© 2022, The Author(s), under exclusive licence to Research Society for Study of Diabetes in India.Objective: The study aimed to evaluate the fear of hypoglycemia (FoH), nutritional factors, and behavioral strategies before exercise in children and adolescents with type 1 diabetes (T1D). Materials and methods: A total of 116 patients with T1D aged 6–18 years were included in the study. FoH was evaluated with the Virginia University Child/Teen Low Blood Sugar Scale. The nutritional and physical activity habits of the patients were evaluated. Results: FoH scores of patients who generally missed meals were higher than those who did not miss (p < 0.05). No significant relationship was found between the FoH and the energy, carbohydrate, lipid, and sucrose intakes of the patients. FoH scores were higher (p = 0.041) and HbA1c% was lower in patients who exercised regularly (p < 0.05). The behavioral subscale score of the patients who kept their blood glucose in the safe range before exercise (p < 0.001) and the anxiety subscale score of the patients who measured their blood glucose during exercise were higher (p < 0.05). Patients who reduced their insulin dose independently of blood glucose level before exercise had higher behavioral subscale scores (p < 0.05). There was a significant positive correlation between the FoH score and the number of hypoglycemia episodes in the last 1 month (r = 0.251, p < 0.001), and a negative significant correlation between the diet compliance score and HbA1c% (r = − 0.266, p < 0.001). Conclusions: Evaluating the FoH and applying healthy behavioral and nutritional practices to prevent hypoglycemia will help patients reduce their stress perception and fear of hypoglycemia and contribute to the goal of glycemic control.