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T1DM & Coeliac fertility, pregnancy and post-partum:
A Patient Case Study

The 30-year old client client was referred with her partner in March 2021 by her GP regarding optimal 

dietary management for pregnancy planning/fertility with T1DM and coeliac disease. 


The couple were hoping to be pregnant by the end of 2021.  


Nutritional Diagnosis: 

The client had a predicted energy excess related to a food and nutrition knowledge deficit as 

evidenced by her food diary showing low intake of vegetables (1/5), fruit (0/2), grains - all highly 

refined (4-6/6), dairy (1/2.5), and very high intakes of discretionary items (6-8/day). Her partner’s 

diet was similar. 



  • T1DM - pt reports current HbA1c at 7.2% - currently on Govt funded CGM 

  • Coeliac disease dx 2018 - pt reports good management  

  • Pt reported Cowden Syndrome to be considered in plan 


InBody270 body composition analysis on presentation showed: 

  • Wt=90.2kg / BMI=29.8kg/m2 

  • Body fat mass = 33.3kg / 37% of body mass 

  • Abdominal fat = 17.4kg 

  • Visceral fat level = 15 (healthy range 1-9) 

Education Provided: 

  • Australian Dietary Guidelines Gluten Free 

  • Australian Physical Activity Guidelines / Exercise benefits for weight loss and diabetes 

  • management 

  • Review of carb counting for diabetes management 

  • Healthier gluten free hypo treatments 

  • Meal planning training in planning pregnancy 

  • Fat loss principles with T1DM and coeliac disease 

  • Men's Fertility Checklist 

  • Full fertility supplement review for both, based on dietary intake and medical conditions 

       (including 5mg folate started)

  • Easy fertility boosting meal ideas 

  • ∙Balancing blood glucose response in various meals to minimise BGL excursions from the 

  • normal range 

  • ∙Using diet to avoid hypos during and after exercise 

  • ∙Regular dietary analysis in FoodWorks to ensure optimal micro and macro nutrient balance 


After falling pregnant in October 2021 we provided regular support, reminders and ideas to achieve 

optimum nutrition through pregnancy and postpartum: 

  • Australian Dietary Guidelines for pregnancy gluten free 

  • 1st trimester checklist including hydration, calcium intake, weight management 

  • 1st trimester diabetes considerations including high hypo risk 

  • ∙2nd trimester checklist including reducing folate intake, managing increased energy 

        requirement, optimising baby’s brain development 

  • 2nd trimester diabetes considerations including dealing with increasing insulin resistance, 

       increasing to sufficient CHO levels while maintaining BGL stability 

  • 3rd trimester checklist including reflux, constipation, continuing weight mx (monitor closely) 

  • 3rd trimester diabetes considerations including more severe IR so encouraging pre-meal 

  • insulin 40-45 minutes before eating, meal prep for birth and postpartum, planning for hypos 

       on birth day and what will happen with breastfeeding 

  • Postpartum checklist to ensure nutrient sufficient for healing, mental health and weight loss 

       moving forward. 

  • Postpartum diabetes considerations including possibility of infant being likely to go to NICU, 

       therefore activity + no food on top of vast changes in insulin requirements + delays in 

  • lactogenesis -- later higher risk of mastitis – referral to lactation consultant 



The original nutritional diagnosis was resolved, and they gave birth to a healthy boy in 2022. All are 

doing well from a health perspective. 

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