Smoking in diabetes

• Help stopping
• smoking triples damage
• see the effect on your eyes
• your partner and passive smoking
• how to stop, with your mouse
• how to stop
• links & leaflets
• Varenicline (Champix) &
  Zyban (bupropion)
• lozenges & other nicotine replacment therapy
• nicotine addiction, dependance, motivation
• order resources smokefree.nhs.uk

Smoking ...do you need help stopping

• smokefree.nhs.uk find local service
• Milton Keynes
  
  
• North Birmingham PCT offers patients help stopping:

Mrs Pauline Beale
Stop Smoking Service Co-Ordinator
Kings North House, No 1 Blenheim Way, Kingstanding
Birmingham  B44 8LS

Helpline: 0800 052 5855
Fax Number: 0121 465 5418
Public Email: stopsmokingservice@benpct.nhs.uk
Website: www.benpct.nhs.uk

Smoking doubles-quadruples damage

Smoking doubles the damage to the body caused by diabetes by causing hardening of the arteries. This particularly affects the body's larger arteries to the legs and brain, making amputation and strokes more likely. Smoking doubles the risk of diabetes (BMJ).

Researchers (EASDec 2002) have discovered smoking triples-quadruples the retinopathy progression rate of diabetic complications (the graph below underestimates this risk).

each cigarette increases retinopathy progression rate 15-20% enlarge & press F11

The harmful effect does not depend on whether you smoke cigarettes, a pipe, or cigars, but is more dependent on the amount you smoke.
Smoking 5 cigarettes a day is much safer than 20 a day, so cutting down (if you are unable to stop) is still very helpful. Visit three excellent websites (below).
The diagram above illustrated the harmful effects, but is very diagramatic.
If 20 cigarettes a day triples retinopathy progression (increases it to 300%), that is equivalent to 300/20 = 15% for each cigarette smoked.

Your partner and passive smoking

Your partner develops a quarter of the harmful effects you experience. If you smoke 20/day, this is equivalent to your partner smoking 5/day.

5 cigarettes a day equivalent increases your partners disease rate by 12-25% or more (cataracts, heart disease, strokes) etc. The exact figures are not known.

10000 people a year die in the UK from passive smoking, many in the hospitality industry, see .

How to stop..follow the path with your mouse...

How to stop

Useful links

There are fantastic resources on the internet to help you stop!

Don't become addicted to surfing the net!
But, if you do, use a peddle powered computer so you can keep fit at the same time...............................

Leaflets & phone numbers

Phone quitline.....tel 0800 002200

Health Education Authority, Trevlyan House
30 Great Peter Street,
London SW1P  2HW.

Medications to help you stop

• Varenicline (Champix)      dose
• Zyban (bupropion)
• Nicontine replacement therapy

Nicotine replacment therapy including lozenges

See here for details about new lozenges that you can suck instead of smoking a cigarette. They contain nicotine, and are rumoured to be very helpful in helping you to stop smoking. They are available from any chemist.

For professionals, see this excellent article about nicotine replacment therapy.

Nicotine Addiction, assessing dependance & motivation to stop

This is reviewed here, and in an excellent article for professionals here in the BMJ. Simple advice as to how to stop. Essentially the degree of addiction can be judged by the

• number of cigareetes smoked/day
• the time to light the first cigarette first thing in the morning

Suggested phrasing in consultations (Coleman)

• "The best thing you can do for your health is to stop smoking, and I would advise you to stop as soon as possible."
  
• "Tobacco is very addictive, so it can be very difficult to give up, and many people have to try several times before they succeed. Your chances of succeeding are much greater if you make use of counselling support, which I can arrange for you, and either nicotine replacement therapy or the antismoking drug Zyban [bupropion], which I can prescribe for you if you wish."
  
• "If you are ready to try to give up smoking now, then the best thing is to see a counsellor as soon as possible, and I can arrange that for you. If not, then I'd like you to take home this leaflet and read it, or ring the NHS smokers' helpline, to get further information."
  
• "The best thing is to get counselling from experts, but if this isn't possible, you should make sure that you have good information on the health effects of smoking and some tips on ways of stopping smoking and that you know where to turn for further help and support."
  
• "How do you feel about your smoking?"
  
• "How do you feel about tackling your smoking now?"

Strategies used in intensive behavioural support (Coleman)

• Review smoking history—number smoked per day, time of first cigarette in the day. Ask smoker to keep diary of activities that coincide with smoking
• Review smoking behaviour—past quit attempts, what helped, and reasons for failure
• Emphasise need for total abstinence
• Emphasise need to combat psychological and physical nicotine addiction, where appropriate
• Identify triggers to smoking and encourage smoker to develop strategies for countering these (for example, avoid places or activities associated with smoking)
• If relevant, encourage smoker to develop strategies for avoiding relapse when drinking alcohol
• Encourage appropriate action: set quit date, inform or enlist support of peer group or family, and prescribe nicotine addiction treatment
• Follow up to review progress and prescribe or issue nicotine addiction treatment

Changing behaviour...guiding, scaffolding

Guiding style is best BMJ:

Clinician

Your test result is high today ( informing ) and I wonder what sense you make of this (asking followed by listening )?

Patient

I don't know. I am not surprised because it's hard enough getting by day to day without worrying about this as well.

Clinician

Everyday life can't stop because you have diabetes (listening).

Patient

Yes, exactly, but I know I do need to be careful.

Clinician

In what way?

Patient

I need to watch my diet and get more exercise. I know that, but it's not so easy.

Clinician

What might be manageable for you right now?

Patient

It's got to be exercise, but please don't expect great things from me.

Clinician

Well, a change in diet or exercise will be a great help ( informing ). How might you succeed with more exercise (asking )?

Cessation interventions in routine health care (Coleman)

Use the 5 'A's approach flow chart BMJ

• Ask about smoking at every opportunity
• Assess smokers' interest in stopping
• Advise against smoking
• Assist smokers to stop
• Arrange follow up