This chapter applies Langdon Winner’s insights on the politics of technological artifacts to contemporary biomedical technologies for Type 1 Diabetes (T1D) management. As people with T1D rely on continuous monitoring and treatment technologies to survive, these systems, especially artificial pancreas systems (APS), shape more than clinical outcomes. They participate in the production of knowledge, access, and authority within healthcare. By examining the development and use of APS, the chapter investigates how these technologies can embed and reproduce values, reinforce existing power structures, or generate new forms of inequity. At the same time, innovations emerging from citizen scientists and the broader DIY diabetes community highlight alternative models of technological design, governance, and ownership that challenge dominant assumptions. Drawing on science and technology studies, medical sociology, and bioethics, the chapter reconsiders prevailing narratives about biomedical innovation and interrogates whose needs and perspectives guide these systems. Ultimately, it argues for a more reflexive and inclusive approach to technological development in diabetes care, one that recognizes the political dimensions of biomedical technologies and centers the diverse experiences of those who depend on them.