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Smoking a major risk for diabetes patients

Margarita Persico

LAWRENCE, Mass. — Angel Rivera’s life changed on Dec. 24, 2007, when he was rushed to the hospital. He had excruciating pain just below his stomach.

He was diagnosed with fatty pancreas disease and diabetes. His blood glucose was measured at 994; it was supposed to be less than 100.

Rivera was surprised. According to his medical record, the cause of the illness was alcoholism, but he said he had only drunk an alcoholic beverage once in his life and did not like it.

“Just a sip with my father, when I was 14,” he said.

Instead, he believes another vice was the culprit.

“I only smoked cigarettes,” said Rivera, 39, a 6-foot-2-inch Puerto Rican man who said he started smoking 18 years ago and has tried to quit numerous times.

If you smoke, some physicians say, it doesn’t matter if you have an otherwise healthy lifestyle — you’re still at risk for a host of medical problems. Recent research indicates that cigarette smoking can contribute to the development of diabetes. And because it raises blood sugar levels, cigarette smoking can also make it harder to control the disease once it develops, according to the American Diabetes Association.

“When one has diabetes, one shouldn’t smoke,” said Dr. Trinidad Tellez, associate director of community health promotion and disparities investigations at Greater Lawrence Family Health Center (GLFHC). “… Smoking puts individuals with diabetes at much higher risk — including raising the risk of dying of a heart attack or stroke by 11 times.”

Tellez also said that smoking increases blood glucose and cholesterol levels, as well as blood pressure — all of which are particularly dangerous for diabetics.

“Quitting smoking helps people with diabetes stay healthy and live longer [and] lowers a person’s risk for heart attack, stroke, nerve disease, kidney disease and oral disease,” Tellez said.

Rivera said that stress drove him to smoke even more. He worked the night shift and was an on-call employee for a janitorial cleaning service based in Lawrence, and had trouble making ends meet.

“It’s not easy … I smoked like crazy,” Rivera said.

Rivera isn’t alone. Managing stress is one of the most common reasons that people smoke, and smokers become more aware of stress when they first kick the habit, according to the National Cancer Institute.

According to a study conducted in Japan, smoking cigarettes increased the risk of type 2 diabetes among men and women between the ages of 40 and 79. The disease was even more prevalent among men, like Rivera, who have a family history of diabetes. The results of the study were published in the American Journal of Epidemiology.

Rivera said he regrets that he didn’t learn how detrimental smoking can be for diabetics until after he was diagnosed with his disease. He also said he wishes he had known the importance of his family health history in early detection and combating of diabetes.

Smoking is just one risk factor for developing diabetes. The American Diabetes Association, U.S. Centers for Disease Control and Prevention, Cleveland Clinic and Joslin Diabetes Center have identified many other risk factors, including being overweight or obese, having a family history of the disease and race. Diabetes is more common in blacks, Latinos, Native Americans, Asians, Arabs, Pacific Islanders and people of Indian descent than in their white counterparts.

Rivera had several strikes against him: He’s Latino, he smoked, he was overweight and diabetes runs in his family.

“All my family on my father’s side is diabetic except my grandfather and his wife,” Rivera said. His great-grandmother was also diabetic.

Rivera said his father, who lives in Puerto Rico, has been a diabetic for more than 30 years. He has developed complications such as diabetic neuropathy, a condition in which nerves become damaged as a result of high blood sugar levels.

The problem presented in Rivera’s father after he stepped on a nail, and his toe did not heal.

“They amputated a toe and he continued with the illness. They are going to amputate the foot,” Rivera said.

Angela Villaman-Curran, a registered nurse and patient educator at GLFHC, said that is one of the problems with neuropathy. Since patients may have no sensation in their extremities due to the nerve damage, if they get cut or something becomes embedded in their skin, they may not feel it.

“The object stays in there, and when they realize what has happened, there is a large ulcer and they end with amputations,” she said.

Now, like his father, Rivera is having problems with neuropathy. He’s already had surgery on one foot.

He had an early warning seven years ago, when he said his doctor told him to follow up with regular medical visits to check on his blood sugar reading. At the time, his sugar was measured at 300, more than three times the desired level. But, Rivera admits, he did nothing to treat himself until his hospitalization in 2007.

There are many negative consequences of not actively treating diabetes.

“The awful things [are] … kidney failure, or eye disease, heart attack, strokes, amputations,” said Dr. Elisha H. Atkins, an internist at Massachusetts General Hospital’s Chelsea HealthCare Center.

Some complications can be fatal, according to Tellez of the Greater Lawrence Family Health Center.

“Most people die of heart disease, and having diabetes triples your risk of heart [disease],” he said.

Rivera said his diet was not helping, either.

“I used to have my dinner with three cans of soda, diet or regular. Now I don’t like it,” said Rivera, who said he never liked other types of sweets, but ate fast food regularly due to his work schedule.

Now he worries about his 17-year-old son.

“When my son was young, he did not care much for sweets,” Rivera said. “Now he wants to eat at Dunkin’ Donuts, and I tell him no.” Rivera said he allows his son to eat at the fast-food restaurant only once a week.

“It’s not easy,” he said.

Today, with the help of insulin, Rivera’s diabetes is under control. Since becoming a regular patient of nurse educator Villaman-Curran, he said he’s learned a lot about managing his disease. When he was first diagnosed, he did not know how to use a syringe. Now, when necessary, he is able to inject himself with the insulin formula Levemir.

“Since we do not learn about diabetes in school, at least people like [Villaman-Curran] and the other doctor … orient me,” said Rivera.

Rivera said he made too many mistakes in the past when it came to dealing with his health, but now he’s ready to try to do things right and be a good role model for his son.

He said he never misses education programs and medical appointments, and now believes preventive behavior is key — since that fateful December 2007 hospital visit, he has not touched a single cigarette.

“Observe and look at what you eat,” he recommended. “For those who have and don’t have [diabetes], take care of yourself and go for checkups every six months. Be informed.”