Who doesn't sometimes need help navigating life with diabetes? That's why we offer Ask D'Mine, our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil addresses some concerns about how our medicine choices are sometimes just plain unaffordable, and he also sounds off on the big bad topic of smoking with diabetes.

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Katie, type 2 from Kansas, writes: I am on Victoza and my co-pay just went up to $97.00 a month. My Rx needs to be refilled, but I will have to wait three weeks before I have the funds to cover the co-pay. Do you think being without the medication for that long will hurt me much? Any suggestions to help me during this time, such as diet, etc., will be greatly appreciated.

Wil@Ask D'Mine answers: First, don't panic. Second, call your doc and see if he or she has a sample pen you could have to tide you over. The friendly folks at Novo are "heavy samplers," meaning they're generous with the free samples that they give out to docs.

On the Victoza website, there's also information about an instant savings card program you apparently don't have to pay more than $25 for the first 24 Victoza prescriptions... so that could be something to explore as an option, along with other Rx "discount coupons" that are scattered around online.Victoza Savings Card

If those options fail, eat very low-carb for the few weeks you're without the med. That will help keep your blood sugar in check. Be aware of the fact that your hunger will spike, and try to control the temptation to go crazy at the dinner table. And the lunch table. And the breakfast table.

Once you've re-stocked your medicine cabinet, my advice is that you DO NOT restart the Victoza at the full dose you were using. Re-start at the baby dose you used when you first began taking the medication, and then gradually move the dose back up over a number of days or weeks. You need to do this because you'll be off it just long enough for your body to "un-adjust." Going from zero to sixty (or from zero to 1.8 mg in this case) after several week's absence will cause you to throw up on your shoes.

Jacob, type 2 from New Jersey, writes: Yes, yes, yes, I know, I know. Smoking is bad for me, yada, yada, yada, blah, blah, blah. But life is too short not to have some fun. So don't give me the company line about how bad smoking is. Instead, tell me, if I'm going to smoke in moderation, what is the "healthiest" smoke? Oh, and my wife said I had to ask you if smoking is more dangerous for people with diabetes than it is for "normal" people.

Wil@Ask D'Mine answers: You're right that no smoking is "healthy," but actually some kinds of smoking are less healthy than other kinds... so... I guess by default that means some types of smoking are "healthier" than others.

Commercial cigarettes are the least healthy, followed by "natural" cigarettes, followed by pipes and cigars. And the jury is out on these new "electronic" cigarettes. Actually, I just got a question about those puppies, so we'll take about them in detail in the near future. For today we'll stick to smokes that require a flame to enjoy, rather than the ones that require a battery.

Commercial cigarettes are the "worst" in my book because they have a lot more additives and chemicals in them than the "all natural" varieties do. So if I were a cigarette smoker, I'd go that route. [Comment Flame Prevention Disclaimer: There's a line of people longer than the list of the 599 chemical additives to commercial cigarettes who disagree with the statement I just made.] Chill out, people. I'm talking about subtle shades of grey here. Jacob himself admitted smoking is "bad" for him. All I'm doing is helping him to choose the least bad, and that's good medicine.

Now, one of the arguments against "natural" cigarettes is that even though there are no added chemicals, pesticides and the like are still used in growing the tobacco plants, so if you want to be really organic and natural, you can always legally grow your own tobacco. Of course, let's not forget that tobacco, no matter how purely it's grown, still carries a bundle of health risks, ranging from high blood pressure to face-eating cancer.

Oh, sorry. You asked me not to give you the company line.Natural Cigs

Moving on. "Healthier" still than a natural cigarette would be to take up smoking a pipe or stogie for your fun. There are two reasons pipes and cigars are "healthier" than cigarettes. First, the products—like the natural cigs—tend to have fewer chemicals added to them; and second, most cigar and pipe smokers don't inhale the smoke into their lungs (you'd cough for three weeks if you did). Instead, pipes and cigars are "puffed," the smoke is drawn into your mouth, savored for its flavor and heat, then blown out again. The smoke is still a carcinogen, but the risks are heaps lower by keeping the carcinogen in your mouth rather than all the way the hell down in your lungs (never minding the fact that those delicate little alveoli in your lungs are easily clogged with soot).

I doubt that any one cigar is healthier than any other, and there's a dizzying array from which to choose. J•R in Selma, North Carolina, boasts that they have the world's largest walk-in humidor—and it's fully stocked with over 200 different brands of cigars. Bear in mind that most brands have many makes and models. Oh, and fun trivia, cigars range wildly in price from pennies each to over a thousand dollars a pop. The people who smoke the latter probably light them with hundred dollar bills—and the health impact of fumes from burning cash has never been properly evaluated, it's too expensive to study.

There are probably just as many options to choose from when it comes to filling a nice old briar pipe (of which there are exactly 35,462 to choose from on eBay this morning. I know because I checked).

As to your wife's question: Sorry, the answer is maybe so. People with diabetes, especially the type 2 variety such as yourself, are more likely than sugar normals to have heart attacks. And smoking has a vasoconstrictive effect, raising blood pressure, which, in medical theory, raises heart attack risk still further. Of course, from my more humanistic perspective, not being able to relax is really bad for the blood pressure and therefore also for your heart attack risk, so if a stogie helps your relax, it's really almost a prescription medicine, right?

But seriously, I don't think so. I don't think that smoking is any worse for us than it is for sugar normals. Still, we can't kid ourselves that any form of smoking is healthy. And when you smoke, you need to think about those around you, too, and be aware of the dangers of second-hand and third-hand smoke.

So is it better for your health not to smoke at all? Yes. Of course it is. But will smoking in moderation, especially something like a pipe or cigar, kill you? Probably not before something else gets you.

Life is a dangerous business.


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.