Diabetic angiopathy includes those complications associated with chronic hyperglycaemia. The major long-term complications of diabetes can be categorized into two classes: macrovascular (i.e., cardiovascular complications) and microvascular (i.e., nephropathy, retinopathy, and neuropathy). Clinically evident diabetic vascular disease is rare in children and adolescents with type 1 diabetes mellitus: however, the permanent threat of severe vascular organ disease within one or two decades, of early invalidity and limited life expectancy following long-term poor metabolic regulation (which is known to the health professional but only incompletely sensed by the young patient), forces the paediatrician to try to reach from the start the aim of normoglycaemia instead of merely somewhat reduced hyperglycaemia, normal lipid and amino acid patterns and near normal fluctuations of all metabolic parameters. With our present means of intervention, this goal is achieved only temporarily, if at all, necessitating immense permanent efforts by the patient and his or her family, including a greater responsibility (compared to that of his/her peers) for his/her everyday lifestyle. In this review natural history, risk factors and screening of diabetic microvascular and macrovascular complications will be described, with particular emphasis to the aspects of these complications in childhood and adolescence. Pediatric diabetologists, other health professionals and families of children must be aware of the risk of diabetic angiopathy (a Damocle's sword on the head of patients with diabetes) and try to do their best for preventing these complications.