Does Nicotine Raise Blood Sugar? Understanding the Link Between Smoking and Diabetes

Tobacco may be becoming less popular, but e-cigarette use (or “vaping”) is on the rise. There’s no getting around the facts: Smoking is harmful for your health. But for people with Type 1 or Type 2 diabetes, there are specific risks to be aware of — this includes effects on blood sugar levels and possible damage to the kidneys, liver, and blood vessels. 

Here’s how smoking and diabetes interact and how you can protect yourself from some serious complications.

Does smoking affect blood sugar and lead to diabetes?

Even if you don’t have diabetes, smoking can mess with your blood sugar levels and increase your risk of getting diabetes by 30% to 40%. In fact, a 2016 study found that compared to people who smoked, non-smokers generally had lower hemoglobin A1C levels (a measure of how much sugar is in your blood).

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How does this happen? First, toxic chemicals from tobacco promote inflammation in your body. The inflammation can damage your cells and make them malfunction. Over time, this can cause your cells to become resistant to insulin, leading to issues with blood sugar control and raising your risk for diabetes. Second, those same toxins can cause cells in your pancreas that make insulin (known as beta cells) to die off. Without insulin, your body can’t move sugar from your bloodstream into your cells to make energy, and your blood sugar can build up.

What’s the risk of smoking if you have diabetes? 

Diabetes raises your risk for complications like:

• Heart disease (like heart attack and stroke)

• High blood pressure

• Kidney disease

• Nerve damage

• Vision loss

• Foot pain and ulcers 

• Certain infections

If you have diabetes, smoking makes these issues even more likely. This is because smoking can cause further damage to blood vessels as well. 

The cardiovascular risks of smoking are especially important to highlight. People with diabetes who smoke have been found to have higher cholesterol levels and blood pressure than people with diabetes who don’t smoke. So smoking causes even more damage to the heart and blood vessels than diabetes and high blood sugar alone. This can lead to serious problems like heart attack, stroke, and an earlier death. As such, the American Diabetes Association (ADA) strongly urges any person with diabetes who smokes to do their best to quit.

If you have diabetes, you’re probably familiar with these possible complications already. The good news is that many studies show that quitting smoking, along with managing your blood sugar levels, can greatly lower your risk of experiencing any of these. In one study, for example, people who had diabetes and early signs of kidney disease who stopped smoking saw improvements in kidney function, blood sugar control, blood pressure, blood fat levels, and insulin resistance. These findings translated to fewer cases of blood vessel disease and nerve disease.

Is it bad to vape if you have diabetes?

Many people have switched from cigarettes to vaping or e-cigarettes thinking that they’re less harmful. Some think that may even help them quit smoking altogether. But, research does not show that switching to vaping helps people quit. Vaping even without nicotine may also cause significant damage to your body. This can be caused by multiple factors, including materials used in the vaping products themselves which are not well understood at this time.

Can vaping raise your blood sugar levels?

It is well accepted that nicotine raises blood sugar levels — whether it is inhaled from traditional cigarettes or e–cigarettes. But given vaping and e–cigarettes are relatively new, there is less research on its effect on blood sugar and diabetes risk. But one recent study found that people who use vaping products had a 22% greater risk of developing prediabetes. This is almost as high as the risk of developing diabetes from regular cigarettes.

What are the benefits of quitting smoking with diabetes?

Some people who smoke and have diabetes are worried that quitting smoking will lead to high hemoglobin A1C (A1C) levels, a sign that their blood sugar levels have gone up. A review of four separate research studies shows that quitting smoking tends to improve blood sugar control and lower A1C levels in the long run. 

That same review did note that there may be a temporary rise in A1C following quitting, lasting 1 to 3 years depending on how heavily you used to smoke. After 10 years, though, people who quit had the same A1C levels as people who had never smoked, meaning that A1C levels had lowered over those years.

How can I quit smoking?

Quitting smoking can take many attempts and a lot of self-motivation. That is why it’s important to work with experienced counselors and healthcare providers and to keep trying. What works will also depend on your own individual situation. But some ways that have been shown to work include: 

• Going “cold turkey” and quitting all at once

• Smoking less and less over time by setting a limit to how many cigarettes you smoke per day and per week

• Using nicotine replacement products like nicotine gum, lozenges, or patches to help replace the urge to smoke, which may be helpful if you smoke a lot every day and experience symptoms of withdrawal (such as headaches, anxiety, restlessness, irritability, and cravings) when you try to quit

• Using mobile apps that give you tips, inspiration, and tools to help you practice smoking cessation habits each day

• Asking your provider about whether a smoking cessation drug might be good for you

• Finding a counselor or looking for support groups that focus on helping people who want to quit smoking

• Participating in a smoking cessation program

For more resources and help, visit smokefree.gov. They list specific resources — from healthcare providers to apps — that are tailored to people of different ages, genders, and backgrounds. If you have diabetes and are trying to quit, your provider may have other helpful suggestions to help you try to quit.

Why trust our experts?

Written by:

Timothy Aungst, PharmD

Timothy Aungst, PharmD, has worked in pharmacy practice for the past decade with different roles and responsibilities. He has served as an associate professor of pharmacy practice for almost a decade, a clinical pharmacist in outpatient cardiology management, and now in home healthcare.

Reviewed by:

Sarah Gupta, MD

Sarah Gupta, MD, is a licensed physician with a special interest in mental health, sex and gender, eating disorders, and the human microbiome. She is currently board certified by the American Board of Psychiatry and Neurology.

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