While we look at the relationship between what we eat and diabetes, we tend to overlook a habit that is a bigger health hazard for people living with diabetes smoking. Smokers are three times more at risk of developing diabetes than non-smokers.
Many studies have shown that smoking increases the risk of developing Type 2 diabetes by 30 to 40 per cent. Those with prediabetes are likely to hurtle faster towards full-blown diabetes while those living with diabetes are prone to higher HbA1c (average of three months) counts. Non-smokers show much better control of HbA1c levels.
The problem is both diabetes prevalence and tobacco use are increasing rapidly in India. The International Diabetes Federation (IDF) in 2003 and the American Diabetes Association (ADA) in 2004 strongly recommended that people with diabetes not smoke because of increased risk of complications.
How does smoking increase diabetes risk?
There are over 4,000 chemicals in cigarettes, 51 of which are known to cause cancer. These result in inflammation and build oxidative stress in several organs. They cause insulin resistance in the liver, muscles and adipose tissue. They also affect functioning of the pancreas and increase the risk of chronic pancreatitis, which is a cause of secondary diabetes. Insulin may help blood sugar enter cells but nicotine changes cells, so they don’t respond to insulin, which increases blood sugar levels.
What about people with diabetes who smoke and drink alcohol? Alcohol itself increases the risk of chronic pancreatitis. Smoking doubles the risk of developing secondary diabetes.
What are other complications triggered by smoking?
Smoking worsens the risk of diabetes-related complications. The connection between smoking and heart attack or strokes is already well known. If you already have Type 2 diabetes and are a smoker, the risk of heart attack/stroke is trebled or quadrupled. Smoking increases the likelihood of blood clots in the arteries leading to heart attacks. It reduces the flow of oxygen to the heart and damages heart muscles.
Nicotine is a vasoconstrictor, which means it narrows down the arteries, causing ischemia. When this happens in the peripheral blood vessels, that ensure blood supply to legs and feet, there is a higher risk of developing peripheral vascular disease and gangrene.
If not managed properly, smoking can accelerate long-term complications such as heart disease, kidney disease (nephropathy), nerve disease (neuropathy), eye disease (retinopathy) and foot disease.
In extreme conditions, smokers are at a higher risk of amputation than non-smokers. Research has shown that smoking triggers pancreatic cancer as well as other forms of cancer.
That’s why I tell my patients to give up smoking for good. Many of them ask me if there is a safe limit. Fact is there isn’t. Even one cigarette a day causes harm. Besides smokers, behaviourally, also have lesser discipline in diet and lifestyle management.
