By Richard R. Rubin, Ph.D., C.D.E. I just finished reading an article with important and encouraging news for people with diabetes who want to stop smoking. In this study a nurse offered a program for patients at hospital diabetes clinics. Six months later 17 percent of the patients had quit smoking, and most of those who were still smoking had cut back significantly. That 17 percent who quit altogether might seem like a small number, but it is seven times the number who usually stop smoking in a six-month period. Just as important, we know that each time a smoker hears a stop-smoking message, a few take it to heart and quit. So if you smoke, please read on. Smoking and diabetes can be a deadly combination, especially for women. Breast cancer is the most feared cancer among women, but today more women die of lung cancer. Smoking also increases your risk for cardiovascular disease (heart attack and stroke). When you have diabetes, your risk of cardiovascular disease is four times greater than people without diabetes; the combination of smoking and diabetes increases your risk to 11 times that of someone who doesn’t smoke or have diabetes! Almost 70 percent of all people with diabetes die of cardiovascular disease, and women with diabetes lose the gender protection other women seem to have when it comes to heart attack and stroke. Smoking also increases the risk for other diabetes complications: it increases blood sugar levels and nerve and blood vessel damage, so people who smoke have more serious foot problems, like ulcers, and more kidney damage as well. People who smoke also suffer more often from less serious problems. They are more likely to have colds and respiratory infections, more dental problems and bleeding gums, more problems with joint mobility. Not a pretty picture, is it? Yet many people with diabetes underestimate the negative health effects of smoking. Some experts say that quitting smoking is the single most important thing a person can do to live a long, healthy life; they say it is even more important than good blood sugar control! People with diabetes still smoke, despite the tremendous risk they are taking. Smoking rates are about the same for people with diabetes as they are for the general population. In the year 2000, the proportion of women who smoked was greater than the proportion of men who did (23 percent to 20 percent). People with diabetes continue to smoke because quitting is hard. If you never smoked, or have quit, congratulations! If you smoke and wish you didn’t, identifying the reasons you smoke could be an important first step towards quitting. Here are some of the reasons I hear most often. Nicotine is highly addictive, so it’s no surprise many people are hooked. They get physical symptoms like headaches, dizziness or restlessness when they try to quit smoking, or even when they haven’t had a cigarette for a while. One woman told me that when she tried to quit smoking she had cravings like she was longing for a lost love. "Smoking gives me energy." Nicotine works like coffee for some people; it wakes them up and gets them going. When they are tired, it can also keep them going. "I smoke to relax." Many people say smoking helps relieve stress. It’s amazing, but nicotine can pick you up and it can settle you down. "I like smoking." Most smokers tell me they enjoy smoking- it brings them pleasure and makes good times even better. "Smoking curbs my appetite." Some people say they eat less when they smoke, and this can be especially important for people with diabetes, especially women, who may be concerned about their weight. There are many ways to quit smoking, and different methods work for different people. Some people wake up one morning, decide they will never smoke again, and stick to that commitment without much discomfort. Most people have a harder time quitting, and many try quitting several times before they finally succeed. The best method for you might depend on the reasons you smoke. If you smoke because you are addicted, ask your health care provider about options like nicotine patches, or gum or other medications. Acupuncture or hypnosis can also help. Be sure you get support from your family and friends: tell them you are quitting and ask for their help. Avoid temptation as much as you can, and hang in there when you make the commitment to quit; the physical withdrawal symptoms last about two weeks. If you smoke because it gives you more energy, look for other ways to increase your get up and go. Try to get more rest, find ways to be more active (even a little helps a lot), eat well and avoid boredom. If smoking relaxes you, getting more rest, increasing your activity level and doing your best to cut stress can help you quit. So can doing things that relax you, like listening to soothing music. If you simply enjoy smoking, try focusing on the upside of quitting. Pay attention to how food tastes when you don’t smoke, and how good you look and feel about yourself. If you smoke to control your weight, talk to your health care provider or a dietitian about how to avoid gaining weight when you quit. The physical withdrawal symptoms from nicotine last about two weeks, but many people tell me they are really tempted by cigarettes for at least three months after they quit. And it only takes one cigarette to get you right back to your old smoking habit. So staying off cigarettes can be a real challenge, especially for women, if it leads to weight gain. Keeping in mind your reason for staying off cigarettes can help. Do you want to avoid complications, live to see your grandchildren grow up, feel better day-to-day, or save the money you spend on cigarettes? Think about what you could do with the money you would save each year. Best wishes for a long, healthy, smoke-free life. Richard Rubin, Ph.D., C.D.E., associate professor of medicine and pediatrics at Johns Hopkins, is the co-author of Psyching Out Diabetes: A Positive Approach to Your Negative Emotions, Sweet Kids, and The Johns Hopkins Guide to Diabetes. He also has written extensively on the effects of diabetes education, psychological problems associated with diabetes and techniques for counseling people with diabetes. Updated October 2002 1999-2002 Diabetes Wellness
News. Reprinted with permission of Diabetes
Research and Wellness Foundation. Last Updated: 10/16/2002
The Johns Hopkins University 1996-2003. All rights reserved. This information is not intended to provide advice on personal medical matters, nor is it intended to be a substitute for consultation.
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