Smoking increases the complications of diabetes manifold. India's incidence of diabetes is bound to surpass all previously made predictions. India has two dubious distinctions - firstly, it is the diabetes capital of the world, and secondly, India has the second largest number of smokers in the world.

Ramanathan Iyer, a chronic diabetic for many years, was a confused man. Ramanathan's plague was his inability to control his blood sugar levels despite his best efforts. He had his diet under control, he was a teetotaler, and he was almost religious about his daily exercise regimen, and yet his diabetes would not get controlled. Most of the people know that diabetes is a chronic disease, with no cure - one can keep the disease under control with lifestyle changes at best. What most don't know, is that there is one more lurking factor that impacts a diabetic's blood sugar levels dramatically, and that factor is the highly addictive habit of smoking.

Diabetes is not caused by sweets, as most of the people would tend to think; it is caused by the body's inability to process the sugars. Not many may be aware that smoking can compound the diabetics' problem manifold. Smoking alone can cause a significant reduction in insulin production, often leading to severe complications. There are more than 35 million diabetics in India, many of whom are smokers and these diabetic smokers are unwittingly complicating their dreaded disease putting their lives to extreme risk.

With the dubious distinction of being the diabetes capital of the world, India has yet another dubious distinction - that of having the second largest number of smokers in the world. A shocking statistic is that of the 1.3 billion addicted to smoking worldwide, 74 million are in India alone! The health burden of diabetes epidemic in India will become insurmountable if immediate action is not taken to help diabetics stop smoking.

Diabetic must know about smoking and diabetes
● People with diabetes are three times as likely to die of cardiovascular diseases. Smoking and diabetes together make you 11 times more likely to die of a heart attack or stroke.
● Smoking raises your blood sugar levels and cuts your body's ability to use insulin, making it hard to control your diabetes.
● Smoking one cigarette reduces the body's ability to use insulin by 15 per cent.
● Smoking increases cholesterol levels and the levels of other fats in blood. This increases the risk of having a heart attack.
● People with diabetes who smoke are twice as likely to have circulation and wound healing problems. These can lead to leg and foot infections, which can sometimes lead to amputation.
● Smokers with diabetes are more likely to develop nerve damage (neuropathy) and kidney disease (nephropathy).
● Smokers with diabetes have more problems with dental disease, bleeding gums and ulcers.
● Smoking can lead to insulin resistance, the researchers say - meaning that it can interfere with how well the body uses insulin. Insulin resistance usually precedes type 2 diabetes.

Resolution for diabetic smokers
Considering the impact that smoking has on a diabetic's health, it is essential that a smoking diabetic put cessation of smoking as the top-most priority in his/her agenda for a better life. However, quitting smoking is quite tough and research shows that less than 5 per cent of the actual quitters stopping smoking permanently without any help. However, all is not lost, for research shows that a holistic approach to smoking cessation can give up to a 45 per cent success rate in quitting. Apart from a high motivation to quit, other support systems like counselling, regular visual reiteration, yoga, and other modern smoking cessation therapies have helped quitters get rid of their addictions permanently.

If you are a smoking diabetic, it is never too late to stop smoking. The starting step is willpower and knowledge - your understanding of the harmful effect of smoking on your diabetes and general health. Empower yourself by understanding the support that you will need. Talk to your family for their support, and talk to your endocrinologist/diabetologist to learn why and how to stop smoking. There are many things that will help in your journey to the smoke-free healthier world like yoga, exercise and read about effects of smoking, nicotine. In fact, discussions with other diabetic smokers who have quit can give the necessary motivation and momentum to quit smoking immediately.

Of course, modern medicine never fails to marvel. As much as there are many medicines for the control of blood sugar, artificial insulin for the deficient, for smoking cessation too, humankind has graduated from mere Nicotine patches to modern and safe pills, which work very effectively. In fact, to help the ailing diabetic smokers there is also a safe new molecule called Varenicline, which works directly on the physiology of Nicotine addiction process at the roots. In fact, this molecule (called Chantix in USA) is already being used in many western nations and already 5 million smokers have benefited from the treatment.
Being a diabetic is not your choice, but being free of the disease certainly is. If you haven't already regarded quitting smoking as the topmost resolution to kick start the New Year, it is high time you did yourself a favour. Quit smoking! Smoking cessation should top the New Year's resolution list for any smoking diabetic.

(The author is a consultant chest specialist at Lilavati Hospital, Mumbai)