Fresh insights into the pathogenic mechanisms by which hyperglycaemia induces tissue and organ injury are the basis for rapidly evolving therapies in diabetes. Especially promising as targets for intervention are products of oxidative stress, including kinins and growth factors. Improving results of renal replacement regimes now incorporating pancreatic islet transplants are able to delay and prevent end-organ damage in diabetic individuals. This text looks at the evolving story of the taming of diabetes, which should be of direct concern to nephrologists, endocrinologists, ophthalmologists, primary care physicians and medical students.