Diabetes Forecast

How to Quit Smoking Now

You think about it. Your family bugs you about it. Your doctor recommends it. It’s time to stop smoking

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Daniela Patulea knew that she had to quit her 38-year smoking habit—in fact, she had already tried several times. At one point, she went six months without a cigarette before giving in and smoking a few at a party. Soon enough she was back to a pack a day. Then in October 2015, she hit a turning point: She was diagnosed with type 2 diabetes.

“That really scared me,” says Patulea, now 61. “And my son said, ‘Mom, I want to have you in my life for a long time.’ That stayed with me.” Still, the addictive power of nicotine is such that at first she kept on smoking. Diet and exercise helped reduce her A1C from 9.9 to 6.6 within three months, and when she finally quit smoking at the six-month mark she was able  to keep it at that level despite some weight  gain. While she still takes metformin for  her diabetes, she no longer takes blood  pressure meds.

Patulea’s diabetes diagnosis four years ago may not have been bad luck or coincidence. Decades of research show an intimate connection between cigarette smoking and diabetes, and that link is two-pronged. First, smoking raises the risk for type 2 diabetes by 30 to 40 percent, according to the Centers for Disease Control and Prevention (CDC). Second, once you have diabetes—either type 1 or type 2—smoking greatly ups your odds of serious complications, including cardiovascular disease, kidney failure, vision loss, and peripheral artery disease, a condition in which narrowed arteries limit blood flow to the limbs.

Why is that? Smoking and diabetes share many common effects, says Joel Zonszein, MD, director of the Diabetes Center at Albert Einstein College of Medicine in New York. Combining the two is like doubling up on the damage. “Studies show that certain chemicals in cigarettes cause insulin resistance, which can lead to [type 2] diabetes,” Zonszein says. “Smoking is also associated with the accumulation of abdominal fat, another risk factor for diabetes.”

Belly fat can trigger chronic inflammation, which can lead to complications such as retinopathy (eye disease), poor circulation, and heart attack. Yet more potential damage: Smoking raises your risk for all kinds of cancers, and people with diabetes, especially those who are obese, already have a higher risk for cancer.

“It snowballs,” says Melanie Teslik, MS, RN, CDE, a certified diabetes educator in the Department of Endocrinology, Diabetes, and Metabolism at New York University’s Winthrop University Hospital. “Inflammation, high levels of the stress hormone cortisol, toxic abdominal weight, vascular constriction—these all affect each other, and you’re being hit from all directions.” The end result is alarming. People with diabetes are already three times more likely to die of cardiovascular disease; the damage from smoking increases that risk by another 50 percent.

Quitting can make you healthier, and quickly. “Your cells are getting oxygenized and working better right away,” says Teslik. “And once you’re not smoking, insulin works better in your body.” Certain changes, such as lowering insulin resistance and cortisol levels, are not instantaneous. But many people taking insulin may eventually be able to lower their dose after quitting. “Once a patient gets engaged in the process, diabetes can  be managed very well,” says Zonszein.

Quitting Time

Anyone who’s been there can tell you there are a thousand ways to quit. Clearly it’s not easy or everyone would have quit already. (Nicotine is considered by experts to be the third most addictive substance in the world, after heroin and cocaine.) And a study in Applied Nursing Research shows that it may be a little harder for smokers with type 2 diabetes, who score higher on addiction tests than smokers who don’t have diabetes. Cigarette companies have made it harder, too. “Chemicals have been added to cigarettes over time that make them even more addicting,” says Patricia Folan, DNP, RN, director of the Center for Tobacco Control at Northwell Health in Great Neck, New York. “Things like ammonia bind to nicotine and make it reach your brain that much faster. It’s like smoking crack versus using cocaine—nicotine hits your brain in seven to 10 seconds.”

One big advantage over a couple of decades ago is that people now have more aids for quitting. These include nicotine replacements, prescription meds, and online support groups.  Some people find that quitting isn’t quite as tough as they expected once they find the right combination of methods. “I told my son, if I’d known it wasn’t that hard, I would have quit 25 years ago,” says Patulea. Try mixing and matching these tactics.

Nicotine Replacement

“There are five different forms of nicotine replacement—the patch, gum, lozenges, nasal spray, and inhaler—and they can be very helpful,” says Folan. “Many people have had success with combining products—say, wearing a patch, and then popping a piece of the gum when they’re hit with a craving.” But studies show that it’s key to supplement the nicotine replacement with counseling or support groups. A U.S. Public Health Service report on treating tobacco dependence suggests that combining the two may double or even triple your chances of quitting. It’s also important to taper off within a few months, says Melissa Young, PharmD, CDE, a spokesperson for the American Association of Diabetes Educators. “Some people continue to use them  for years, but they’re really designed for short-term use.

Prescription Medications

“Certain oral medications have been found to reduce cravings and help people quit,” says Young. One of  these, Chantix, blocks some of the pleasurable sensations of smoking. Another, Zyban, was originally marketed as an antidepressant; when researchers noticed that users also  lost their interest in smoking, it was approved by the Food and Drug Administration (FDA) in 1997 for that purpose. “At first, people were using these for three months,” says Folan. “But studies have now found that people who take these meds from six  to 12 months are more likely to quit [ for good].” First talk to your doctor  about possible side effects. Both meds can cause sleep problems, vomiting, and seizures; Zyban can also cause mood disorders and suicidal thoughts.


Some of these cigarette-shaped electronic devices, which contain a nicotine-based liquid that’s vaporized and inhaled, have been marketed as quit-smoking devices. Problem is, the research and evidence supporting that use is slim, says Folan. “There are [lots of] e-cigarettes out there, and the FDA hasn’t had a chance to get full information about all of them,” she says. “So, if a two-packs-a-day smoker switches to these products, would it be better? We think so, but we don’t have the data. And we don’t have much data yet about how to get people off these devices, which are delivering nicotine, an addictive substance.” That means that nicotine may still be affecting your insulin resistance, and other chemicals—with unknown effects—are being delivered to your lungs. So it’s best to think of e-cigarettes as transitional devices to help cut back and eventually stop vaping entirely.

Behavioral Changes

Dale Jones had been a smoker for 40 years when a friend persuaded him to quit. He didn’t make elaborate plans beforehand. He decided to take his smoking “off autopilot” by trying to put off each cigarette a little longer. “In four weeks, I went from a pack a day to five cigarettes a day,” he says. “Then I made the decision and said to myself, ‘I’m not going to smoke anymore.’ I used a patch for a couple of weeks, but I started forgetting to put it on, so I stopped. When I had cravings, I did sensory things, like biting into a lemon  or filling my mouth with ice cubes.”  That was 12 years ago. “It’s not about willpower, which means fighting yourself against something you want  to do,” says Jones, now 70. “It’s about willingness, saying you want to make this change.”

Need help making these sorts of behavioral changes? Counseling often works, but there are free resources, too. “Everyone wants to help people quit smoking: the government, insurance companies, even your state or town,” Teslik says. “There are hotlines, like 800-QUIT-NOW, run by the CDC, which also has a free QuitStart app and texting programs.” The websites smokefree.gov, from the National Cancer Institute, and tobaccofreelife.org both offer free tools as well.

Social media and online support groups can offer suggestions, encouragement, and accountability. “Joining the online community BecomeAnEx.org was the best decision I ever made,” says Patulea. “Any time, day or night, you can go online and ask other ex-smokers for help. We all quit differently, but if you get 60 responses, maybe one will work for you.” The website is also where Patulea learned about the book Allen Carr’s Easy Way to Stop Smoking, a bible for quitters. “The book put me in the mindset to quit and demystified how hard it is. You learn new habits—I started using adult coloring books while listening to music. There are a million things that can help.”

The Cost of Quitting

Kicking the habit may cost you. How much depends on the tools you use. Some employers offer smoking-cessation programs, and your health insurer can help cover the cost of other treatments. “In general, most [insurance companies] want to cover at least part of your quit-smoking effort because they know it will save them money in the long run,” says Melanie Teslik, MS, RN, CDE, a certified diabetes educator in the Department of Endocrinology, Diabetes, and Metabolism at New York University’s Winthrop University Hospital. For instance, many cover prescription meds such as Chantix and sometimes cover over-the-counter aids such as nicotine gum and patches.

Medicare Part B covers two quit-smoking counseling attempts per year, each including four in-person sessions with your provider. Over-the-counter treatments are not covered by Medicare, but some prescriptions—such as Chantix and Nicotrol—may be covered by some Medicare Part D plans. 

Keep in mind that no matter what you spend in the process of quitting, you’ll still be saving a huge amount of money as an ex-smoker. Depending on local taxes where you live, supporting a pack-a-day smoking habit costs between $2,000 and $4,500 a year. Using a nicotine patch for three months (the recommended time): around $270. Even if you need to use one for a few extra months, you’ll still be saving hundreds, if not thousands, of dollars.

The Quitter’s Conundrum

For some quitters, there is a painful irony: Research  shows that smokers who don’t have diabetes have an elevated risk of developing type 2 in the first few years after quitting. Studies vary in assessing the timing—some show that the higher risk peaks two or three years after quitting, while others show a peak at five to seven years—but all agree that the risk declines precipitously 10 to 12 years after quitting. The spike in diabetes diagnoses has been linked to weight gain after quitting, but experts agree that the risk from smoking is far greater than that of extra pounds. In fact, a study published in 2018 in The New England Journal of Medicine found that people’s risk for early death was significantly lower after giving up cigarettes—even if they’d packed on pounds after quitting.

Protect Your Kids

It’s harder to quit smoking than avoid  starting in the first place. That’s why it’s  so important to help your kids avoid the temptation to take their first puff. Children of smokers are more likely to smoke, so  if you’re a parent, consider your kids’  health the extra incentive you need to quit.



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