Diabetes is certainly not created equal, and it's even more varied when you take into account the various ways countries manage their health care system. Over the past few months, in our new international series, we've peeked into the lives of PWDs in Spain, Germany, Canada and Australia, and this month we're taking a hop across the pond to visit Becky Thomson, a resident of the United Kingdom (which of course encompasses England, Scotland, Wales and Northern Ireland).
Becky is a 26-year-old administrative assistant at a theater in York, England, where she's lived with type 1 diabetes for about two years. She writes the blog Instructions Not Included and tweets away at @instructionsni. She currently uses an Animas insulin pump, but as she tells us, that's not exactly common in the UK...
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So the UK — land of hope and glory, right? — we've spell with more U's than you can shake a stick at, and a whole other system of blood glucose measurement. But apart from that, how different is life over here in terms of diabetes?
Speaking from this side of the 'pond,' so much of what I hear about from the other side is like a labyrinthine mystery. And when I was diagnosed two years ago, at the age of 24, having had relatively little interaction with the world of doctors, prescriptions and juggling appointments, I was completely lost. So, since you probably know about as much about dealing with all this in the UK as I did, let me give you a whistlestop tour of our system.
The UK is (in my opinion) extremely fortunate in that we have access to the NHS (National Health Service). Scotland and Wales have their own branches of the NHS — oh-so-creatively named NHS Scotland and NHS Wales. Northern Ireland has a similar institution to the NHS, called HSC (Health and Social Care in Northern Ireland), which operates in much the same way. The NHS is free at the point of use — I pay my contribution to funding through paying my taxes and National Insurance, which is deducted from my wages, rather than having to purchase 'health insurance.'
In the UK, you're issued an NHS number, which entitles you to be able to go to a doctor without worrying about having to pay a fee. The same goes for hospital admissions. During my five-day stay at diagnosis, I was never presented with a bill, nor did I ever expect one. I've never paid for test strips, insulin, needles, or now, pump supplies.
Most people pay a prescription charge, of £7.20 (around $12.00) each time they need a prescription filled. This is just an England thing; Scotland and Wales have done away with it. However, having a chronic health problem, I get sent a nifty little card, which means that I'm exempt from paying charges, which I'm very glad for. Even with free health care, this would still make a bit of a hole in my (not very well-lined) pocket.
I have what's known as a GP (General Practitioner), who I see for most health issues. There's often some confusion about whether the GP's practice or the hospital clinic is supposed to look after the diabetes care of people with type 1. I happen to go to the hospital's diabetes clinic, where I have my endo, who I see once a year, and access to a team of four DSNs (Diabetes Specialist Nurses). Normally, you wouldn't actually have contact with as many, but for various reasons, I've dealt with all of them at some point or other! For questions about my care, the DSNs are my point of call on all matters diabetes-related. I'm free to call up or email whenever I need to, and I generally see one of them about every six months as a matter of routine.
In terms of treatment? Most people here are on MDI. I was started off on twice-daily mixed insulin, which didn't work at all for me. I quickly moved on to Lantus and Novorapid. I'm very lucky in having access to an insulin pump, as they're very hard to get hold of over here. Last time I checked, it was only 2-4% of type 1's who had one.
For CGMs, the number will be even lower. I've never seen one in person, and I don't dream of getting hold of one within the next 5 years. This is mainly because each area of the country gets a specific amount of money from the NHS budget to spend. I'm fortunate that my area has an extremely well-maintained budget, which gives me opportunities that people in other areas don't get. It's what's 'lovingly' referred to as a 'postcode lottery,' which I've happened to come up trumps on. Ah well, as I don't gamble, it's the only one I'm likely to, despite what many emails seem to tell me about the Nigerian lottery.
Technology seems to be 'drip-fed' though over here. It's a long time before we get anything new. Omnipod took its time, we don't have the Animas Ping or Dexcom. But we are getting the new Vibe (Animas pump & Dexcom combo), so perhaps things are looking up.
So you have things we don't have, and we have things you don't have. But all in all, we still probably carry around the same amount of gear on a day to day basis. The rules are a bit different, but we're still playing the same game. Just that our blood glucose numbers are a bit different, and I would love to get glucotabs in flavours other than raspberry or orange.
Thanks for that little jaunt into your world, Becky. Everything in life is a trade-off, for sure!