Smoking with Diabetes: What are the risks?

Smoking, widely acknowledged as one of the most detrimental behaviors to one's health, stands as the leading cause of preventable diseases, disabilities, and fatalities worldwide. Even passive smoking poses a significant risk, considering the harmful effects of tobacco and nicotine.

Yet, it is imperative to recognize that for many individuals, smoking is not merely a bad habit but a disease—an outright addiction. It easily becomes a coping mechanism, ensnaring vulnerable people in its grip. The nicotine addiction rapidly reinforces the cycle of continued consumption.

In the UK, 13.3% of adults smoked cigarettes in 2021, which equates to around 6.6 million people.

How can smoking lead to diabetes?

When it comes to Type 2 diabetes, smokers are 30% to 40% more likely to acquire it than people who don’t smoke, and the risk increases with the frequency of smoking. This is due to the following factors:

1. While insulin helps blood sugar enter the cells, but nicotine alters cell function, rendering them unresponsive to insulin, which leads to elevated blood sugar levels.
2. The chemicals present in cigarette smoke can also react with oxygen and damage cells within the body, in a process known as oxidative stress. This triggers inflammation, which further diminishes the cells’ ability to react to insulin.
3. Moreover, individuals who smoke are more prone to accumulating belly fat, even if they are not overweight to begin with, which significantly heightens their risk of developing Type 2 Diabetes.
4. Smoking also raises the level of triglycerides, which is a kind of fat found in the blood. At the same time, the “bad” LDL cholesterol can go up and the “good” HDL cholesterol goes down. High cholesterol and triglycerides have a link to type 2 diabetes.

How does smoking impact diabetic patients?

On their own, Type 1 and Type 2 diabetes come with a set of long-term complications that affect both the macrovascular (involving large vessels, such as arteries and veins) and microvascular (involving small vessels, such as capillaries) systems.

When a person has diabetes and also smokes, the risk of experiencing these complications increases substantially. Elevated blood sugar levels and smoking both lead to the accumulation of fatty deposits in the blood vessels. This goes on to constrict, weaken, clog, and eventually harden them, thus impeding the flow of blood.

Macrovascular problems

Cardiovascular Disease: The risk of heart disease, such as coronary artery disease and myocardial infarction (heart attack), significantly increases in individuals who smoke and have diabetes.

Peripheral Vascular Disease: Smoking and diabetes can cause narrowing and damage to blood vessels in the legs and feet, increasing the risk of peripheral vascular disease. This condition can lead to poor circulation, leg pain, and even limb amputation in severe cases.

Stroke: The combination of smoking and diabetes raises the risk of stroke, as both factors contribute to the narrowing and clotting of blood vessels in the brain.

Microvascular problems

Retinopathy: Smoking and diabetes together increase the risk of diabetic retinopathy, a condition that damages the blood vessels in the retina, potentially leading to vision problems or blindness.

Nephropathy: This combination can also heighten the risk of diabetic nephropathy, which damages the kidneys' small blood vessels and may result in kidney dysfunction or failure.

Peripheral Neuropathy: Smoking and diabetes can exacerbate peripheral neuropathy, causing nerve damage in the extremities, leading to pain, numbness, and loss of sensation.

Autonomic Neuropathy: The combination of smoking and diabetes can contribute to autonomic neuropathy, affecting the autonomic nervous system and leading to issues such as gastroparesis (delayed stomach emptying) and disruptions in bladder and bowel function.

What are the benefits of quitting smoking for diabetic patients?

Quitting smoking, while challenging, is entirely possible and beneficial at any age, so it’s never too late to try. Upon quitting smoking, the body initiates a healing process:

• Within 20 minutes: Heart rate and blood pressure start to decrease, reducing the strain on the cardiovascular system.
• Within 12 hours: The levels of carbon monoxide in the blood, which is a harmful gas found in cigarette smoke, return to normal, improving oxygen transport in the body.
• Between 2 weeks to 3 months: The circulation and lung function begin to recover, making it easier to breathe and increasing overall oxygen levels in the bloodstream.
• Within a year: The risk of heart disease is halved compared to that of a smoker, significantly improving cardiovascular health.
• Long-term: Quitting smoking also enhances the body's ability to use insulin effectively, making it easier to manage blood sugar levels, which is particularly important for individuals with diabetes.

Many people with diabetes worry about gaining weight when they try to quit smoking. However, studies have found that the weight gain doesn't cancel out the immediate and long-term benefits of quitting smoking, which still significantly lower the risk of heart problems and death from all causes.

Key Takeaways

Smoking remains one of the most destructive habits a person can engage in, causing preventable diseases and fatalities globally. It’s connection to diabetes is particularly alarming due to nicotine's impact on insulin sensitivity, oxidative stress, and fat accumulation. It also leads to a heightened likelihood of cardiovascular issues, peripheral vascular disease, stroke, retinopathy, nephropathy, neuropathy, and autonomic neuropathy.

However, the good news is that quitting smoking triggers a rapid healing process and benefits of quitting significantly outweigh the potential for weight gain. The choice to quit smoking is a powerful step towards better health, especially for those living with diabetes, offering a chance at a brighter, healthier future.

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