Emma Drake is the first to admit it — she's addicted to something deadly.

Her day typically begins at 9 a.m., when she wakes up, makes her way to the living room and lights a cigarette. "There's nothing better than having my morning cup of hot tea with a cigarette, and I hate to say this because I know smoking is bad for me," Drake said. She'll smoke two packs by day's end.

This past April, Drake was diagnosed with type 2 diabetes. "I knew something was not right, because I had to go to the bathroom a lot and I was always thirsty."

Drake's doctor advised her to begin making lifestyle changes, including giving up the cigarettes.

"Most people don't understand that having diabetes means they are two to four times more likely to suffer a heart attack or stroke. Add in smoking, and that risk is multiplied," said Richard Nesto, M.D., chairman of the Department of Cardiovascular Medicine at Lahey Clinic Medical Center in Burlington, Mass., and associate professor of medicine at Harvard Medical School.

"The earlier you can quit smoking once you've been diagnosed with diabetes, the better your chances are of preventing coronary artery disease and other deadly complications," said Nesto, a spokesperson for the American Heart Association. "We work with patients on a behavioral goal plan. We start with small steps, such as deciding how many cigarettes to cut back on each day, or alternatives to smoking, such as physical activity."

Five months have passed, and despite visits to her doctor and classes with diabetes educators, Drake still hasn't cut back on the cigarettes. Unfortunately, she's not alone in her struggle. About 22 percent of adults with diabetes smoke. Recent studies show cigarette smoking is the leading avoidable cause of death in the United States, accounting for more than 440,000 deaths each year. It's also the most important modifiable cause of premature death; 33.5 percent of these deaths are cardiovascular-related.

When you smoke, you:

• Decrease HDL (good) cholesterol in your blood, raising your risk of a heart attack.
• May trigger a blood clot to form. A clot may either further narrow the blood vessel or completely block it. This damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections.
• Increase the risk for developing insulin resistance, a condition in which the body doesn't efficiently use the insulin it produces. Insulin resistance predisposes a person to both diabetes and cardiovascular disease.

If you have diabetes, smoking is even worse because you're:

• More likely to get nerve damage and kidney disease.
• Three times more likely than nonsmokers are to die of cardiovascular disease.
• More likely to raise your blood sugar level, making it harder to control your diabetes.

How to quit
You know smoking is bad for you — and you've probably read everything under the sun about quitting smoking — but where do you start? Helen Dumski, R.D., L.D., and director of the Diabetes Association of Greater Cleveland, suggests taking on one bad habit at a time. "If someone is newly diagnosed, the most important thing is for them to identify what they want to change first. The first move has to come from the smoker."

"I want to quit so badly, because sooner or later I know it is going to be me or the cigarettes. I know it's time for me to make some changes," Drake said.

Tips to quit smoking

• Keep busy doing things that make it hard to smoke, like working in the yard, washing dishes and being more active.
• Fight the urge by going to places where smoking isn't allowed and staying around people who don't smoke.
• Avoid situations that tempt you to smoke, like drinking coffee or alcohol.
• Find a substitute to reach for instead of a cigarette. Try a hard candy.
• Don't give up if you smoke a cigarette. Just resolve not to do it again.
• Remind yourself that you're likely to feel better if you stop smoking.
• Tell family members and friends that you need to quit smoking and need their support. If your husband, wife, son or daughter smokes, ask them to quit with you.

This content is reviewed regularly. Last updated 08/15/08.