Tobacco and Diabetes

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Tobacco and Diabetes

Dr. Trudy Manchester, M.D.
Associate Professor of Clinical Medicine - Division of Primary Care and General Medicine, UMASS Memorial Health Care

Diabetes is a metabolic disease which interferes with how the body uses sugar for energy. In some cases, there is too little insulin (as in Type I diabetes). In other situations, the body is unable to use the insulin that is present (as in Type II diabetes). Insulin is a hormone produced by the pancreas that helps to carry sugar into cells where it can be used for energy. Whether there is too little insulin or the insulin just can't work properly, sugar levels in the blood run high in diabetic patients. Over time, a variety of different complications may develop. Blockages may develop in large blood vessels, which may result in strokes, heart attacks, or the need for amputations. Blockages may also develop in very small arteries, which can result in loss of vision, nerve damage, or kidney failure.

Although any of these complications of diabetes can be devastating, medical care for diabetes has continued to improve over time and now much can be done to minimize these complications. Careful attention to diet, regular exercise, weight control, careful monitoring of blood sugars, regular check-ups, and a variety of new medications can all be extremely helpful to patients with diabetes. If blood sugars can be kept close to normal, many of the complications can be delayed or possibly prevented.

So where does smoking fit into the picture? Research has demonstrated that nicotine interferes with the function of insulin, which means it is difficult for cells to use sugar and the sugar builds up in the blood. Smoking may actually increase your risk for developing type II diabetes in the first place! And if you already have diabetes, smoking can greatly interfere with your ability to keep your blood sugar close to normal. As a result, smoking significantly increases the chances that a diabetic will develop the complications of their disease, and diabetics who smoke often have the most severe forms of these complications.

Diabetics who smoke are much more likely to have a heart attack, to have a stroke, and to die prematurely than diabetics who do not smoke. Medical research has also demonstrated that diabetics who smoke are much more likely to develop kidney damage than diabetics who do not smoke. Furthermore, in the diabetics who do experience kidney damage, the progression of that damage will be faster and the extent of disease greater in those who smoke compared to those who do not. The same can be said about the nerve damage that can cause numb or painful feet in patients with diabetes. Diabetic smokers are more likely to have nerve damage, and more severe manifestations of nerve damage, than diabetic non-smokers.

There are a few special considerations for diabetic patients who wish to quit smoking.

1) Blood sugar control - Since nicotine interferes with the function of insulin in the body, blood sugar control is more difficult while smoking. Whether a diabetic quits on his or her own, with the use of nicotine replacement therapy, or with Zyban, blood sugar will tend to be lower once he/she is able to quit! You may be able to reduce your doses of insulin or other medications once you quit. Therefore, closer monitoring of sugars during the early weeks after quitting is very important.

2) Weight gain - Many people who are thinking about quitting smoking are concerned about possible weight. For the diabetic patient, weight gain is a particularly important concern especially if his/her blood sugars are not in good control to begin with. Though it is true that the many people who quit smoking gain 6 to 10 pounds, it is more likely that blood sugar control will improve than worsen, because nicotine will no longer be interfering with insulin function.

Over the long run, modest weight gain carries many fewer health risks than continued smoking for a diabetic patient!

3) Depression - Diabetics are 3 to 4 times more likely to experience depression than non-diabetics, and it is clear that depression can greatly interfere with attempts to quit smoking. Zyban may be a particularly good choice for this subset of patients. Weight gain with Zyban also seems to be a bit less than for nicotine replacement.

All three of these special considerations mean it is particularly important for a diabetic to work closely with his/her primary care provider. Your doctor can help with glucose monitoring, adjustment of therapy, weight gain issues, and selection of the best therapy to assist you in quitting. Remember - diabetics may have the most to lose by continuing to smoke, but they also have the most to gain by quitting!!!!
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"Smoking may actually increase your risk for developing type II diabetes in the first place! "
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Since diabetes seems to be the new epidemic in the US, I thought this article would be helpful to some.
Shalom!