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Tobacco Use and Diabetes
A risky combination
Tobacco and diabetes are a dangerous combination. Diabetes affects the body in many ways, and using tobacco heightens these effects. Tobacco use puts you at higher risk of developing diabetes, and increases the risk and severity of complications. People who smoke or chew tobacco are more likely to develop cardiovascular disease, particularly heart attack and stroke. They are also at risk for eye damage, kidney damage, and nerve pain – all of which are complications of diabetes.
The health benefits of quitting begin within a day and continue for years.
The good news is that tobacco use is a modifiable risk factor. It can be changed! You reduce your risk when you stop using tobacco. Benefits and changes to your body begin as soon as you quit. The longer you stay tobacco-free, the longer the benefits continue.
Tobacco increases diabetes risk
Recent studies have shown that tobacco users have a 44 per cent higher chance of developing type 2 diabetes compared to non-smokers. The risk increases with the number of cigarettes smoked daily. Ingredients in cigarettes and smokeless tobacco increase insulin resistance, which can lead to type 2 diabetes.
Tobacco use also means that complications of diabetes are more likely. Smoking or smokeless tobacco increases the risk of kidney damage, developing nerve pain, and having a heart attack or stroke.
Smoking and the risk of cardiovascular disease
People with diabetes who smoke or use tobacco are three times more likely to develop cardiovascular complications as those who do not. Nicotine is the ingredient in tobacco that causes physical dependency and addiction. It is a stimulant. Like other stimulant drugs, nicotine affects a person’s body in many ways:
- increasing blood pressure and heart rate
- raising bad cholesterol (LDL and TG) and lowering good cholesterol (HDL)
- heightening blood glucose levels
- narrowing and inflaming blood vessels
- allowing fatty material (plaque) to build up in vessel walls
- making blood cells and vessel walls stickier and more prone to clots.
A build-up of fatty material in a blood vessel can form a clot. It can partly block already narrowed vessels and lead to a heart attack, stroke, and other blood vessel disease.
Diabetes alone causes blood vessel inflammation and narrowing. As a result, vessel walls harden and thicken. They shrink in diameter, limiting blood flow. When people with diabetes use tobacco, their vessels narrow even more. Blood pressure rises, further damaging nerves and vessels.
Kidney damage
Research shows that smoking changes the structure and function of the kidneys. A direct link exists between kidney damage and the number of cigarettes smoked. The more a person smokes, the greater the damage.
Diabetes carries its own risk of causing kidney damage. If you have diabetes and choose to smoke or chew tobacco, your risk is compounded. Smoking also speeds up the progress of kidney damage in people with diabetes.
Tobacco damages kidney function because it affects blood flow and blood pressure within the body. Smoking hardens arteries and narrows blood vessels, reducing blood flow to the kidneys. Less blood flow reduces their efficiency and causes damage. Smoking also raises blood pressure. If you already had high blood pressure, tobacco makes it worse. The higher blood pressure then increases the risk of damage to the kidneys.
Nerve pain
People who smoke are nearly twice as likely to suffer from diabetic neuropathy (nerve pain).
A study found that about 62 per cent of patients with diabetic neuropathy smoked cigarettes, compared with 33 per cent of patients who did not smoke. Remember, blood vessels in people with diabetes are already damaged. Diabetes alone inflames and narrows blood vessels. The vessel walls harden and thicken, reducing in diameter and limiting blood flow.
Tobacco interferes with blood circulation and compounds the damage to nerves and blood vessels in people with diabetes. Blood vessels are narrowed further. Your body is less able to carry oxygen to nerves in the hands and feet. If nerve tissues do not receive enough oxygen, they become damaged and can die.
A threat to vision
Diabetic retinopathy is damage to the blood vessels of the retina, the tissue at the back of the eye that is sensitive to light. This damage can reduce vision, and eventually lead to blindness. Too much glucose in the blood can damage tiny blood vessels that nourish the retina. As more and more blood vessels become blocked, the blood supply to more of the retina is cut off. Vision may be lost.
Smoking or chewing tobacco makes it harder for people with diabetes to control their blood glucose because tobacco increases resistance to insulin. The body is less able to move glucose out of the blood and into the cells due to increased insulin resistance. Over time, this higher level of blood glucose damages blood vessels around the body including those in the eye.
Less effective medications
Nicotine in tobacco constricts blood vessels. This slows the rate at which injected insulin can be absorbed. For people who take insulin, this slowing effect may mean that blood glucose is higher more often. Uncontrolled high blood glucose levels increase the risk of developing complications.
Tobacco smoke also changes the way that the body processes medication. Many medications are affected by tobacco smoke, including those used to treat diabetes and manage or prevent its complications. The polycyclic aromatic hydrocarbons in tobacco smoke speed up the rate that the body processes and eliminates medication. When medications are processed and removed more quickly, lower levels remain in the blood. The medication is less able to treat the condition.
Medications affected by tobacco smoke include metoprolol, ramipril, and glyburide. Metoprolol and ramipril reduce high blood pressure and prevent heart attacks and strokes in people with a history of cardiovascular events. As well, they are often used to prevent cardiovascular disease and control high blood pressure in people with diabetes. Glyburide is used to lower blood glucose in people with diabetes.
For people with diabetes that smoke, the risk is twofold. They have a higher risk of complications because of the effect that tobacco has on circulation, blood vessels, and blood glucose. As well, the medications that control their diabetes, and treat or prevent the complications of diabetes, are less effective.
Quitting helps immediately
The health benefits of quitting smoking or chewing tobacco begin within a day and continue for years. Within 24 hours, blood pressure and heart rate begin to drop. The blood vessels are no longer as constricted from the effects of nicotine. Blood can flow more easily throughout the body to tissues and organs. The risk that tobacco creates for heart attacks, strokes, and kidney, eye and nerve damage begins to decrease.
The longer that you do not use tobacco, the less you are at risk for cardiovascular, eye, kidney, and nerve damage. Quitting smoking or chewing tobacco for one year cuts the tobacco-related risk of coronary artery disease in half. What’s more, the risk continues to decline. After five to 15 tobacco-free years, the risk of stroke returns to the level of someone who has never smoked. After 15 years, the risk of coronary artery disease is similar to that of a person who has never smoked.
As well as reducing the risk of complications related to diabetes, quitting smoking or chewing tobacco offers many other benefits. It helps the lungs. Smoking reduces lung function at a more rapid rate than normal. Within two weeks to three months of quitting tobacco, lung function begins to improve. Previous smokers notice less coughing, sinus congestion, fatigue and shortness of breath.
In the long term, the rate of lung function decline will be the same as someone who never smoked. This reduces the risk of lung diseases like emphysema and chronic obstructive pulmonary disease (COPD). For people with COPD, quitting smoking slows the progress of the disease and improves quality of life. The risk of lung cancer steadily declines. Ten years after quitting, the risk of lung cancer is 30 to 50 per cent that of continuing smokers.
People who use chewing tobacco are at a 50 per cent higher risk of developing cancers of the mouth and throat. Quitting smoking or chewing tobacco reduces the risk of cancers of the larynx and oral cavity. It also reduces the risk of cancer of the esophagus, pancreas and bladder.
Many organizations and programs across Canada lend help and support to those who want to quit. For more information about these programs and services, ask your doctor, pharmacist, or other health care provider.
FAMILY HEALTH is written with the assistance of |
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FAMILY HEALTH is written with the assistance of |
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