I’m interested in hearing how heath care in Europe compares with here - was it challenging getting enrolled/switching over?
Would love to hear your thoughts.
Get a cup of coffee/tea. This is going to be a VERY long post with lots of miscellaneous observations. Also keep in mind that I’m in the pediatric endocrinology section.
obviously about half of Europe, including the country I’ve moved to, operates on the Mmol/L system. That’s been an adjustment. I set a cheat sheet of conversions between mg/dl and mmol/L as my phone screen saver before I discovered that Sugarmate will let you choose if you want your readings to display as mmol/L or mg/dL. So now I rely on the sugar mate app a lot as I’m still trying to get comfortable in mmol/L. Sugarmate has also made it easier for my parents because they can follow me in mg/dL, whereas dexcom follow only shares mmol/L.
I chose to stick with the tandem and dex system, which are technically the same but there are minor differences within the apps and menus. For example my pump is set to 24 hour time. I can’t change it to 12 hour. Major thing- the tandem app does not exist here. So that means no bolusing from my phone anymore 
. I really liked to see my basal rates and the readout for when I’d last bolused/different pump alerts in the tandem app so I’ll be happy with when the app comes out here- Whenever that happens. I don’t think that’s top priority at tandem at the moment.
My hospital care here is very similar- I have a dietician, there’s counseling staff available, I’m under the care of a nurse practitioner who specializes in diabetes and a GP. Some of the differences between this hospital and my last one are:
- instead of the whole routine blood testing process checking for c-peptide levels, cbc, thyroid, celiac, etc every 6-12 months, here it’s every 2 years. Of course they’ll run tests inbetween but that’s only if there are concerns.
- I don’t have as many “highly recommended” psychology/counseling/mental health check ins here. At my old clinic I basically had to have an appointment with a staff counselor every year. Sometimes more. I get that approach and I know it’s critical for lots of people who struggle with the mental side of having a chronic condition like diabetes, but I was never a fan of those appointments. I have a strong support system in my family and didn’t like a stranger getting involved. Here it’s more of a “we won’t make you have an appointment with you unless you or your parents want to, or if your endo is concerned about you”
- MyChart is not used at my hospital (yet) so I get a lot of emails.
- after age 15, I don’t need my parents to attend my appointments. In fact they encourage me to come alone. My mom still comes along because we both like to know what’s going on. I’m also the one in contact with the hospital, my phone number and email are the primary numbers in the system, not my parent’s numbers.
- the doctor sets the appointment. Not you. If they set the appointment on a day that you’re busy, you have to call and change the appointment time (which is like…. Every single time). Oh and since there’s no MyChart, you get a letter sent to you in the mail before and after each appointment with all the information.
- nicknames are allowed in the hospital system (at least in my country). My full legal name is buried in the files but my nick name, Lise, is what’s on the paperwork and what I’m known as.
School
Obviously there’s no section 504 here so almost all of the school communication for accommodations and diabetes care is between the school admin and the family. There’s no school nurses. That freaked me out a bit at first but it hasn’t been an issue. I’m responsible for my own management but there are people around who are aware of my diabetes and I just call my parents if I have an issue.
Other stuff relating to supplies
- the nice thing is that pump sets are interchangeable. for the last few weeks I’ve been using European tubing with American cartridges. But they don’t have the auto soft 30 set available here so I’ve had to switch to the auto soft 90.
- my pump and dexcom supplies boxes look the same but the labels are in several languages- German, Dutch, French, Spanish, even Arabic, etc.
- I only get 10 sets a month which lasts perfectly. I used to get 15 sets a month in the USA. Getting more is unheard of, especially considering that
- if you order supplies, it’s at your door within 18-48 hours. In the states we would order supplies 5-7 days ahead of time to give it time to ship. Our poor neighbors have gotten the majority of pump supplies that we’ve ordered because we weren’t expecting the shipment to come so quickly and no one was at home to sign for it.
- I have to go through extra training if I want to get upgraded to control iq on my new tandem. I’m really liking just basal iq so I haven’t tried to finagle the online training/software upgrade needed for control iq.
Food:
Glucose tabs are sold in paper packages here, like mentos, which is a real problem when it rains and your bag gets wet. I brought plastic tubes of glucose tabs with me and those reusable plastic containers are invaluable now.
Food, carbs, etc is about the same in Western Europe but the nutrition labels are really annoying. There are no servings. If I want to eat a tortilla, I it doesn’t say “one tortilla has 35g”. It says “100 g of tortilla has 72g” or something like that. So I have to weigh my food so much more. Yes, my carb counting has gotten more precise but it takes twice as long and so much more math.
I bet that was way more information than you were expecting and sorry to the moderators because this is really off topic.
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I appreciate all the detail and the time you took to share it. Thanks!
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Thanks Lise @6yGodsGr for sharing your new experience; like you, I keep handy equivalence charts between mg/dL, mmol/L, and HbA1c. Several items that you mention, like food labels, doctor frequency visits and appointments, your [not your parents] care responsibility, school, lab test frequency, and the list goes on, are similar to what I experienced “a few years ago”. To me, your new home is something I might like. I’m not surprised that t-Slim supplies are interchangeable - they are all made by the same company that has facilities in Mexico and also near you.
Your note was not too long, and I found it nice to read - I had already brought my mug of coffee to the computer.
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Yes I’d forgotten that A1c is also measured differently here.
In case you ever lose your plastic tubes😫 you can buy tubes of the tabs on Amazon. Here’s a screenshot of one but there are others to choose from. I imagine they would be available where you are as well.
I’m probably straying off topic but just wanted to mention it.
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I lived in England from 1991-2006. Everyone is allowed to sign up with the local General Practitioner. I was on multiple daily injections at the time. At the start, I was not referred to any specialist. My GP (now called PCP in the U.S.) prescribed supplies. Then he had his nurse take over, and she knew nothing and had to ask me what tests my doctor normally ordered. Pumps were not used. I had to use the brand of insulin that had a contract with the National Health Service. No other was available. Before moving there, pumps, syringes and insulin were not covered by insurance in the U.S. In the UK, all supplies are free. The UK first started covering pumps for children and later adults, but that was after I left. So I got a pump in 2007 when I was back in the U.S. That and insulin was now covered by insurance. It seemed odd that I could get insulin with insurance!
While in the UK, I moved a a couple times. After our first move, my GP (PCP) immediately referred me to a specialist whom I was supposed to see once a year. But there were such waiting lists that I once waited 17 months between visits. The specialist was extremely knowledgeable and for once, I was seeing a doctor who knew more than I did. My diabetes specialists in the U.S. were not so knowledgeable and still tend not to be. Even when seeing the specialist, I still had to see my local GP every 3-6 months and he prescribed my syringes and insulin. My PCP did the blood tests. Since it is a national health system and all on computer, the specialist could see all the tests run by the local doctor and never had to order those himself. Again, all of this was absolutely free.
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