Diabetes in childhood and adolescence is a difficult, lifelong, evolving disorder. Insulin treatment is essential for the establishment and maintenance of optimal metabolic control but it is only part of a comprehensive child-focused management strategy which must be initiated at the time of diagnosis. Attention must also be given to other vital aspects of the child's constantly changing circumstances such as food intake, exercise, the psychosocial environment and particularly the young person's individual motivation, attitude and behaviour. The insulin regime must fit the child's eating and exercise habits. Individual biochemical targets should be negotiated and encouragement given on self-care including insulin adjustments. Regular surveillance in specialist children's diabetic clinics is mandatory. Considerable human and financial resources are needed to organize successful paediatric diabetic services. The success of the service will be reflected in a significant reduction in long-term vascular complications in adulthood.