Much progress has been made in the treatment of IDDM in children and adolescents during the past 15 years. The perfect tools required to ensure relative normoglycemia at all times are still not available. Until the time that a perfect and permanent indwelling glucose sensor can be developed and connected to an insulin infusing device, or much less toxic immunosuppressive drugs enable pancreatic or beta-cell transplantation on a wide basis, we should endeavor to provide the best possible care for our patients with this most difficult disease. Education, psychosocial support, and physician availability and knowledge are all important to this effort. Early results from groups treating large numbers of insulin-dependent diabetic youngsters and adolescents suggest that it is possible to keep glycohemoglobin levels in the normal or good-control range in upwards of 50% of patients, although the early Diabetes Control and Complications Trial data has found this to be particularly difficult in adolescents. In our own patients, we have found major hypoglycemic attacks requiring glucagon or intravenous glucose to be rare (much less than one per patient per year). Minor episodes marked by the feeling that one's blood glucose concentration is decreasing rapidly, however, are common. Therefore, education and appropriate snacking are crucial. In our population, we have noted improvement in school performance with improved blood glucose control, but these early impressions have yet to be documented through time. It is the pediatrician's role to start these youngsters on the right track early to avoid complications that usually do not occur until the patient reaches an age when he or she is treated by an internist.(ABSTRACT TRUNCATED AT 250 WORDS)