Metabolic control often worsens during the pubertal years in individuals with type diabetes mellitus (DM). This may be due in part to the developmental transition from dependency on parents to a more autonomous lifestyle. Adolescence is also marked by challenging of authority figures and previous ways of thinking, experimentation, and, in some female teenagers, emergence of disordered eating attitudes and behaviors. The insulin resistance of puberty may be particularly maladaptive for the teenager with type 1 DM and is likely under-recognized. In this review, we examine the impact of physiological and psychosocial changes during puberty in type 1 DM, highlight treatment strategies aimed at modifying these factors, and suggest further interventions that warrant evaluation.