Smoking, Alcohol and Your Risk

Two things belong in a prediabetes conversation that usually get left to other appointments.

Smoking is a recognised risk factor for insulin resistance and prediabetes. This surprises most people, who associate smoking with lungs and heart rather than blood sugar. It contributes to insulin resistance directly, and it multiplies the cardiovascular risk that prediabetes is already raising.

Of everything discussed in this whole category, stopping smoking is the single largest health return available. If you smoke, it outranks every dietary adjustment on this site.

This includes bidis, hookah and chewing tobacco, all of which get treated as different from cigarettes and are not exempt.

Alcohol is more nuanced. It contributes calories, often substantially and without registering as food, and drinks are frequently mixed with sweet mixers that add a further glucose load. Heavy drinking also affects the liver, which matters given how often fatty liver accompanies insulin resistance.

There is no need for a rule beyond moderation and honesty about quantity. What is worth knowing is that alcohol can cause low blood sugar, especially on an empty stomach — relevant later if you ever end up on glucose-lowering medication.

Neither of these is the main mechanism of prediabetes. Both are worth acting on while you are already making changes.