Background: The management of children with type 1 diabetes mellitus (T1DM) remains a major challenge in developing countries. Case presentation: We report an adolescent male who was diagnosed with T1DM at the age of 11 years when he presented at a private hospital with diabetic ketoacidosis. He received emergency treatment there and was subsequently referred to our tertiary hospital for expert care. All through the management, there was poor clinic attendance, poor glucose monitoring, poor compliance with insulin therapy, and ultimately, poorly controlled diabetes. Later, he developed diabetic autonomic neuropathy which manifested as unawareness of bladder fullness with secondary enuresis and fecal incontinence. He was also severely malnourished. At his last admission, seven years after the initial diagnosis, he presented with burnt hands and feet, which were injuries sustained from putting his extremities in naked flames when he lapsed into a coma during a religious activity. He received multidisciplinary management but died a few weeks later. Discussion and conclusion: This case is being reported to draw attention to the plight of children with T1DM from the low socioeconomic class in developing countries. In such children, poverty and ignorance may have profound negative effects on the management and outcome of T1DM.