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Smoking and diabetes
There is a growing body of evidence to suggest that smoking is an independent risk factor for diabetes and that among people with diabetes, smoking aggravates the risk of serious disease and premature death. People with diabetes already have an increased risk of heart disease, which is further elevated if they smoke. Diabetes acts in several ways to damage the heart: high glucose levels affect the walls of the arteries making them more likely to develop fatty deposits which in turn makes it more difficult for the blood to circulate.
People with diabetes are more likely to have high blood pressure and high levels of fats such as triglycerides. They are also more likely to have lower levels of the protective HDL cholesterol.
Smoking has also been identified as a risk factor for insulin resistance which can lead to diabetes. People with insulin resistance cannot properly use insulin and such people may initially have higher than normal amounts of insulin circulating in their blood, a condition known as hyperinsulinemia. Several factors, including genetics and obesity, increase a person’s risk of insulin resistance and smoking has also been shown to increase the risk of this condition. It is believed that catecholamines, a type of hormone, are produced in greater quantity in smokers and act as an antagonist to insulin action.
The elevated risk of heart disease among people with diabetes increases the risk of premature death. In one study of women aged 60 to 79 who smoked and developed Type 2 diabetes, an estimated 65 per cent of the cardiovascular disease deaths among the subjects was attributed to the interaction of cigarette smoking and diabetes. The same study suggested that smoking may trigger fatal events in people with diabetes whose circulation has been compromised due to vascular disease, or blood vessels damaged by a combination of smoking and diabetes. A large prospective study of US nurses found that among those with diabetes the relative risks of mortality were 1.31 for past smokers, 1.43 for current smokers of 1-14 cigarettes per day, 1.64 for smokers of 15-34 cigarettes per day, and 2.19 for current smokers of 35 or more cigarettes per day.
Smoking is associated with multiple complications of diabetes. Nephropathy (kidney disease) has been shown to be common in Type 1 diabetic patients who smoke and smoking increases the risk of albuminuria in both types of diabetes. The relationship between cigarette smoking and retinothapy (disorders of the retina) is less well defined than that of other microvascular complications of diabetes. However, some studies have found an association between smoking and diabetic retinopathy. The relationship between cigarette smoking and retinothapy (disorders of the retina) is less well defined than that of other microvascular complications of diabetes. However, some studies have found an association between smoking and diabetic retinopathy.
There is overwhelming evidence that stopping smoking reduces the risk of cardiovascular disease, lung disease, cancer and stroke. As diabetes increases the risk for heart disease and stroke, it follows that stopping smoking will reduce the risk of complications from diabetes such as heart disease. Few studies have evaluated smoking cessation treatment specifically for people with diabetes but the limited research available suggests that smokers with diabetes may be less successful in quitting than smokers without diabetes and that intensive strategies should be considered to optimise successful cessation. One possible explanation for the lower quitting rates among people with diabetes is the fact that stopping smoking is associated with weight gain and this is likely to be of concern in people who have diabetes and are already overweight. One US study found that concerns about weight gain among smokers with Type 1 diabetes were particularly prevalent among women, obese smokers, and those in poor metabolic control. Stopping smoking also reduces the risk of premature death. The US Nurses’ Study found that among women with Type 2 diabetes who had stopped smoking for 10 or more years had a mortality relative risk of 1.11 compared with diabetic women who were never smokers.
In the light of the growing evidence demonstrating that smoking is an independent risk factor for diabetes and that it is also an aggravating factor for diabetes complications, smoking cessation advice should be a routine component of diabetic care. Concerns about weight gain should be addressed by health care providers whilst emphasising the fact that the health benefits of smoking cessation far outweigh post cessation weight gain, even in people who are focused on weight management.
More information on diabetes mellitus
What is diabetes mellitus? - Diabetes mellitus is a a condition characterized by hyperglycemia resulting from the body's inability to use blood glucose for energy. Diabetes mellitus can result in coma. Over time, complications can include nerve injury, blindness, kidney failure, and premature atherosclerosis with all of its complications.
What causes diabetes mellitus? - Diabetes mellitus is a disorder caused by insufficient production of the hormone insulin by the pancreas, or insensitivity of cells to the effects of insulin. Insulin is responsible for the absorption of glucose into cells for their energy needs and into the liver and fat cells for storage.
What is insulin? - Insulin is a hormone that is produced by specialized cells (beta cells) of the pancreas. In addition to helping glucose enter the cells, insulin is also important in tightly regulating the level of glucose in the blood.
What types of diabetes mellitus are there? - There are four main types of diabetes mellitus. They are type 1 diabetes mellitus, type 2 diabetes mellitus, type 3, and Gestational diabetes mellitus (type 4).
What is type 1 diabetes? - Formerly known as juvenile diabetes or insulin-dependent diabetes, type 1 diabetes is a life-long condition in which the pancreas stops making insulin. Type 1 diabetes develops most often in young people but can appear in adults.
What is type 2 diabetes? - Type 2 diabetes is the most common form of diabetes mellitus. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not use the insulin they make. Type 2, also known as non-insulin dependent diabetes, typically occurs after the age of 40 years.
What're signs and symptoms of diabetes mellitus? - Type 2 diabetes almost always has a slow onset (often years). Early symptoms of Type 1 diabetes are often polyuria (frequent urination) and polydipsia (increased thirst, and consequent increased fluid intake).
What is diabetes insipidus? - Diabetes insipidus (DI) is a disease characterized by excretion of large amounts of severely diluted urine, which cannot be reduced when fluid intake is reduced.
What is diabetic coma? - Diabetic coma is a medical emergency in which a person with diabetes is unconscious because the blood glucose level is too low or too high. Patients with diabetes mellitus type 1 are especially prone to this condition.
What are the complications of diabetes mellitus? - Many people with diabetes mellitus eventually develop complications. A very common short-term complication of diabetes mellitus is hypoglycemia (abnormally low blood sugar levels).
How to diagnose diabetes mellitus? - The diagnosis of type 1 diabetes is usually prompted by recent symptoms of excessive urination (polyuria) and excessive thirst (polydipsia), often accompanied by weight loss. The diagnosis of other types of diabetes is made in many other ways.
Diagnosis protocol for diabetes - People over age 45 should be tested for diabetes. If the first blood glucose test is normal, they should be re-tested every three years. A diagnosis of diabetes is made when any three of these tests is positive, followed by a second positive test on a different day.
What is the treatment for diabetes? - Diabetes is a chronic disease with no cure, but it can almost always be managed effectively. Nowadays, the goal for diabetics is to avoid or minimize chronic diabetic complications, as well as to avoid acute problems of hyperglycemia or hypoglycemia.
What type of diabetes diet is suggested? - For some people with diabetes mellitus, a healthy diet and weight loss is enough to keep glucose levels in the blood normal.
What medications are available for diabetes? - Oral diabetes medicines, or oral hypoglycemics, can lower blood glucose in people who have diabetes, but are able to make some insulin. Six FDA-approved oral diabetes medications are now on the market.
How to prevent diabetes? - Diabetes prevention is proven, possible, and powerful. Studies show that people at high risk for type 2 diabetes can prevent or delay the onset of the disease by losing 5 to 7 percent of their body weight.
What should a child diabetes do every day? - To control diabetes and prevent complications, blood glucose levels must be as close to a "normal" range as safely possible. Families should work with a health care provider to help set a child's or teen's targets for blood glucose levels.
Smoking and diabetes - There is a growing body of evidence to suggest that smoking is an independent risk factor for diabetes and that among people with diabetes, smoking aggravates the risk of serious disease and premature death.