Background Insulitis in type 1 diabetes (T1D) seems to be both mild and rather rare, and immune cells are found also in the exocrine pancreas, which often is small. We wanted to see whether clinical pancreatitis at diagnosis of T1D in children is a commonly missed diagnosis. Methods Clinical symptoms suggesting pancreatitis were investigated in a retrospective case-control study in 191 newly diagnosed T1D patients (105 boys, 86 girls) with age at onset 0.2 to 18 (mean = 10.05, SD = 4.71, median = 10.36) years, 23/191 (12%) with ketoacidosis at diagnosis. Blood samples were taken on day 4 and stored at -20 degrees C until analyses for P-amylase and C-reactive protein (CRP), and compared with 100 age-matched healthy control children with plasma stored at -80 degrees C, and 46 with plasma stored at -20 degrees C. Results At diagnosis, 23/191 (12%) patients had mild transient abdominal pain, 2/23 with obstipation, and 5/23 also transient mild diarrhea. Five of 23 patients with abdominal pain had pH amp;lt; 7.30. None had clinical acute pancreatitis. One diabetic patient had P-amylase 1.3 mu kat/L (normal range = 0.15-1.1 mu kat/L), while 62/191 (32.4%) diabetic children had P-amylase below the normal range. None (0/100) of the -80-controls and only 1/46 (0.14 mu kat/L) of the -20-controls had the P-amylase level in the normal range. Five diabetic children, but no controls, had increased CRP, but not related to P-amylase or to gastrointestinal symptoms. Conclusions Acute pancreatitis seems to be very rare at diagnosis of T1D, but decreased exocrine function quite common, which supports that T1D sometimes is part of a more generalized pancreatic disorder.