Aims/hypothesis <p>Physical education (PE) in adolescents with type 1 diabetes remains underexplored despite its key role in shaping adolescents’ engagement with physical activity. While the only available data about inclusion of individuals with type 1 diabetes in PE lessons are based on interviews with teachers, this study aimed to explore the first-person perspectives of adolescents.</p> Methods <p>This was a child-centred qualitative study using grounded theory. We conducted semi-structured interviews with 25 adolescents (11–15 years) with type 1 diabetes recruited from diverse middle schools.</p> Results <p>Students’ experiences in PE are shaped by the balance between equal participation, recognition of diabetes-related needs and discreet support for autonomous glucose management, which together foster a psychologically healthy environment prompting competence, connection and autonomy. Fear of hypoglycaemia was not identified as a barrier to PE participation. Adolescents instead called for greater teacher support and regretted that excessive caution sometimes undermined their engagement and sense of competence. They sought equal participation without discrimination, with minimal adjustments for hypoglycaemic episodes. The practical constraints of insulin pumps further highlight the need for more discreet technological designs.</p> Conclusions/interpretation <p>The study emphasises teachers’ central role and the need for education on self-regulating physical effort according to glucose levels, which remains underdeveloped. Practical recommendations are identified to better meet the needs of young people with type 1 diabetes in middle school PE.</p> Graphical Abstract <p></p>