It is not clear how best to support youth with type 1 diabetes to participate in physical education (PE) at school. The aim of this study was to explore perceptions of facilitators and barriers to PE in youth with type 1 diabetes and to determine how schools can help these individuals to be physically active. Interviews and focus groups were conducted with youth with type 1 diabetes aged 7-9 (n = 8) and 12-14 (n = 8) years with type 1 diabetes, their parents (n = 16), diabetes professionals (n = 9) and schoolteachers (n = 37). Data were thematically analysed. Four main themes were identified relating to support needs of youth with diabetes in school in general and specifically in PE lessons: (1) differences between primary and secondary schools; (2) areas requiring address in all schools; (3) what teachers can do to help accommodate youth with type 1 diabetes; and (4) what schools can do to help accommodate youth with type 1 diabetes. Diabetes support varied across schools. Primary schools in particular could improve communication between schools and primary specialist PE teachers regarding youth with type 1 diabetes to aid participation in PE. Diabetes knowledge was limited among all teachers. Participants felt that diabetes could be used as an excuse to sit out of PE and that teachers' fears could facilitate this. Improved and consistent diabetes management training and guidance on the responsibilities of teachers is necessary. Better communication between schools, teachers, parents, youth with type 1 diabetes and diabetes professionals is also required. The findings have helped produce suggestions for practice and research on how to improve support for youth with type 1 diabetes in schools in general and specifically in PE lessons.