BACKGROUND Diabetes Mellitus (DM) is a metabolic disorder characterized by absolute or relative insulin deficiency. There are four types of diabetes mellitus. Among them, type 1 DM (T1DM)is the most common type in younger population. It results from autoimmune destruction of the pancreatic beta cells, hence absolute insulin deficiency. These patients need exogenous insulin to maintain normal state of metabolism as well as normal glucose levels in the body, otherwise life-threatening complications can occur. The most common acute complications are Diabetic Ketoacidosis (DKA) and hypoglycemia. OBJECTIVE The aim of this study was to determine the trend and clinical presentations of acute complications among children and adolescents with T1DMreceiving care at KCMC hospital in the past 5 years METHOD This was a prospective cohort study of 5 consecutive years (2011-2015), involving medical records of 113 patients with T1DM who attended the clinic during the period. Data on demographics, acute T1DM compilations and clinical presentations of those acute complications were taken from the enrolled patient’s medical records and recorded in a questionnaire for each patient. Yearly proportions were calculated to show the trend of complications with time. Frequency of clinical presentations was determined. Descriptive analysis was done. RESULTS A total of 113 patient files were studied. 35.4% of the patients presented with at least one episode of DKA and 47.8% of the patients presented with at least one episode of hypoglycemia through the entire study period. There was a slight downward trend of total DKA cases as well as severe hypoglycemia cases through the years and an upward trend was seen in the cases of DKA at diagnosis and total hypoglycemia episodes. The common clinical presentations of DKA were found to be fatigue, vomiting/nausea, polyuria/polydipsia and abdominal pain in descending order. The common presentations of severe hypoglycemia xii were found to be loss of consciousness, general body malaise and seizures in descending order. CONCLUSION Acute complications among patients with T1DM is still high and the presentations vary from person to person. More efforts and interventions are needed to focus on early diagnosis and maintenance of good glycemic levels after diagnosis.