By Joseph Gustaitis
Unless you’ve been living on a desert island for the past 20 years, you’re undoubtedly aware of all the research demonstrating the dangers of smoking. There are plenty of magazine articles and TV public service ads explaining them. Nevertheless, certain interesting facts about cigarette smoking may have escaped your attention. Also, general information about smoking hazards almost never includes facts about the relationship between smoking and diabetes. The following quiz might help you discover if you’re up to speed on the latest information – and might surprise you, too.
(You can find the answers later in the article.)
1. In the United States, how many deaths per year are attributed to smoking?
2. Of people with diabetes who have amputations involving their feet or legs, what percentage are smokers?
3. The nicotine patch is highly recommended for helping people with diabetes quit smoking.
4. As harmful as smoking is, at least it doesn’t raise your blood glucose level.
5. In 1997, 36.4% of high school students in the United States were smokers. What percentage of high school students are smokers today?
6. Which of the following harmful substances is found in tobacco smoke?
B. Prussic acid (hydrogen cyanide).
C. Carbon monoxide.
D. All of the above.
7. The children of women who smoke are more likely to develop Type 2 diabetes.
1. A. A whopping 443,000 deaths per year in the United States are attributed to the harmful effects of smoking. Proof that smoking is a grave health hazard was first offered in 1964 in a report by the US Surgeon General’s Advisory Committee on Smoking and Health. This panel concluded that a smoker runs a much higher risk of developing lung cancer than a nonsmoker. But the list of maladies related to smoking does not stop there; it also includes heart disease, stroke, emphysema, impotence, and a host of other cancers, including cancers of the mouth, esophagus, larynx, kidney, and bladder. People who smoke pipes and cigars also have a higher risk of lung cancer and cancers of the mouth, esophagus, and larynx than nonsmokers.
2. A. According to the American Diabetes Association’s Complete Guide to Diabetes, no less than 95% of all amputations performed on people with diabetes are on smokers. Smoking narrows the blood vessels, causing the poor circulation that can lead to a foot or leg infection, which can make an amputation necessary. Unfortunately, it has been reported that despite this serious risk, only about half of persons with diabetes are advised by their health-care providers to quit smoking – a clear indication why self-education is so important.
3. FALSE. Nicotine replacement therapy, such as nicotine gum or a nicotine patch, has been shown to be effective in helping people quit smoking, especially if it is used in conjunction with behavioral counseling. It is especially useful for people who are addicted to nicotine – these are individuals who smoke more than 20 cigarettes a day and who need to have a cigarette within 30 minutes of waking up in the morning. However, the nicotine patch has been shown to raise blood sugar levels in some people with diabetes. This fact alone does not make the nicotine patch totally inadvisable for people with diabetes, but it does mean that those who try it will have to be especially careful about blood glucose monitoring. If you have diabetes and want to quit smoking, you might consider drug therapies other than nicotine replacement first. The drug bupropion (brand names Zyban and Wellbutrin) is effective, and physicians can also prescribe clonidine or nortriptyline if bupropion does not work for you. Group therapy has been found to be very helpful, and organizations such as the American Lung Association and the American Cancer Society can help you find a local support group. You may also find smoking-cessation classes and therapy in the yellow pages of your telephone book under the heading “Smokers Information and Treatment Centers.” If you are successful in quitting, get back to your health-care provider with the good news. Your ability to control your diabetes will most likely be improved, and you may need to change your insulin dose or your pill schedule.
4. FALSE. It might seem surprising, but researchers have learned that smoking actually raises your blood sugar level, which makes it more difficult for you to control your diabetes. Why this should be is uncertain, but it is theorized that nicotine and other ingredients of tobacco smoke make it more difficult for insulin to work properly.
5. C. This is one bit of good news on the smoking front. In May 2002, the Centers for Disease Control and Prevention (CDC) released a report showing that although over 25% of US high school students smoke cigarettes, the smoking rate among them has been falling since 1997. By 2009, the CDC reported only an estimated 19% of high school students smoked. Several factors were cited for the decline, including more effective school-based anti-smoking programs, smoking prevention campaigns in the mass media, and an increase in the cost of cigarettes. However, it seems that a diagnosis of diabetes in an adolescent is not enough to keep that person from taking up the habit. In other words, teens with diabetes still start smoking.
6. D. And it just begins there. Researchers have found some 4,000 chemicals in tobacco smoke. Some of these are not especially dangerous (nitrogen and oxygen, for example), but other ingredients are – for example, formaldehyde, benzene, and hydrogen cyanide. Tobacco smoke contains about 60 known carcinogenic chemicals. Surprisingly, nicotine, although it is toxic and is an irritant, is by itself not a major health hazard for most people. Yet because it is addictive and has a soothing, narcotic effect, it is most likely the major reason that people smoke.
7. TRUE. The British Medical Journal recently published the first study linking maternal smoking and a child’s diabetes, and it showed that the risk of developing diabetes increased over 4.5 times in children of women who smoked more than 10 cigarettes a day compared to women who were nonsmokers. The risk was still substantial in women who smoked fewer than 10 cigarettes a day. In addition, the researchers discovered that children of mothers who smoked were also more likely to become obese. The report suggests that smoking robs the developing fetus of nutrients, causing metabolic abnormalities that last for the child’s entire life.
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