even when eventually granted, often involves prolonged uncertainty — a period during which life with diabetes continues uninterrupted.

After obtaining a favorable judicial ruling granting access to insulin pump therapy, I chose to document the legal process in detail on my blog. The objective was practical rather than advocacy-driven: to translate a complex legal pathway into clear, accessible information for others attempting to understand it.

What followed was unexpected. Adults living with type 1 diabetes began contacting me directly. Many of them had never seriously considered using an insulin pump. For years, the technology simply did not exist as a realistic option within their decision-making framework.

Pumps were perceived as devices for those with exceptional resources. The existence of a legal pathway changed that perception. Once people realized that access might not be strictly limited by price, interest began to grow.

Many inquiries did not initially concern legal strategy. Instead, conversations frequently centered on foundational uncertainties regarding the technologies themselves:

• Is it actually possible to file a legal appeal after living with type 1 diabetes for many years?
• How long does the legal process typically take?
• What are the realistic chances of obtaining a favorable ruling?
• Does switching to a pump still make sense after many years of using insulin pens?

These recurring exchanges revealed a consistent dynamic accompanying coverage barriers.

Information as an Access Variable

For many adults, the barrier is not solely legal or economic. It is informational. Even individuals actively considering judicial appeals often expressed uncertainty regarding device functionality, treatment models, or the operational structure of Uruguay’s coverage framework.

Alongside the blog, I shared explanatory posts on these topics through my Instagram account (@diabetes.uruguay). The responses mirrored the same patterns observed in private consultations: recurring confusion, recurring fears, recurring misconceptions.

In this environment, knowledge functions as a determinant of access. Information circulates primarily through informal patient networks, personal contacts, and social platforms rather than structured institutional channels. Legal pathways become intertwined with disease management strategies.

Judicial Reliance as a Structural Signal

The increasing reliance on legal appeals, combined with consistently high rates of favorable rulings, points toward a structural tension within Uruguay’s access framework. Type 1 diabetes is a lifelong condition, yet eligibility systems that shift abruptly at fixed age thresholds generate predictable consequences: judicial appeals, prolonged uncertainty, and unequal access dynamics.

Advanced diabetes technologies are widely associated with improved glucose stability, reduced severe hypoglycemia, and a meaningful reduction in the cognitive demands of disease management. Uruguay’s public health system has already acknowledged their clinical value for younger populations. Extending this logic to adults would align coverage policies with a simple clinical reality: the condition does not change with age.

However, broadening insulin pump coverage beyond age-based limits would inevitably entail a considerable financial commitment for Uruguay’s National Resources Fund. The cost structure of pump therapy and associated supplies is substantial, and budgetary considerations are an unavoidable element of public health policy. At the same time, consistently favorable judicial rulings indicate that clinical justification frequently exists within the current system. This is where the core tension emerges.

While no formal petition currently exists, visibility and informed public discussion remain essential. Many policy shifts begin not with regulation, but with recognition of structural gaps. Sharing lived experiences and documenting access barriers therefore remains a meaningful form of engagement.

Because while the condition is lifelong, access frameworks are still evolving.