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This difference is also seen between smokers and ex-smokers, though the clinical significance of these findings is still unclear.11 Biochemical insulin-nicotine interactions and metabolism in diabetic patients It has long been hypothesized that smoking decreases insulin sensitivity, and that this effect may be mediated by nicotine through the stimulation of insulin-antagonizing substances such as cortisol, catecholamines, and growth hormone.12 Other mechanisms that may influence the development of diabetes as side effects of nicotine have been reported, including the inhibition of gastric motility and its influence upon the differentiated emptying of solids and liquids,13,14 faster glucose absorption,15 and increased erythrocyte permeability to glucose.16 However, Wareham et al
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