Diabetes and smoking

The best-known effect of smoking is that it causes cancer. But smoking can also aggravate many of the problems that people with diabetes already face, such as heart and blood vessel disease. Smoking related problems include:

• Smoking cuts the amount of oxygen reaching tissues. The decrease in oxygen can lead to a heart attack or stroke
• Smoking increases your cholesterol levels and the levels of some other fats in your blood, raising your risk of a heart attack
• If you are pregnant, smoking can result in an abnormally small baby and a higher risk of having a miscarriage or stillborn baby
• Smoking damages and constricts the blood vessels. This damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections
• Smokers with diabetes are more likely to get nerve damage and kidney disease
• Smokers are more prone to get colds and respiratory infections
• Smoking increases your risk of developing limited joint movement
• Smoking can cause cancer of the mouth, throat, lung, and bladder
• People with diabetes who smoke are three times as likely to die of cardiovascular disease as are other people with diabetes
• Smoking increases your blood pressure
• Smoking can raise your blood glucose level
• If you are a man, smoking can increase your chance of becoming impotent

Why quitting is so hard

It’s not easy to give up smoking. Chances are you’ve thought about quitting before or have tried to. To understand why it’s so hard, and to develop ideas about how to go about giving up, it helps to understand the nature of smoking addiction. The addictive part of smoking can be divided into three parts:

• Addiction to nicotine
• Habit (ingrained responses, e.g., always smoking after a meal)
• Feelings (particular feelings that trigger the urge to smoke)

Some people are addicted in all three ways and some are not. If you find it really hard to give up, chances are you may have the lot.

Nicotine addiction

Nicotine is one of thousands of chemicals in cigarettes. It’s an addictive substance and causes most of the withdrawal symptoms you feel when you first stop.

Two hours after you stop smoking all the nicotine is out of your system. The nicotine by-products are gone in two to three days. Once the nicotine has gone it’s the addiction, the habits, and the feelings that make you want to keep smoking.

It is often helpful to think of the withdrawal symptoms from nicotine as 'recovery symptoms'. These symptoms include:

• Headaches
• Tingling of toes and fingers
• Irritability

Habits

You have trained yourself into thinking you can’t do some things without a cigarette. For example:

• coming home from school or work - craving
• work, school, family pressures – craving
• after a meal - craving
• out with friends - craving
• boredom - craving
• alcohol - craving

Feelings

Feelings are also important. You may smoke when you are happy, sad, stressed, tired, and bored. You might also use cigarettes to cover up uncomfortable feelings such as when you’re angry, embarrassed or nervous.

How do I quit?

Most people who quit successfully go through three stages:

• Building up your determination to quit
• Stopping or gradually reducing the number of cigarettes you smoke each day
• Learning new coping skills, eg: saying “no” to friends when they offer you a smoke, recognising your triggers to smoke and dealing with them

How long these three stages take depends on you. Each person is different. Sometimes though, there are “blocks” in your own mind that make the quitting process take longer. Some of the common blocks and what you can do about them are:

Fear of losing friends

It can be really hard if your friends and family / whanau keep on smoking while you are quitting. Sometimes you can encourage them to quit. You can spend more time with friends who don't smoke. Some of the people around you who smoke might try to give you a hard time for quitting. But remember most people will admire you for stopping smoking.

Fear of failing

Not everybody quits the first time around. That’s OK. Most people who successfully stop smoking have had two or three serious attempts to stop. Each time you quit you learn more about why you smoke and about how to stay smokefree next time. Work out what got you started again and build a strategy to deal with it next time. Keep trying, you will succeed. Don't beat yourself up if you relapse. You tried to quit in the first place and you can do it again! Keep trying, you will succeed.

"We’re all going to die sometime"

You could get run over by a bus too – but who lies out in the middle of the road waiting for it!

Sadness

Sometimes you might feel sad about quitting. It’s OK to feel like this. Smoking has been part of your life. The feelings will go away. Replace them with the satisfaction of knowing you are a person who is trying to quit.

Once you’ve decided to quit, choose an easy day to stop. A day when you won’t be under too much pressure but will also have plenty to occupy yourself. Keep busy, but make sure you have some fun things lined up for the day. Some tips for quitting include:

• Clean up before your quit day. Toss out all your cigarettes, lighters and ashtrays
• Choose a quit method that suits you. Cold Turkey means stopping suddenly and completely. Cutting down is another way. You could reduce your smoking by half and/or delay your first cigarette by an hour each day
• Take with you only the number of cigarettes that you plan to smoke that day
• Remember, there is no such thing as failure. Cutting down on the number of cigarettes you smoke is a great start, but make sure you still set a quit date
• If you try one way of quitting and it doesn’t work, then try something else. Don’t give up. Each attempt at quitting brings you closer to quitting for good

What does it feel like to quit?

When you give up smoking you may experience one or more recovery symptoms. Some people call these withdrawal symptoms but they are actually a good sign. They mean your body is getting rid of harmful chemicals.

Most symptoms will last only a few days, but some take a few weeks to settle down. Hang in there, they will go away.

Some people experience some of the following recovery symptoms:

Cravings

These can be really strong and hard to deal with. It helps if you know how to deal with them. Read more on dealing with cravings . . .

Occasional headaches

Quitting can be stressful, so try and relieve the pressure by doing some deep breathing or some exercise.

Tingling fingers

Cigarettes reduce blood supply. When the blood supply improves, more oxygen can cause your toes and fingers to tingle.

An upset stomach

This can be a problem while your body is getting rid of the nicotine. A varied diet with lots of fruit and vegetables and water (6–8 glasses a day) can help.

Restlessness and difficulty concentrating or sleeping

Your body is adjusting to being free of nicotine. These feelings will pass as your system settles down. Deep breathing and relaxation exercises can help.

Coughing

Your lungs are cleaning themselves out. The little hairs that clean the lungs are working again and getting rid of the unpleasant stuff in your lungs.

Feelings of grumpiness and sadness

For some people, quitting can be like losing a friend. It’s normal and OK to feel sad. Do things you enjoy – listen to music, read a book, watch a movie, visit a friend.

Wanting to eat more, using food as a substitute

Choose your food carefully and drink lots of water.

Lacking energy

Feeling tired, spaced out or lethargic are common reactions. Get lots of rest, exercise and fresh air.

Feeling bored

Stay active and make sure you have plenty to do.

Once you've quit

Once you’ve quit the next step is to stay off. The first three months or so after quitting are the hardest time. Most people who return to smoking do so then. During those first three months, they’ve broken their physical addiction but not yet lost their psychological dependence on cigarettes.

It can sometimes take just one cigarette to make you feel like you are back on the smoking treadmill. So have some ideas up your sleeve to deal with temptation. For example, plan to take a bath, chew sugarless gum, sip some water, find something to do with your hands, or step outside for some fresh air when the urge to smoke hits you.

If you know you are going to be around smokers, be prepared. Practice an answer for when you’re offered a cigarette. Seek out non-smokers in the group. Don't apologise for not smoking. Be proud. You've achieved a lot.

If you don’t manage to quit first time

Quitting can be hard. You might be going along OK, then suddenly you feel like smoking again. Sometimes, as you gain confidence, you start to think that quitting is easy, so why not smoke again?

Remember every craving only lasts a few minutes. You can deal with it: delay, deep breathe, drink water or do something else.

Remind yourself of the early days when you found it really tough. Think of how far you have come. Do you really want to start all over again?

List your reasons for quitting on a card and carry it with you. Read the reasons whenever you feel the urge to smoke.

If you slip up – remember that one cigarette doesn’t mean you have failed. You are not weak and you are not back on cigarettes. If you think of yourself as 'failing' you can feel weak and ignore all the good work you have done. Touch base with the reasons why you have stopped and the success you have had so far.

Work out why you smoked and how you can prevent it next time. Don’t use a slip as an excuse to go back to smoking.

If you go back to regular smoking

If this happens don’t despair and don’t give up your plan to quit. Remember:

• Every day that you spend smokefree makes your body healthier. It also helps to break your habit and weaken your addiction
• You took a long time to learn the habit of smoking, so you may take a while to learn to become a non-smoker
• Use what you learned from your quit attempt and plan another quit date as soon as possible
• The "Quitline” is there to help you.

Quitline - 0800 778 778

The Quitline offers free and confidential support to callers who have decided to quit smoking. Along with advice and support the Quitline also provides some smokers with subsidised nicotine patches and gum.

When you are put through to the call centre you’ll be asked if you would like to receive a quit information pack, nicotine patches or gum, or speak with a Quit Advisor.

The Quit Advisors make regular call-backs to give you support and advice while you stop smoking. And you can call them if you need to. They will help you to decide on an individual programme best suited to help you give up smoking.

If you are a heavy smoker (10 to 15 cigarettes a day or more) and are ready to quit, you may be eligible for a subsidised eight-week course of patches or gum.

If gum or patches are suitable, you will be mailed an exchange card to take to a pharmacy. It usually costs $5 for the initial four-week supply. After that you may qualify for a second four-week supply, which usually costs $10.

If you have diabetes you will need to talk to your GP before Quitline can offer you gum or patches (note: this rule also applies to people who are breastfeeding or have other medical conditions like heart disease).

Note: for more information on Quitline and for quit smoking tips and information visit www.quit.org.nz

Getting back to normal

Once your body’s metabolism returns to normal, you may put on a little weight. The average weight gain for people stopping smoking is about 7 pounds. If you are worried about gaining weight, talk to your dietitian about changing your food and exercise plans.

You may also need to talk with your health care provider after you quit. Your blood glucose levels may improve. If this happens your insulin or tablet doses may need to be adjusted. If you are taking medication for high blood pressure or high cholesterol levels, these may improve so much that you and your health care provider may want to change your treatment.

Quitting smoking is probably the most important thing you can do for your health and for those around you.