Smoking and Increased Risk for Diabetes

Most people are aware that smoking cigarettes increases the risk of lung diseases—like cancer or chronic obstructive pulmonary disease—but smoking also affects people with diabetes and can increase the complications of it.

In a 2014 Surgeon General’s report, it was stated that people who smoked cigarettes are at a 30 to 40% higher risk for developing type 2 diabetes than non-smokers. Even among people smoking cigarettes, they found different risk levels and the more cigarettes smoked the higher the risk for developing diabetes.

Man with cigarette, lighter, and medical device on arm

Albina Gavrilovic / Getty Images

Can Smoking Cause Diabetes?

Smoking does contribute to the risk of developing type 2 diabetes. This is attributed to the increased information and oxidative stress that can cause cell damage interfering with their function.

High levels of nicotine in the body can decrease the effectiveness of insulin and make it harder for smokers to control their blood sugar levels.  

Other risk factors for developing diabetes include:

  • Age
  • Ethnicity
  • Being overweight, especially in those who carry their weight around the abdomen
  • Family history

Other Health Complications

Both diabetes and smoking affect the health of cells and can cause damage to tissues. This is because of an increased inflammation and increased strain that can be placed on blood vessels by both of these.

There are some health complications that people with diabetes who also smoke are at an increased risk for developing.

Cardiovascular Complications

The health of the heart and blood vessels are affected by both diabetes and smoking.

  • Smoking is known to cause damage to blood vessels by the increased inflammation. It also increases the risk of forming a plaque in blood vessels, which can either completely occlude blood vessels or can cause a heart attack or stroke.
  • Uncontrolled diabetes can also damage blood vessels. When the amount of sugar in the blood is elevated for long periods of time, it causes damage to blood vessels especially when they are smaller veins or arteries.

People with uncontrolled diabetes are at a higher risk for a heart attack or stroke. They are also at a higher risk for developing heart disease at a younger age than those without diabetes.

Circulation Problems Leading to Lower Extremity Infections, Ulcers, and Amputations

Because of the effects that both smoking and diabetes have on blood vessels, it increases the risk for wounds and nonhealing ulcers to affect the arms and legs.

Blood vessels get smaller as they spread to the extremities, so the damage caused by diabetes and smoking is seen in these areas first.

It's more difficult for people who smoke and have diabetes to heal wounds that develop because of a decreased blood flow. In some cases, the infection in their limbs can become so severe that they require amputations.

Kidney Disease

The kidneys are another organ that is commonly damaged by both diabetes and smoking. Chronic kidney disease affects the kidney’s ability to filter wastes, toxins, and excess nutrients from the body. The buildup of these can lead to serious health complications.

In the final stage of renal disease, people often require dialysis to remove the buildup of wastes or a kidney transplant.


Retinopathy is a complication of diabetes that affects the eyes that can lead to impaired vision and—in some cases—blindness. Retinopathy isn't reversible, but early interventions to control blood sugar levels can stop the progression of the disease.

Early symptoms of retinopathy include:

  • Dark areas of vision
  • Blurry vision
  • Floaters
  • Challenges perceiving colors

Peripheral Neuropathy

Diabetes is a common cause of peripheral neuropathy, which is damage to nerves outside of the brain and spinal cord, typically affecting the hands and feet. Symptoms of peripheral neuropathy are:

  • Weakness
  • Numbness
  • Pain from nerve damage

Smoking has been identified as a risk factor for diabetic peripheral neuropathy. The increased inflammation and oxidative stress caused by cigarette smoking is likely the reason smoking impact the health of the nerves in the hands and feet.

Reducing Risk

Taking care of diabetes and quitting smoking are both important to taking care of one's health. Making lifestyle changes can help lower the risk of developing the health complications associated with diabetes and smoking.

When it comes to managing diabetes, monitoring blood sugar levels is crucial.

Hemoglobin A1C tests measure the average for glucose levels over the past three months because it tests how much glucose has been integrated into the red blood cells. New red blood cells are made every three months, which is why this tells how well controlled blood sugar levels are over time.

Monitoring blood sugar levels is one part of managing diabetes. The other side to controlling diabetes is lifestyle changes and including medications if they are recommended by your doctor.

Changes to your lifestyle can have a big impact on your blood sugar levels and it is even possible to manage diabetes through lifestyle changes alone without medications.

Smoking Cessation

Research shows that stopping smoking can reduce the risk of developing complications that are associated with cigarettes. Even though the risk still may be higher than those who have never smoked, that risk is reduced more for each year that someone has stopped smoking.

It's important for everyone to stop smoking for their health, but it is especially important for people who have diabetes. This is because high nicotine levels in the body change the effectiveness of insulin and increase the risk of developing complications.

Weight Loss

Research shows a weight loss of 10% in people who are overweight improves the body's response to insulin. One of the reasons being overweight—particularly in the abdomen—increases the risk for diabetes is because it decreases the body’s ability to utilize insulin.

Losing weight can make the insulin produced by the body more effective and it can reduce the need for medications to manage diabetes.

Diet Changes

Changes to diet are important with diabetes because the amount of sugar (carbohydrates) in a diet directly affects blood sugar levels. Diet changes are also necessary to lose weight and maintain that weight loss.

Working with a dietitian or a certified diabetes educator can help make effective and sustainable changes personalized to someone's diet.

As a rule of thumb, incorporating more vegetables, fruit, whole grains, and lean proteins is a great starting to a healthy diet.

Increase Physical Activity

Physical activity increases the body's ability to use insulin because the muscles need more energy to move more. A few ways to increase physical activity throughout the day is going for a walk, workouts, and group fitness classes.

Discuss any new exercise routine with a healthcare professional prior to beginning.

Smoking Cessation Resources

It can be very difficult to quit smoking, but there are tools that can help.

Tips to quit smoking:

  • Try nicotine replacements – patches, gums, or medications
  • Avoid situations and locations associated with smoking
  • Distract from the cravings by chewing sugar-free gum, something crunchy like celery, going for a walk, or a hobby like needlework that gives the hands something to do
  • Practice stress management techniques to manage stress, such as meditation, journaling, yoga, or deep breathing
  • Join an online or in-person smoking cessation support group for social support while quitting and to hear other’s tips for how they managed tobacco cravings

Help to Quit Smoking

The Center for Disease Control has a free quitline that provides tips, resources, and support for smoking cessation. You can reach the quitline by calling 1-800-QUIT-NOW (1-800-784-8669) or by visiting their Tips From Former Smokers page.

A Word From Verywell

Smoking cessation is important for everyone in general but it is especially important for people who have chronic diseases like diabetes. Quitting smoking and managing your blood sugar levels can decrease your risk of developing complications of diabetes.

Maintaining a relationship with your primary care physician or an endocrinologist is important for people with diabetes or who are at risk for diabetes in order to monitor and control their blood sugar levels.

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Article Sources
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