Search for a command to run...
**Background:**Post-viral hyperglycemia in children represents a distinct and underrecognised clinical entity characterised by transient or persistent elevation of blood glucose following viral illness, associated with beta cell inflammation, insulin resistance, and potential progression to overt diabetes. Standard management protocols utilising high-dose multi-dose insulin regimens may not adequately address the underlying pathophysiology of beta cell recovery in this population. **Objective:**To describe a novel, comprehensive clinical management protocol for paediatric post-viral hyperglycemia developed and validated over 10 to 12 years of single-centre clinical practice, incorporating SGLT2 Inhibitors at alternate day initiation, post-prandial Repaglinide at graduated doses, physiological once-daily bedtime basal insulin, hydroxychloroquine as an anti-inflammatory and insulin-sensitising agent, and a structured five-point safety counselling and sick day emergency management framework. **Methods:**Observational retrospective descriptive study of 25 paediatric patients presenting with post-viral hyperglycemia at Dibya Aditya Diabetes Care, Cuttack, Odisha, India, between 2013 and 2025. Patient demographics, clinical presentation, treatment protocol details, safety outcomes, and clinical response parameters were reviewed and documented. **Results:**All 25 patients demonstrated clinical improvement characterised by weight gain, improved energy levels, reduction in fatigue, and stabilisation of blood glucose parameters. Zero episodes of diabetic ketoacidosis were recorded. Zero urinary tract infections or genital infections attributable to SGLT2 Inhibitor therapy were recorded. Zero hospitalisation for medication-related complications was observed. The alternate day initiation protocol for SGLT2 Inhibitors successfully prevented calorie deficit and dehydration during the initiation phase in all patients. The post-prandial Repaglinide protocol with the No Food No Medicine rule resulted in zero hypoglycaemic emergencies across the cohort over the entire observation period. **Conclusion:**The protocol described represents a safe, effective, and physiologically rational approach to the management of post-viral hyperglycemia in paediatric patients. The novel elements of alternate day SGLT2 Inhibitor initiation, post-prandial Repaglinide dosing, and the structured sick day emergency protocol represent original clinical contributions requiring further validation through multicentre randomised controlled trials. Keywords Post-viral hyperglycemia, paediatric diabetes, SGLT2 inhibitors, empagliflozin, dapagliflozin, remogliflozin, repaglinide, beta cell rehabilitation, alternate day SGLT2 initiation, physiological basal insulin, sick day protocol, paediatric diabetic ketoacidosis prevention, post-viral beta cell dysfunction, insulin resistance children, hydroxychloroquine diabetes, novel paediatric diabetes protocol, Odisha, India. © 2026 Dr. Aditya Bikram Mishra. All rights reserved. The clinical protocol described in this manuscript, including but not limited to the alternate day initiation strategy for SGLT2 Inhibitors in paediatric post-viral hyperglycemia, the post-prandial Repaglinide administration protocol, the graduated beta cell rehabilitation dosing strategy, the sick day emergency management protocol, and the five-point safety counselling framework, constitutes the original intellectual contribution of Dr. Aditya Bikram Mishra, developed and validated at Dibya Aditya Diabetes Care, Cuttack, Odisha, India, over a period of 10 to 12 years of continuous clinical practice. Any reproduction, adaptation, citation, or clinical application of this protocol must appropriately acknowledge the original author. Unauthorised use without proper attribution is a violation of academic and intellectual property ethics. **Funding Statement:**This research received no external funding. All clinical observations were made in the course of routine clinical practice at Dibya Aditya Diabetes Care, Cuttack, Odisha, India. **Ethical Statement:**This study is a retrospective observational description of anonymised clinical practice data. No identifiable patient information is disclosed. The protocol described was implemented as part of routine clinical care. Formal ethics committee review was not applicable for this observational protocol description. **Acknowledgements:**The author acknowledges the trust placed by the families of all 25 paediatric patients described in this study, without whose cooperation and faithful compliance with the safety protocols described, the clinical outcomes reported would not have been achievable. The author further acknowledges the children themselves, whose resilience and recovery over 10 to 12 years of clinical follow-up provided the validation for every element of this protocol.