Youth-onset type 2 diabetes is an emerging condition impacting Indigenous populations worldwide. Schools have an important role in supporting students to manage their health.We undertook a qualitative study to (i) explore the lived experience of type 2 diabetes, diabetes management and support in school environments and (ii) co-design recommendations for age-appropriate, culturally safe school-based strategies and supports. Interviews and focus groups were undertaken with Aboriginal and Torres Strait Islander youth, caregivers, health professionals and school-based staff. Aboriginal and Torres Strait Islander youth were involved in determining the research topic.We found a need for school-based measures to address diabetes stigma, medication management, privacy and confidentiality, healthy eating and social and emotional wellbeing and identified further needs for staff training.In many cases, schools are providing extensive support to students, but without adequate resources, supportive systems and policies or staff training, current approaches are insufficient.Recommendations include whole-of-school responses to address diabetes stigma and to generate sensitive approaches to nutrition, school-based management plans for students with T2D and adoption of Aboriginal and Torres Strait Islander-driven approaches.