Abstract Failure of the thyroid gland requires thyroid hormone replacement therapy, which is relatively easily adjusted to replicate the normal physiological state by monitoring plasma levels of thyroxine and/or thyroid-stimulating hormone. In contrast, failure of pancreatic b-cells requires insulin therapy, and optimal replacement requires monitoring, not of the absent hormone (insulin), but of its major substrate (glucose). The fact that glucose levels are also regulated by several other (counter-regulatory) hormones, by nutrient ingestion, by energy expenditure and by many poorly understood psychosocial stressors, plus the inadequacy of current insulin replacement regimens, means that truly physiological insulin replacement remains an elusive goal almost 80 years after the discovery of insulin. This contribution focuses on the role of self-management in type 1 diabetes and the tools available to achieve management goals.