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Dr. Bill's Commentaries

Quit smoking   (January 2, 2010)

Are you still smoking? If so, you'll probably continue despite the fact that people with diabetes who smoke are at higher risk of just about every complication of diabetes. Fear of diabetes complications is rarely enough to get a smoker to quit. As one author wrote:

"Nothing, short of death, will force a smoker to end their habit. Sorry, but there is no magic pill. Influencing and changing the way your brain reacts to nicotine can improve your chances of quitting smoking permanently. But you must first want to quit, and be willing to stick it out, even if you experience some discomfort. Remember, too, that smoking is more than just a nicotine addiction. As a smoker, you have created a life that tends to revolve around your next cigarette. To quit, you'll need to change and disrupt your routine, stop doing certain behaviors that tend to trigger a desire for a cigarette such as getting a drink at a bar, and perhaps most important, you must believe that you can actually quit smoking." (Fred H. Kelley)

If you do make the decision to quit, behavior changes will be needed, and will be difficult to implement. Many of the websites mentioned below have information to help the reader to set up a plan to quit.

Medications to help quit smoking are also available, but clearly they will not work unless coupled with behavior changes. They are best used as part of a combination program of intensive behavioral interventions plus medication.

Some products are over-the-counter, like Nicorette. (The manufacturer has a special part of the Nicorette website titled Committed Quitters that's worth a peek if you're thinking of quitting.)

Several prescription drugs are available to help with smoking cessation. One of the first non-nicotine drugs was Zyban (bupropion). When it is given in association with intensive behavioral support, it leads to a near doubling of the smoking cessation rate, achieving long term abstinence in about a fifth of smokers who use it to quit. By the way, there's an interesting story about Zyban, which has the same ingredient (bupropion) as an older antidepressant, Wellbutrin. When it was found that Wellbutrin helped some users quit smoking, the manufacturer "repackaged" Wellbutrin and marketed it as a smoking-cessation drug under a new name: Zyban.

Another prescription drug, Chantix (varenicline) is also available to help quit smoking. It's apparently somewhat more efficacious than Zyban. Chantix is currently heavily promoted, despite a black-box warning in the prescribing information that "Serious neuropsychiatric events, including, but not limited to depression, suicidal ideation, suicide attempt and completed suicide have been reported..." Chantix may also have effects on glucose control. The label is vague, indicating that insulin dosage adjustment may be necessary. It also mentions that side effects that have been reported include diabetes mellitus (Infrequent), and hypoglycemia. So if you have diabetes and are considering Chantix, be sure to check your blood glucose regularly while on it.

Additional reading material about smoking cessation can be found at the following websites:

Smokefree.gov
Tobacco Cessation - You Can Quit Smoking Now!
Develop a Plan of Action
Quit Smoking
Chantix, at quitsmoking.com
Zyban, at quitsmoking.com
Smoking: It's Never Too Late to Stop

P.S. -- if you are a smoker who didn't make any New Year's resolutions for 2010, do yourself a favor: resolve to quit smoking.

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Dr. Bill Quick began writing at HealthCentral's diabetes website in November, 2006. These essays are reproduced at D-is-for-Diabetes with the permission of HealthCentral.



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