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Wednesday, December 17, 2008

Smoking and Diabetes

So, you're a smoker and you've been diagnosed with type 2 diabetes. And you're sick of people telling you to quit? Yeah, I know. Been there, done that. In 2001 I finally succeeded in quitting after nearly forty years of forty-a-day. As an ex-heavily-addicted smoker, I know how hard it was to give up. There were few people I detested more when I smoked than ex-smokers who would say "I just decided to stop - it's just willpower." Yeah, right. Idiot.

So why should you?

Well, I presume you're reading here because you have diabetes and want to avoid the usual complications. That word doesn't really seem nasty enough to cover heart disease, kidney failure leading to dialysis, blindness or salami surgery, does it? So, to try to avoid those you are testing your blood glucose levels, changing your menu, doing some extra exercise and learning everything you can to give yourself a chance of a more enjoyable, longer life. Great stuff - you are doing the work and deserve the rewards.

But you still smoke? It's time to think about that.

Usually, scare stories only provide partial help - but I'll pass these on anyway. Because I don't want to hear from anyone, anywhere, claiming that smokes aren't harmful to a diabetic.

Start by doing a simple google scholar search on "smoking and diabetes". The references at the foot of this article are a small sample of the 283,000 hits. Just one small snippet among many: "Particularly, survival of smokers with diabetes on hemodialysis is abysmal."

I first discussed this in 2005 on alt.support.diabetes. A friend of mine, Annette, responded with this interesting, but alarming, comment:

"Here are a few interesting tit-bits about tobacco use and metabolism to add to the list. I discovered some during my look at cyanide in plants and how the body detoxifies itself from this potentially deadly poison.

Tobacco contains a VERY high level of cyanide. Workers who handle and process the leaf have been fatally poisoned just through skin contact with the leaf.

I have read that people who smoke or use tobacco have been found to be consistently deficient in Vitamin B12. This vitamin is the body's main line of defense against the chronic low-level state of cyaniditis. It gets depleted by having to de-toxify the cyanide that keeps coming in all the time. After all there are small amounts of cyanide in most of plants we eat. Fine, unless you smoke. Diabetics are particularly likely to have sub-optimal levels of Vit B12 anyway, especially if they use that otherwise helpful med, metformin. So that's a double whammy. Even supps have a hard time keeping up the supply.

Cyanide binds strongly to the iron in the body, which then lowers the uptake and presence of oxygen in the blood and cells. That's why it can kill so fast. No oxygen! Smoking contains carbon monoxide, which also replaces oxygen in the blood. Breathe in enough, and that will cause death too. Same reason. Cigarette smoke lays down "soot" in the lungs, as well as being carcinogenic. So less oxygen is being absorbed by those wonderful "ventilators". A triple whammy!

Now the body does fight bravely to deal with these assaults. It tries to "wash" the offending soot out of the airways with mucous, hence the classic "smoker's" cough. It tries to detoxify the cyanide, hence low levels of B12 that are needed elsewhere. It does it's best to kill cancerous cells, but of course can simply fail to handle such a constant intake of carcinogens, and cancer can get the better of all it's efforts. Finally, the lungs endeavour to correct the lack of sufficient oxygen for normal metabolism, and stretch so as to increase the amount of air taken in with each breath. Long term though, they gradually lose their elasticity, like worn out elastic in waist bands, and can no longer function effectively. I'm not surprised that smoking raises the risk of heart attacks. Every living cell in our bodies need oxygen, those hard working muscles in the heart in particular. But if none of the above get you, the emphesema will.

Just one more tip to close off. I'm not cogniscent of why, but smoking definitely has been shown to raise insulin resistance. If you decide to quit, keep an eye on your bg levels (especially if you are a T2). The insulin resistance can improve so rapidly, you may find yourself suffering from a hypo!

Good grief, you may even be able to drop all your oral medications, enjoy exercise, and find bg management a breeze. It's that much of an influence."

You already know you need to quit, but if you need further convincing browse through the references below. I've checked that all the links still work if you want to read deeper.

For the sake of those who love you , even if that's only you, quit. I know it's not easy, but it will be worth it.

Cheers, Alan
Everything in Moderation - Except Laughter.

Further reading:
Cigarette smoking and health. American Thoracic Society Cigarette smoking remains the primary cause of preventable death and morbidity in the United States.
Preventing cardiovascular events in patients with diabetes mellitus. Abraham WT.
Smoking is known to be particularly dangerous for those with diabetes, and it is important for health care providers to help their patients stop smoking.
Effects of smoking on systemic and intrarenal hemodynamics: influence on renal function. The mechanisms of smoking-induced renal damage are only partly understood and comprise acute hemodynamic (e.g., increase in BP and presumably intraglomerular pressure) and chronic effects (e.g., endothelial cell dysfunction). Renal failure per se leads to an increased cardiovascular risk. The latter is further aggravated by smoking. Particularly, survival of smokers with diabetes on hemodialysis is abysmal.
Effects of cigarette smoking, diabetes, high cholesterol,and hypertension on all-cause mortality and cardiovasculardisease mortality in Mexican Americans. The San AntonioHeart Study
After adjustment for sex, age, and socioeconomic status in multivariate analyses, current smoking, diabetes, high cholesterol, and hypertension were positively associated with all-cause mortality and cardiovascular disease mortality in Mexican Americans. Overall, these risk factors accounted for 45% of all-cause mortality and 55% of cardiovascular disease mortality in this ethnic group.
Smoking, diabetes and hyperlipidaemia. Mikhailidis DP, Papadakis JA, Ganotakis ES.
Department of Chemical Pathology & Human Metabolism, Royal Free Hospital & School of Medicine, Univ. of London, United Kingdom.
The epidemiological evidence linking smoking with insulin resistance is considerable. This evidence is even more convincing because there is a dose response relationship between smoking and the risk of non-insulin dependent diabetes (NIDDM). Similarly, there is a time-dependent decrease in risk of NIDDM for those who quit smoking.
Insulin resistance (in the form of impaired glucose tolerance, IGT) may precede the development of NIDDM. There is a biochemical basis for the smoking-IGT/NIDDM relationship. Smoking increases the risk of developing diabetic complications like nephropathy, neuropathy and retinopathy Smoking is also an independent risk factor for myocardial infarction and all-cause mortality in NIDDM. Smokers are both insulin resistant and lipid intolerant.
Smoking and diabetes D Haire-Joshu, RE Glasgow and TL Tibbs
There are consistent results from both cross-sectional and prospective studies showing enhanced risk for micro- and macrovascular disease, as well as premature mortality from the combination of smoking and diabetes.
Smoking is associated with progression of diabetic nephropathy
RESULTS--Progression of nephropathy was less common in nonsmokers (11%) than in smokers (53%) and patients who had quit smoking (33%), P < 0.001. In a stepwise logistic regression analysis, cigarette pack years, 24-h sodium excretion, and GHb were independent predictive factors for the progression of diabetic nephropathy.
The Effects of a Smoking Cessation Intervention on 14.5-Year Mortality
Intervention: The intervention was a 10-week smoking cessation program that included a strong physician message and 12 group sessions using behavior modification and nicotine gum, plus either ipratropium or a placebo inhaler. Results: <snip>Differences in death rates for both lung cancer and cardiovascular disease were greater when death rates were analyzed by smoking habit.
Getting to Goal in Type 2 Diabetes: Role of Postprandial Glycemic Control
Slide 9. MRFIT: Impact of Diabetes on CVD Mortality These are data from the Multiple Risk Factor Intervention Trial (MRFIT) study, where people with and without diabetes were classified as having: no risk factors at all, only 1 risk factor, 2 risk factors, or all 3 risk factors. Risk factors were hypertension, hyperlipidemia, and smoking. For any given number of risk factors, the chances of getting cardiovascular disease are markedly increased in people with type 2 diabetes. This increased risk is related to hyperglycemia.

1 comment:

Anonymous said...

well I have type two, I fond out November of 2011. Thank you for this post. I have 10 butts left. I am going to (try)to wake up tomorrow morning and not smoke. Well we will see how it goes.