The non-dipping blood pressure (BP) pattern, characterized by a less than 10% decline in sleep-time BP compared to awake-time values, is prevalent in individuals with type 1 diabetes mellitus (T1DM) and is associated with increased cardiovascular (CV) risk. This review discusses the prevalence, pathophysiological mechanisms, complications, and management strategies of the non-dipping pattern in T1DM. The non-dipping pattern is linked to poor cardiac autonomic function, higher rates of albuminuria, early markers of diabetic kidney disease, and increased arterial stiffness. It is also associated with a two-fold increase in all-cause mortality. Despite its clinical significance, there is no consensus on specific treatment recommendations for non-dippers with T1DM. While some studies suggest that bedtime administration of antihypertensive medications, such as ACE inhibitors and angiotensin II receptor blockers, can improve the dipping pattern and reduce CV events, these findings are primarily based on studies in the general hypertensive population. Emerging evidence also indicates a potential role for vitamin D supplementation and lifestyle interventions in improving BP variability. Further research is needed to develop evidence-based management strategies tailored to non-dippers with T1DM, aiming to reduce CV risk and improve long-term outcomes.