Tobacco Use and Blood Sugar

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Hello everyone. My name is Jennifer Youngblood and I am the tobacco cessation educator with the health and preventive services team at Optima Health. Every November, we participate in the Great American Smokeout event held by the American Cancer Society. This year, although very different from any other, we wanted to create a great presentation for this event. Since most of you, if not all, participate in a yearly wellness event, I'm sure you've all heard the term biometric screening.

Because a lot of you inquire each year about how to improve your biometric screening values, we decided to incorporate one big influence of these values: tobacco use. Did you know that tobacco use affects your weight, your cholesterol and blood pressure as well as blood glucose and A1c? Yes, it does, right? So I have created one big presentation and divided into 3 smaller ones for your viewing convenience. In this specific presentation, I will discuss the effects of tobacco use on blood glucose and A1c.

So, our agenda for this presentation: we're going to talk a little bit about workplace wellness programs and then more specifically biometric screenings. And then this Bottom bullet point here - how tobacco use effects our blood glucose and A1c. So, looking at workplace wellness programs first. Workplace wellness programs have become increasingly popular as employers have aimed to lower health care costs and improve employee health and productivity. In 2018, 82% of large firms and 53% of small employers in the United States offered some type of wellness program. This growth has been aided by public investment such as the affordable care act, which included funds to promote the development of workplace wellness programs. Workplace, wellness programs tend to focus on modifiable risk factors of disease such as nutrition, physical activity and smoking cessation. Workplace wellness programs include a coordinated set of activities that support employees in making changes to help behaviors that may reduce their risk for certain chronic conditions and enable employees with existing diagnosis to manage them more effectively. Comprehensive multi-component programs typically include health assessments and biometric screenings to quantify risk factors, education and coaching for lifestyle behavior modification which includes tobacco cessation, Physical activity promotion, stress reduction and weight management and, in some cases, employers offer chronic disease management.

So, we talked about the components of a workplace wellness program. We're going to zero in here on the biometric screening. That's the main focus of our presentation and its how tobacco use affects those biometric values. So here we are with biometric screening. A biometric screening is a clinical screening that’s done to measure certain physical characteristics. It can be used to assess your height, weight, your BMI (or body mass index), blood pressure, cholesterol and blood sugar. The goal of a biometric screening is to give a snapshot of your health and alert you to any changes in your health status. The screening may be offered by your employer, your union, a public health organization, or nonprofit group. It may also include wellness counseling and education, risk assessments and exercise programs. Biometric screenings are not a substitute for a regular physical exam by your healthcare provider because it doesn't diagnose disease, but it may indicate possible risk factors for disease.

Let's take a closer look again. A biometric screening aims to alert you to any possible health risk. It also provides an easy way to keep track of your changes in those vital statistics from year to year. The screening process is quick and it usually takes place at your workplace. Your test results are often available right away and can alert you to potential health conditions such as diabetes, high blood pressure and heart disease. Employers use biometric screenings to get a sense of employee health risks. Sometimes employers offer incentives to encourage employees to participate in those screenings. During a biometric screening your vital statistics are measured and blood work is done as a part of the screening. Also a biometric screening is typically used to measure and assess your height, weight, your waist measurement, your body mass index (or BMI), Which is an estimate of your body fat based on your height to wait ratio, blood pressure and pulse measurement, Fasting blood glucose, hemoglobin A1c levels, blood cholesterol levels and triglycerides. Some screening programs may also include a measure of your aerobic fitness or ask about your tobacco use and even exercise habits.

So, now we've talked about workplace wellness programs and biometric screenings being a component of those. And now for the nuts and bolts of our presentation - how tobacco use directly affects our blood glucose and our hemoglobin A1c. Everyone knows tobacco use is bad for you. But did you know it can lead to type 2 diabetes and if you have diabetes, tobacco use can make it much worse? Let's talk about how they're connected and why quitting is one of the best things you can do for your health. Insulin helps blood sugar in our cells but nicotine changes cells so they don't respond to the insulin which increases blood sugar levels. Chemicals in tobacco harm cells in your body and cause inflammation. This also makes cell stop responding to the insulin. People who use tobacco have a higher risk of belly fat which increases the risk for type 2 diabetes even if they aren’t overweight. All in all, if you use tobacco, you're 30 - 40% more likely to get diabetes type 2 than people who don't use tobacco. The more you use tobacco, the higher your risk.

What is type 2 diabetes exactly? Type 2 diabetes is a chronic condition that affects the way your body metabolizes your blood sugar (or your glucose and important source of fuel for your body). With type 2 diabetes, your body either resists the effects of insulin, which is a hormone that regulates the movement of the blood sugar and your cells, or doesn't produce enough insulin to maintain normal glucose levels. Type 2 diabetes used to be known as adult onset diabetes. But today, more children are being diagnosed with the disorder; probably due to the rise in childhood obesity. There's no cure for type 2 diabetes, but losing weight, eating well, quitting tobacco and exercising can help manage the disease. If diet and exercise aren't enough to manage your blood sugar well, you may also need diabetes medications or some type of insulin therapy. Managing diabetes as challenging and smoking or tobacco use can make it even more so. Nicotine increases your blood sugar levels and makes them harder to handle. People with diabetes who used tobacco often need larger doses of insulin to keep their blood sugar close to their target levels. Diabetes causes serious health complications such as heart disease, kidney failure, blindness and nerve damage that can lead to amputation, which is the removal by surgery of body parts like a toe, foot or leg. If you have diabetes and use tobacco, you're more likely to have complications and worse complications than people who have diabetes and don't use tobacco. Heart disease deserves special attention. It's the leading cause of death in the United States and both tobacco use and diabetes increase your risk. Overtime, high blood sugar from diabetes can damage blood vessels as well as nerves in and around your heart. Tobacco use can damage blood vessels too by increasing plaque which we've already talked about.

So, we talked a little bit about type 2 diabetes and how tobacco use effects are blood sugar numbers. I thought it would be good to discuss our A1c number. We talk about our blood sugar levels and then there's a term: the hemoglobin A1c. If your physician is curious about what your blood sugar has been up to, he may order a simple test called hemoglobin A1c. You will get this test to find out what your average blood sugar has been over a 3-month period. This is important to know if you're at risk for pre-diabetes or type 2 diabetes or if you're managing an already diagnosed diabetes. The A1c test 9is a simple blood test that measures your average blood sugar levels over the past 3 months. So when sugar enters your bloodstream, it attaches to hemoglobin (a protein in your red blood cells). Everybody has some sugar attached to their blood cells, or their hemoglobin, but people with higher blood sugar levels have more. The A1c test measures the percentage of your red blood cells that have sugar-coated hemoglobin. So, and then in the chart here, if you look on the left side, It'll give you blood sugar numbers and then it also gives you blood sugar numbers on the right, and then in the middle is your A1c number. So, if someone were to tell you, if your physician were to tell you, you're A1c number is a 5, you can see in the 2nd green box down from the top, that would mean that your blood sugar range is 97 to 123 and that's the average that your blood sugar has ranged over that 3-month period. So the number on the left is the low end of your blood sugar and the number on the right is the higher number. The number in the middle is the A1c range both very, very important numbers to know and be familiar with.

So, in conclusion, as we talked about how tobacco use affects your blood glucose and hemoglobin A1c, we know that nicotine changes cells. So, they don't respond to insulin which is going to increase our blood sugar level. Chemicals in tobacco are going to harm cells in our body and cause inflammation Which also makes cell stop responding to the insulin. Tobacco users are 30 - 40% more likely to get type 2 diabetes. Nicotine increases your blood sugar levels and makes them harder to handle tobacco use. And diabetes can cause high blood sugar. I'm sorry, high blood pressure and can damage to blood vessels in and around your heart. Increased blood sugar equals increase hemoglobin A1c. And lastly, tobacco use increases our blood glucose and our hemoglobin A1c, respectively. November 19th, 2020, the Great American Smokeout takes place. Um, I Recovered this picture from their website and their advertisements for that event. And I found this quote, which is very, very fitting: “You don't have to stop in 1 day, start with day 1.” And make day one November 19th, 2020.

November 19th, you can start your journey toward a tobacco free life during the Great American Smokeout event. Quitting smoking is going to improve your help immediately, no matter what the age. Quitting is hard, but you can increase your chances of success with help and I've listed two resources here for help. Available to Sentara employees can contact WebMD telephonic coaching for 12-week program with a certified health coach trained in tobacco cessation methods. They do offer nicotine replacement therapy and advice on proper usage. And always available on the Optima Health website at, you can view the self-paced program called “Get Off Your Butt: Stay Smokeless for Life” and other valuable resources on the web page. Thank you all for listening to the presentation today and have a good day. Thank you.