Smoking and Diabetes: Is it Time to Quit?

Smoking and having diabetes further intensifies the risk of long-term health problems.

For people with diabetes who want to work on smoking cessation, learning about the dangers of smoking and discovering methods to help quit can help them make more informed decisions about their health and quality of life.

How does smoking affect diabetes?

Smoking impacts the health of people who already have diabetes; however, it’s essential to know that people who smoke are 30-40% more likely to develop type 2 diabetes than nonsmokers. If someone has a family history of diabetes or other risk factors for developing diabetes, then picking up the habit of smoking could escalate the risk.

People with diabetes who smoke tend to have a more difficult time managing their blood sugars. This is because nicotine, the addictive chemical in cigarettes, can cause insulin resistance.

When someone has insulin resistance, their body doesn’t use insulin sufficiently, which leads to increased blood sugar levels. Over time, insulin resistance can interfere with insulin production, leading to a diagnosis of diabetes in someone previously undiagnosed.

Nicotine can also increase triglyceride levels, which is a type of fat in the blood. High triglyceride levels are a risk factor for developing insulin resistance and type 2 diabetes in some studies. Nicotine can also cause hypoglycemia, or low blood sugar, in those taking insulin to manage their diabetes.

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Risks of smoking with diabetes

Having diabetes is a risk factor for developing other health problems, which is why managing blood sugar levels is so important.

Over time, high blood sugar damages blood vessels and can impair healthy circulation, which can result in cardiovascular disease and other diabetes complications.

Smoking has long been known to be a significant risk factor for cardiovascular disease, which is otherwise known as heart disease. Smoking increases the risk of blockages forming in the arteries, which can lead to a heart attack or stroke, depending on where the blockage occurs.

Heart disease: Diabetes is a primary risk factor for developing cardiovascular disease. Deaths from cardiovascular disease are about 1.7 times higher in people with diabetes than those without. The risk is higher because people with diabetes tend to have higher levels of cholesterol and fat in their blood, as well as higher blood pressure (hypertension), which can lead to hardening and narrowing of blood vessels over time.

Smoking also increases the risk of hardening and narrowing of blood vessels, which is why it exacerbates the risk in those who already have diabetes.

Kidney disease: Chronic kidney disease is a diabetes complication that occurs in about 25% of people with diabetes. High blood sugar levels damage the blood vessels in the kidneys over time, which can cause the kidneys to lose some of their ability to filter blood and remove waste from the body. Increased blood pressure, which is more common in those with diabetes, can also damage the kidneys. Smoking further increases the risk of chronic kidney disease, which can lead to dialysis if it progresses to end-stage renal disease/stage 4-5 chronic kidney disease.

Diabetic neuropathy: Diabetic neuropathy refers to the damage of nerves due to chronic high blood sugar. Smoking has a positive association with the prevalence and incidence of diabetic peripheral neuropathy. Some symptoms of peripheral neuropathy include numbness and tingling of the extremities such as hands and feet, a burning sensation in the legs, pain, weakness, decreased coordination, and increased risk of unnoticed injuries such as ulcers, which can lead to amputations.

Another common type of neuropathy is autonomic neuropathy. The autonomic nervous system controls the heart, bladder, lungs, stomach, intestines, sex organs, and eyes. Complications of autonomic neuropathy include delayed stomach emptying (gastroparesis), hypoglycemia unawareness, frequent urinary tract infections, and sexual dysfunction, among others.

Diabetic retinopathy: People with diabetes are prone to vision problems such as cataracts and glaucoma. Poorly controlled blood sugar levels can lead to diabetic retinopathy, which can lead to blindness. This process can be escalated by smoking.

Chronic obstructive pulmonary disease (COPD): Smoking is a risk factor for developing COPD, which can cause airflow blockage and breathing problems, leading to shortness of breath, tightness in the chest and other symptoms. Exposure to secondhand smoke can also increase the risk of COPD, even in nonsmokers.

Cancer: Smoking increases the risk of certain cancers, such as pancreatic, kidney, bladder, and colon cancers. Diabetes is also linked to the development of colon, bladder, and pancreatic cancers.

10 Tips for Quitting Smoking

1) Find your “why”: To make a behavior change, such as working on nicotine addiction, there needs to be a motivator or reason to make the change.

These motivators can be things such as wanting to be able to be active with your kids or the desire to decrease the risk of lung cancer after watching a loved one battle cancer. Reminding yourself of your motivation when things get hard can keep you on track with your goals.

2) Prepare yourself ahead of time: Deciding to stop smoking is a big one, and requires preparation versus just jumping in cold-turkey. Speaking with your healthcare provider about your intentions, as well as family and friends, can help provide a much-needed support network on your journey towards smoking cessation. If no one else knows your goals, it would be easier to call it quits if things get difficult.

3) Consider nicotine replacement therapy and/or medications: Nicotine replacement therapy, such as nicotine gum and patches, are helpful for some people. These options are beneficial because they don’t contain many of the toxins in cigarettes, but do provide nicotine, which is the addictive ingredient in cigarettes. Alternatively, some medications such as bupropion (Wellbutrin) and varenicline (Chantix) have been approved by the FDA to be used for smoking cessation.

4) Utilize resources: Customized smoking cessation plans and support are available such as 1-800-QUIT-NOW,, and

5) Be patient with yourself: Habits take time and persistence to break, and the longer you’ve been smoking, the greater ingrained that habit is. If you expect to be entirely off cigarettes within a week after deciding to quit, you may want to re-evaluate your goals for a more realistic plan. Cutting back on cigarettes slowly is still major progress, and by being realistic with your goals, the more likely you’ll be able to attain them.

6) Consider your triggers: Some people tend to smoke in certain situations, such as with coworkers on a lunch break or while drinking alcohol. Try to adjust your surroundings to support you in your success; for example, not going out to smoke at lunch and instead of going out to a restaurant to sit down and eat. If you break the most difficult triggers first, it’ll help propel you along your journey to stop smoking completely.

7) Find support through like-minded individuals: Smoking cessation support groups are helpful for some people because they can talk about their journey, struggles, and successes among people going through the same thing. The American Lung Association can help you find a group clinic in your area.

8) Start over fresh: Once you’ve decided to stop smoking, remove the cigarettes, lighters, ashtrays, and anything else that reminds you of your former habit. Wash any of your smoke-scented clothing and attempt to rid your surroundings of any lingering smoke smell. This can help facilitate the mental decision to make a fresh start and move forward.

9) Know that it sometimes takes several attempts: People who quit smoking often take more than one attempt to do so. By trial-and-error, you can learn what works for you and what doesn’t. These experiences, though they may be frustrating, are really helping you prepare for success by formulating a plan that works for you as an individual. No two people follow the exact same smoking cessation plan.

10) Increase physical activity: Exercise is a useful tool for many people on their journey to stop smoking. When the urge to smoke hits, getting outside for a walk around the block or going for a jog can not only be a positive behavior replacement, but it helps your brain release “feel good” hormones called endorphins, which can help ease stress and worry during this challenging transition.


Having diabetes and smoking exacerbates the risk of diabetes complications, such as cardiovascular events and amputations.

Smoking is not only a risk factor for developing type 2 diabetes, but it can make managing diabetes more difficult due to the insulin resistance caused by nicotine.

Cigarettes are addictive due to their nicotine content, which makes stopping smoking difficult, especially for those who have smoked for many years. However, quitting is 100% attainable with the right mindset, support, and individual plan. By stopping smoking, those with diabetes can be confident that they have drastically reduced their risk factors for heart disease and stroke, as well as improving lung health.

There are many resources available to those wanting to stop smoking, including nicotine replacement therapy, prescription medications, support programs, and more. Being patient and learning what does and doesn’t work can help those wanting to quit move towards success.

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  1. Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes. Transl Res. 2017;184:101–107. doi:10.1016/j.trsl.2017.02.004
  2. Chang SA. Smoking and type 2 diabetes mellitus. Diabetes Metab J. 2012;36(6):399–403. doi:10.4093/dmj.2012.36.6.399
  3. Spijkerman, A, van der A, D, Nilsson, P, Ardanaz, E, Gavrila, D, et al. (2014). Smoking and Long-Term Risk of Type 2 Diabetes: The EPIC-InterAct Study in European Populations. Diabetes Care. 37 (12), p3164-3171.

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