It is recognized in the USA that diabetes mellitus is the most common single cause of end stage renal disease (ESRD)1. At the time that this recognition emerged, continuous ambulatory peritoneal dialysis (CAPD) became established as an accepted form of treatment for ESRD patients, taking a place alongside haemodialysis and renal transplantation2. The degree to which ESRD patients are accepted for any form of treatment, and if so, by which modality, is a reflection of complex social, political and economic factors which vary worldwide. In no subgroup of patients has this been more evident than in the case of diabetic ESRD patients. Where the general acceptance of patients has been low, as in the UK, the acceptance of diabetics has been especially low. Where the acceptance has been high, as in the USA, the proportion of diabetics entering ESRD programmes has been steadily rising, and is reaching 45% of all new patients3. This account will concern itself with the diabetic ESRD patient who has been accepted for treatment by CAPD. The complex interactions between CAPD, uraemia and diabetes will be presented, taken partly from the author’s personal experience.