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Diabetes & Smoking

we are the yolo group!
by

Ahmed Samir

on 26 October 2015

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Transcript of Diabetes & Smoking

Diabetes & Smoking
Ass.Prof.Dr. Samir Elsheikh
Diabetes and Metabolism Unit
Smoking is a Serious Problem

Effect of Smoking on Diabetes

Smoking Cessation
In the year 2000
1 in every 6 deaths
worldwide was caused by smoking


By the year 2030
1 in every 3 deaths
worldwide will be due to smoking

70% of these deaths will be in
developing countries.

There are more than
1 billion smokers
in the world today
20% of the world's population.

Tobacco kills more people than any other single agent.

Smoking
kills at least a third of current smokers
, many more will develop serious illness because of tobacco. 
Those killed by tobacco lose on average 10-15 years of life

Globally, nearly 5 million people are killed by tobacco each year, with current trends that number will double to 10 million

In this 21st century, unless urgent action is taken,
more than one billion people will be killed by tobacco.
Research has shown:

Half of all regular smokers die prematurely:
* ¼ in middle age (35-69)
* ¼ in old age

Stopping before 35 avoids most of the risks of premature death
Diabetes $ Smoking
Effect of smoking on Non-Diabetics
U.S. research indicates that the most harmful effect of smoking is linked to a significantly
higher risk of developing Type 2 diabetes.

a 44% higher chance
of developing Type 2 diabetes compared with non-smokers

the risk increases with the average number of cigarettes smoked daily.

Effect of smoking on Diabetics
- More likely to experience
neuropathy, nephropathy and retinopathy.

-
Three times
more likely to
die of cardiovascular-related complications
than non-smokers with diabetes.

- More likely to have
problems maintaining proper blood sugar levels
, because smoking raises blood sugar
Smoking, Diabetes & Pregnancy
Women who smoke during pregnancy are at
increased risk of developing gestational diabetes
and also increase the risk of their
offspring developing diabetes later in life.
Gestational
Why?
- Smoking has been identified as a possible risk factor for
insulin resistance

- Smoking has also been shown to deteriorate glucose metabolism

- It has been associated with a
risk of chronic pancreatitis
and pancreatic cancer, suggesting that tobacco smoke may be toxic to the pancreas
1+1=2
Diabetes + Smoking = 4
Recommendations for Clinical Practice
Ask
about smoking at every opportunity and update records
Advise
all smokers to stop in a personalized and appropriate manner
Assess
motivation to stop
Assist
the smoker to stop
Arrange
follow up if possible
Withdrawal effects: duration and frequency
Light-headedness
Sleep disturbance
Poor concentration
Craving
Irritability/aggression
Depression
Restlessness
Increased appetite
<48 hrs 10%
< 1 wk 25%
<2 wks 60%
> 2 wks 70%
< 4 wks 50%
< 4 wks 60%
< 4 wks 60%
> 10 wks 70%
Varenicline
Bupropion
Effects on Smoking Satisfaction, Craving &Withdrawal
Pharmacotherapy
for smoking cessation

Alpha4 beta2 nicotine receptor blocker (varenicline)

Antidepressants (bupropion)

Nicotine replacement therapy (NRT)
Action
Nicotinic acetylcholine receptor partial agonist

1.Stimulating the receptors→reduces craving and withdrawal symptoms

2.Blocks nicotine from acting on the nicotinic receptors
Dosage
Days 1-3 >>
0.5 mg once daily

Days 4-7 >>
0.5 mg twice daily

Day 8 to the end of treatment >>
1 mg twice daily
Used for 12 weeks
Side effects
Nausea (28.1%)

Headache (15.5%)

Insomnia (14.0%)

Abnormal dreams (10.3%)
Action
Antidepressant & smoking cessation aid

Norepinephrine-dopamine reuptake inhibition

No weight gain or sexual dysfunction
Benefits
Reduces the severity of nicotine cravings and withdrawal symptoms.

Course: 7 -12 ws

doubles the chance of quitting smoking
Side Effects
Seizures
is the most controversial side effect
Dose-dependent

not be prescribed to individuals with epilepsy or other conditions that lower the seizure threshold
Smoking Satisfaction
varenicline & bupropion both had a moderate effect on
reducing smoking satisfaction & psychological reward
after smoking while taking the drug
Craving
Both reduced craving but
varenicline had twice the effect .
Both reduced urge to smoke but varenicline had twice the effect size

Withdrawal
Both reduced the negative affect associated with quitting about equally
Varenicline
reduced restlessness .
Varenicline
increased appetite
Electronic cigarette
It is an electrical inhaler that vaporizes a propylene glycol or glycerin or polyethylene glycol-based liquid solution into an aerosol mist, simulating the act of tobacco smoking.
As of April 2010, T
he American Association of Public Health Physicians (AAPHP)
supports electronic cigarettes sales to adults


"because the possibility exists to save the lives of four million of the eight million current adult American smokers who will otherwise die of a tobacco-related illness over the next twenty years."
In May 2009 the US Food and Drug Administration (USFDA) Division of Pharmaceutical Analysis tested 19 varieties of electronic cigarette cartridges produced by two vendors NJoy and Smoking Everywhere

Diethylene glycol
, a poisonous and hygroscopic liquid, was detected in one of the cartridges manufactured by Smoking Everywhere

Tobacco-specific nitrosamines (TSNAs),
known cancer-causing agents, were detected in all of the cartridges from one brand and two of the cartridges from the other brand.

Nicotine can also be traced in some claimed nicotine-free cartridge
Full transcript