OBJECTIVES: According to International Diabetes Federation 2013, India has the highest number of Type 1 Diabetic (T1D) patients in the world. And, the only published report on the costing of the treatment of T1D in India had shown the median income spend as 22%; however, this is over ten years old, now. In this background, this study has estimated the annual direct out of pocket expenditure on medical care of T1D patients attending a tertiary care hospital situated in Northern India. METHODS: This questionnaire based study was conducted in the outpatient department of endocrinology of a tertiary care hospital. Responses from 26 T1D patients and/or their caregivers were captured. Based on their inputs, the cost of clinical consultations, laboratory investigations/ procedures and hospitalizations were calculated. The cost of Self-Monitoring of Blood Glucose (SMBG), Insulin and related supplies & other medications (if any) were calculated based on current month usage and annual cost was calculated. RESULTS: The mean age of T1D patients was 17.7±6.2 years. 11.5% patients were employed and 15.4% were not working due to T1D. Only 4 patients had HbA1c under 7%. A median amount of INR53310 was spent annually, accounting for 15.7% of their annual family income (IQR 7.33-31.25%). Median cost of insulin (INR16659) was highest followed by SMBG (INR7250). 50% patients had 1 or more comorbidities. A statistically significant correlation was found between the number of comorbidities and cost of care (p=0.002). Only 19.2% patients reported a diabetes related hospitalization in the previous year. And, the mean cost of hospitalization, was found to be INR102299 with a wide variation. CONCLUSIONS: Families of T1D patients spend a huge part of their income. Prevention of diabetic complications and hospitalization are paramount to reduce this cost.  Strategic approaches for the glycaemic control are the only way to reduce the cost of diabetes medical care.