Whether it's smoked, snorted, chewed, or inhaled as secondhand smoke, tobacco kills. If it were a quick killer like rat poison, it wouldn't last on the market for a day. But tobacco kills slowly, and by the time you realize that there's a problem, the damage has been done, whether it's lung cancer, stomach cancer, chronic lung disease, amputation, or a combination of these. Unfortunately, too many people wait until they have an irreversible disease to put away their cigarettes or other forms of tobacco for good. And at that point, it hardly matters anymore.
In the following sections, I explain the dangers of smoking for folks with T1DM and give you guidelines for quitting.
If you're a young person (or a not-so-young person) with or without diabetes, don't make the biggest mistake of your life and start using tobacco in any form. If you've started already, stop today!
The dangers of tobacco
Some of the ways that tobacco hurts the person with diabetes include:
i It increases arteriosclerosis, the condition of changes in arteries that lead to heart attacks, strokes, and loss of blood supply to the legs that results in amputations. (See Chapter 5 for details on T1DM complications that affect the heart.)
i It increases blood pressure, which also leads to worsening of arteriosclerosis and the tendency to have a stroke.
i It increases the clustering of platelets, the tiny disks in the blood that normally prevent a small cut from becoming a hemorrhage. Increased platelet clustering causes clumping within the arteries, blockage of blood flow, and death of tissues, especially the heart, brain, and arteries.
i It increases pain in the legs and heart in people with diminished blood flow.
i It reduces blood flow in arteries immediately in addition to contributing to the long-term worsening of arteriosclerosis.
Can you stop smoking? Forty-six million Americans have done it, so why not you? There are numerous ways you can go about it. You may be able to do it the first time you try, but don't give up if that doesn't happen. Many people manage to quit for good on their second, third, or fourth attempts. The important thing is to keep trying!
Some people can stop "cold turkey," making up their minds to quit immediately and never touching another cigarette. Others require a scare like chest pain or shortness of breath. Still others find success in nicotine replacement therapy because the nicotine in cigarettes is what's so addictive. Some of the forms of nicotine replacement therapy include:
^ Nicotine gum: Available without a prescription, you chew the gum for a while until the need for a cigarette is gone. Then you park the gum in your cheek until you again feel the urge and chew some more. Each day, you decrease the number of pieces of gum you chew, and finally you reach a day when you don't need it at all.
^ Nicotine inhaler: You need a prescription to get a nicotine inhaler. It delivers a vapor into the mouth, and the tissues in the mouth absorb the nicotine. Sometimes it causes irritation in the mouth.
^ Nicotine nasal spray: Available by prescription, you use the nicotine nasal spray whenever you feel the urge for a cigarette. Over time, the urge diminishes. People with sinus problems have trouble using this form of replacement therapy.
^ Nicotine patches: You can buy patches over the counter or with a prescription if you need a higher dose. The nicotine is absorbed through the skin, and you decrease the strength of the nicotine in the patch as your need for nicotine diminishes.
There are also certain drugs that block the addictive power of nicotine in your brain. Among the drugs that are safe for folks with T1DM are
^ Bupropion SR (brand name Zyban): Takes away the craving for nicotine, but researchers don't know exactly how it does it. You take this prescription-only drug twice daily. The dose should be no greater than 300 mg daily, and no single dose should be greater than 150 mg to avoid the risk of seizures.
^ Varenicline (brand name Chantix): Seems to be more effective than bupropion in helping people stop smoking. This new drug blocks the places in the brain to which nicotine attaches, so there's less craving and a reduction of the pleasurable effects of nicotine. Here's how you use varenicline:
• You set a date to quit smoking and then start taking this drug a week earlier.
• You take it after a meal with 8 ounces of water.
• The dose is 1 mg twice daily for 12 weeks. If you haven't stopped smoking after the first 12 weeks, you'll benefit from another 12 weeks on the drug.
Varenicline can cause drowsiness, so you shouldn't drive or use heavy machinery until you know how you react to the drug. Elderly people may be particularly sensitive to its effects, and it shouldn't be used in children under 18 or breastfeeding mothers. Pregnant women need to discuss use with their doctors before they start the drug.
The combination of bupropion and nicotine replacement therapy may be even more effective than either alone. However, the safety and effectiveness of combining varenicline and nicotine replacement hasn't been studied.
If you want more help to accomplish the critical task of giving up tobacco in any form, talk to your doctor and consult these great resources:
1 The American Cancer Society has all kinds of pamphlets and other materials as well as books and tapes on quitting smoking; call 1-800-227-2345 or visit www.cancer.org.
1 The American Lung Association has information and clinics to help you to stop smoking; call 1-800-586-4872 or visit www.lungusa.org.
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Quit smoking for good! Stop your bad habits for good, learn to cope with the addiction of cigarettes and how to curb cravings and begin a new life. You will never again have to leave a meeting and find a place outside to smoke, losing valuable time. This is the key to your freedom from addiction, take the first step!