Cigarettes and Diabetes

Both Smoking and Smokeless Tobacco Raise Health Risks in Diabetes

Woman smoking a cigarette
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We know that smoking is bad for everyone, but is it particularly bad for people with diabetes. Can it even lead to developing diabetes? There is evidence that smoking causes insulin resistance in both diabetic and nondiabetic people. The CDC says that smokers are 30-40% more likely to develop type 2 diabetes than nonsmokers, and smokeless tobacco also raises your risk. The risk increases the more you smoke.

 Not only that but if you smoke, you are more likely to have difficulties in getting your insulin dose right and controlling your blood sugar.

Smoking Risks for Everyone

People who smoke cigarettes, or who are exposed to any amount of second-hand smoke, experience a higher risk of cardiovascular disease, lung cancer, and head and neck cancers than the general population. Smoking-related cardiovascular problems include high blood pressure, heart attack, high cholesterol, and peripheral vascular disease (claudication).

Smoking Risks Specific to People with Diabetes

Smokers with diabetes are more likely to have serious complications, including heart and kidney disease, infections that lead to amputations, retinopathy that can cause blindness, and peripheral neuropathy that causes numbness.

The Nurses' Health Study, which has provided a wide range of valuable information on women's health and lifestyle issues, showed that diabetic women who smoke have an increased risk of death compared with diabetic women who do not smoke.

Smokers with diabetes have worse glycemic (blood sugar) control than nonsmokers, even with optimal self-monitoring. High blood sugar contributes to countless other health problems.

On the positive side, studies have shown that the health benefits for people with diabetes who stop smoking begin immediately.

These benefits continue to increase with the length of time a person remains smoke-free. As far as the cardiovascular effects of smoking are concerned, 10 years after quitting, a former smoker's risks resemble those of a typical nonsmoker.

Links Between Smoking and Diabetes Complications

Smoking results in increased albuminuria (blood protein in the urine), which leads to nephropathy (kidney damage) and a greater risk of end-stage renal disease that requires dialysis, and is also associated with decreased survival in comparison with dialysis patients who do not smoke.

People with diabetes who smoke are more likely than those who don't smoke to develop retinopathy (damage to the eyes) and neuropathy (damage to the nerves). Neuropathy can lead to an increased risk of injury, particularly to the feet. When a foot injury occurs, its healing can be complicated by the diminished blood flow and oxygenation to the extremities that results from both diabetes and smoking. This can then result in wounds that do not heal, which can lead to infection.

In the most severe cases, infections can result in functional loss of the extremity or even amputation.

The Risks of Smokeless Tobacco in Diabetes

Smokeless tobacco includes snuff and chewing tobacco. Although studies have not shown any definitive risk between smokeless tobacco and cardiovascular disease and/or diabetes, smokeless tobacco is well known to cause head and neck cancers, as well as other abnormal lesions in the mouth.

Smokeless tobacco users have a higher incidence of diabetes, and smokeless tobacco has been associated with insulin resistance in people with diabetes. In addition, the nicotine in smokeless tobacco causes a rise in blood pressure, which increases the risk of diabetes-related complications. Smokeless tobacco also causes an increased risk of mouth sores and the resultant possibility of infection. It is well documented that people with diabetes are at a higher risk of infection in general, and an open sore further increases this risk.

Help for Smokers Who Want to Quit

One multicenter study of diabetic patients who smoke found that a nurse-counseling smoking cessation intervention by telephone and office follow-up resulted in a 17% smoking cessation, higher than the rate of cessation without a nursing intervention.

Going "cold turkey," in other words, giving up smoking entirely on a designated day, is generally recommended over gradually cutting back on the number of cigarettes smoked per day. People often experience more symptoms of nicotine withdrawal with gradual tapering, which sometimes causes them to relapse.

The Patch and Other Techniques for Quitting

Smoking is as much a behavior pattern as it is a substance addiction. People who smoke may find that using a nicotine replacement therapy -- for example, the patch, gum, lozenges, nasal spray or inhaler -- may allow them to overcome smoking-related behaviors without the physical effects of withdrawing from nicotine. Once smoking behaviors are controlled, people may be better able to tolerate the withdrawal effects without returning to cigarettes.

Other pharmacologic options that can help smokers quit include Zyban (bupropion) and Chantix (varenicline). Originally marketed as an antidepressant, Zyban was eventually found to aid smokers in trying to quit. It has a controlled-release formula, and is now specifically marketed for smoking cessation.

Chantix blocks nicotine receptors in the nervous system, and has been proven to help people stop smoking. It is recommended that patients take Chantix for a period of weeks before giving up cigarettes, with the idea that they will not miss the nicotine, having had the nicotine receptors in the nervous system blocked for some time.

At this time, other drugs including anti-anxiety and anti-seizure medications are being explored, but there is little or no data to support their efficacy in helping smokers quit. Currently the pharmaceutical industry is working to develop new medications to help those who wish to stop smoking.

Hypnosis and acupuncture are widely used to aid smoking cessation. Although these studies do not provide evidence that these techniques actually help people quit smoking per se, experts believe that those who attempt these therapies may be more invested in giving up their smoking habit. Therefore, these techniques may be encouraging.

The health risks of using tobacco in any form have been clearly established. Whether you suffer from diabetes or not, quitting smoking is a lifestyle change toward better health.


U.S. Department of Health and Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014.

U.S. Department of Health and Human Services. A Report of the Surgeon General. How Tobacco Smoke Causes Disease: What It Means to You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2010.

Östenson CG, Hilding A, Grill V, Efendic S. "High consumption of smokeless tobacco ("snus") predicts increased risk of type 2 diabetes in a 10-year prospective study of middle-aged Swedish men." Scand J Public Health. 2012 Dec;40(8):730-7. doi: 10.1177/1403494812459814. Epub 2012 Oct 31.

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