A gap exists between our expectations of tight blood glucose control for type 1 diabetes and the reality of safely achieving it particularly during pregnancy. Technological and pharmaceutical advances will not alone achieve near-normal blood glucose control and optimal health outcomes without recognising the social, cultural and behavioural context of those living with diabetes. Neither will educational programmes completely overcome the fundamentally disordered metabolic pathways and/or the additional physiological challenges of pregnancy. New technologies, including continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (CSII) and closed loop insulin delivery have the potential to transform diabetes care. Improved integration of theses technological and educational aspects of care will pave the way for truly personalised, diabetes self-management and improved pregnancy outcomes for women with type 1 diabetes.