A colleague asked my opinion about patients with diabetes and smoking. Smoking in any form and in any quantity is dangerous to everyone. Not only the smoker is affected but to those exposed to the second hand smoke as well can develop problems associated with smoking. Patients with diabetes who smoke are playing a deadly game of “chicken” with themselves. The hallmark of diabetes is microvascular disease that affects the eyes, the kidneys, and the sensory nerves that can lead to loss of protective sensation to the feet.

Smoking causes vasoconstriction, which damages the very same small vessels that may become narrowed or occluded as a result of chronically elevated blood glucose levels. While patients with diabetes are challenged every day by the demands of their physical health, they voluntarily add an additional layer of stress against their body by smoking. Patients with diabetes have no choice about their diabetes, but they do have a choice about smoking.

There is no OK amount of smoking. Whether your risk of lower extremity amputation is 15 % or 1 % it is still all bad.

Patients with diabetes who are still smoking will want to know that 36 hours after they stop smoking all of the nicotine is gone from their system. After that there is no physiological reason to smoke. So, if you can make it past the 36 hour threshold, you should be home free. What the current smoker needs to realize that quitting smoking is something that THEY MUST WANT TO DO. It is not because anyone else tells them to stop. They must want to stop themselves. Not until they want to quit will they quit.

Realize that we all have been snookered by cigarette companies advertising and marketing; cigarettes don’t wake us up or make us sleepy, they don’t make our food taste any better. They don’t calm us down or make us more attentive. What they do is destroy the smoker’s health and the health of those around the smoker. So, the trick to quitting is to change what smoking means to the smoker. I suggest to my patients that every time they light up a cigarette the word POISON will come to their mind. That is usually enough to change what cigarettes mean to them to help the smoker to quit.

-drhinkes