Smoking & Diabetes

Tobacco & Diabetes

The Top Ten Way Use Of Tobacco Hurts Diabetics

• Smoking cuts the amount of oxygen reaching tissues. The decrease in oxygen can lead to a heart attack, stroke, miscarriage or stillbirth.
• Smoking increases your cholesterol levels and the levels of some other fats in your blood, raising your risk of a heart attack.
• Smoking damages and constricts the blood vessels. This can worsen foot ulcers and lead to blood vessel disease and leg and foot infections. Of people with diabetes who need amputations, 95 percent are smokers.
• Smokers with diabetes are more likely to get neuropathy (nerve damage) and kidney disease.
• Smokers get colds and respiratory infections easier causing fluctuation in the glucose levels.
• Smoking doubles your risk of getting limited joint mobility.
• Smoking can cause cancer of the mouth, throat, lung, and bladder.
• People with diabetes who smoke are three times as likely to die of cardiovascular disease as are people with diabetes who do not smoke.
• Smoking increases your blood pressure.
• Smoking raises your blood glucose level, making it harder to control your diabetes.

Are you aware of….

Did you know that quitting smoking now can dramatically improve your ability to control diabetes? It is critical that you stay in communication with your doctor, as he may want to change your insulin dose or diabetes pill schedule. Similarly, if you are being treated for high blood pressure or high cholesterol levels, your condition may improve so much that your doctor may want to change your treatment.

Recommendations Regarding Diabetes and Smoking

Assessment of smoking status and history

Systematic documentation of a history of tobacco use must be obtained from all adolescent and adult individuals with diabetes.

Counseling on smoking prevention and cessation

All health care providers should advise individuals with diabetes not to initiate smoking. This advice should be consistently repeated to prevent smoking and other tobacco use among children and adolescents with diabetes under age 21 years.

Among smokers, cessation counseling must be completed as a routine component of diabetes care. Every smoker should be urged to quit in a clear, strong, and personalized manner that describes the added risks of smoking and diabetes.

Every diabetic smoker should be asked if he or she is willing to quit at this time. If no, initiate brief and motivational discussion regarding the need to stop using tobacco, the risks of continued use, and encouragement to quit as well as support when ready. If yes, assess preference for and initiate either minimal, brief, or intensive cessation counseling and offer pharmacological supplements as appropriate.

Counseling on Smoking Prevention and Cessation

Health care providers should advise all individuals with diabetes not to initiate tobacco use of any kind. For people who smoke, effective cessation treatments are available and should be incorporated into routine diabetes care. There is a dose-response relationship between type, intensity and duration of treatment, and smoking cessation. In general, minimal interventions are defined by less than three minutes of counseling, whereas brief interventions are defined as 3 to 10 minutes of counseling.

More intensive interventions include greater than ten minutes of counseling, skills training and problem-solving content, conducted over a period of several weeks and multiple sessions. More intense interventions are most effective in producing long-term abstinence from tobacco and are recommended for smokers.

Pharmacological supplements are effective elements to include for smoking cessation in conjunction with behavioral interventions. The evidence is clear that use of nicotine replacement therapy (NRT) combined with behavioral counseling is more effective and much more beneficial than simply prescribing nicotine replacement therapy alone.

The risks of continued smoking compared with the use of pharmacological supplements needs to be considered in the presence of special circumstances, such as pregnancy or other diabetic complications. Health care providers should also be cognizant of special issues that may affect successful cessation, such as weight management. Health care providers should emphasize smoking cessation as a priority of state-of-the-art care for all diabetic smokers.

Effective systems for delivery of smoking cessation

Training of all diabetes health care providers in the Agency for Healthcare Research and Quality (previously known as the Agency for Health Care Policy and Research) guidelines regarding smoking should be implemented.

Follow-up procedures designed to assess and promote quitting status must be arranged for all diabetic smokers.

Assessment of Smoking Status and History

The routine and thorough assessment of tobacco use is important as a means of preventing smoking or encouraging cessation. Special considerations should include assessment of level of nicotine dependence, which is associated with difficulty in quitting and relapse.

Effective Systems for Delivery of Smoking Cessation

Health care providers need to be aware of and implement smoking cessation guidelines developed by the reputed and reliable agencies. Effective systems for implementing these guidelines should be incorporated into the routine practice of diabetes care. System components include the repeated conduct and documentation of routine screening for smoking status, integrated advice, counseling and support regarding routine screening for smoking status, and follow-up.