Background: Diabetes mellitus (diabetes) is one of the most common metabolic diseases in children worldwide and the incidence of type 1 diabetes (T1D) is growing. T1D is complicated to manage and adolescents with diabetes face unique, age-specific challenges. The purpose of this article is to discuss ways in which schools can create a positive environment and improve the experiences and outcomes for adolescents with T1D. Methods: The Cumulative Index of Nursing and Allied Health Literature (CINAHL) and PubMed databases were searched and yielded a total of 27 articles that were used in this integrative literature review. Results: Common concerns identified by students with T1D and their parents included a lack of full-time school nurses, lack of teacher knowledge of diabetes, lack of access to diabetes tools, lack of freedom to perform diabetes self-care, lack of nutritional information in cafeterias, and lack of communication between parents and school personnel. Students who are unable to attend school on a daily basis may not be able to achieve their academic potential. Conclusions: Implications for school health including specifics for school nurses, teachers, students, and school environment were identified.