Habits to Rethink

Chapter 43 · Vihang Rahul Vasa

• Smoking and tobacco in any form: quitting is the best choice: avoid it as much as possible. Tobacco smoke increases inflammation and oxidative stress in the body, which worsens insulin resistance and makes plasma glucose (blood sugar) harder to control. It also damages blood vessels, significantly increasing the risk of complications such as heart disease, stroke, kidney damage, and nerve problems in people with diabetes. Smoking can contribute to liver inflammation and fibrosis, see MASLD (Metabolic dysfunction–associated steatotic liver disease, liver fat linked to metabolic problems like obesity, diabetes, cholesterol or insulin resistance), Chapters 5 to 9, which may further impair glucose metabolism. If quitting is difficult, ask your doctor about evidence-based smoking cessation treatments, including nicotine replacement therapy (such as patches or gums) where appropriate, as a step toward complete cessation.

• Alcohol: Alcohol has a variable effect on plasma glucose (blood sugar) and does not behave like simple sugar. When consumed, the liver gives priority to processing alcohol, which may reduce its ability to release glucose into the bloodstream and can increase the risk of low plasma glucose (blood sugar), hypoglycaemia, particularly if taken on an empty stomach or along with certain diabetes medications. At the same time, some alcoholic beverages contain carbohydrates that may temporarily raise plasma glucose (blood sugar) levels. Because of these mixed effects, plasma glucose (blood sugar) responses can be unpredictable. If you drink alcohol, discuss the risks with your doctor, especially if you take a medicine that can cause a low; your doctor’s advice for you comes first. And be careful with what alcohol is mixed with: cocktails made with soft drinks, juices, or energy drinks add a heavy dose of sugar: the mixer pushes plasma glucose (blood sugar) up while the alcohol pushes it down later, a double trouble that is hard to predict. Many mocktails are just as sugar-loaded. If you drink at all, never on an empty stomach, keep it simple, and check your plasma glucose (blood sugar), and be honest with your doctor about your habits, so the advice you get is for the life you actually live.

• Soft Drinks, Juices, and Energy Drinks: Here is my own view, from experience, of what each kind does to a person living with diabetes and MASLD (Metabolic dysfunction–associated steatotic liver disease: liver fat linked to metabolic problems like obesity, diabetes, cholesterol or insulin resistance).

Sugary soft drinks and colas: a large dose of sugar with nothing to slow it: a fast plasma glucose (blood sugar) spike, and the fructose in them goes straight to the liver as fat.

Fruit juices, even “100% natural”: the fibre is gone and the sugar remains; a glass of juice hits the blood almost like a cola, and the fructose burdens the liver the same way.

Carbonated sodas: sugar plus acid; the acid wears the teeth, and in my experience the fizz worsens acid reflux, bloating, and stomach discomfort.

Zero-calorie and “diet” drinks: no sugar, but they keep the taste for sweetness alive, and the long-term effect of sweeteners on the body is still debated. Discuss them with your doctor; do not treat them as a free pass.

Energy drinks, the one I would worry about most, very high sugar plus a heavy dose of caffeine and other stimulants: a sharp glucose spike together with a raised heart rate and blood pressure. I avoid them entirely, and I would advise anyone with diabetes, cardio-metabolic disease, and a strained liver to ask their doctor before touching one.

Flavoured and sweetened milk, packaged lassi and milkshakes, malt “health” drinks: sold as nourishment, but most carry as much sugar as a cola. Plain milk or plain curd is the honest version.

Café drinks, tea or coffee with syrups, cream, or sweet toppings, this is a dessert, not a drink. The sugar in one cup can be more than in a cola. Plain tea or plain coffee, without sugar, is the drink; everything added to it is sugar.

Sports drinks: they contain sugar and salts. They are made for athletes who sweat for hours and need both replaced quickly. For a person living with diabetes, the sugar goes into the blood fast and pushes plasma glucose (blood sugar) up, exactly like a soft drink, and the salts do nothing useful for a morning walk. In my experience, water is enough for ordinary exercise; ask your doctor before using any sports drink.

Protein shakes and supplement drinks, a subject of their own (see Chapter 46, the gym chapter), and speak to your doctor before starting any.

Water, and unsweetened tea or coffee, have no sugar in them: they do not raise your plasma glucose (blood sugar).

• Fast, Fatty & Junk Food: Limit intake of ghee, butter, excess oil, fried items, and processed fast foods. These foods are typically high in unhealthy fats (especially trans and saturated fats) and refined carbohydrates, which can worsen insulin resistance and make plasma glucose (blood sugar) harder to control. They also promote chronic inflammation, a key driver of diabetes-related complications. Regular consumption can lead to fat accumulation in the liver (fatty liver), which over time may progress to liver inflammation and fibrosis, further impairing glucose metabolism. In addition, junk food often lacks fibre and essential nutrients, leading to rapid plasma glucose (blood sugar) spikes and poor overall metabolic health. These foods also raise blood lipids, cholesterol and triglycerides, increasing the risk of cardio-metabolic disease.

(References for this chapter, fruit juice and sugar-sweetened drinks and the risk of Type 2 Diabetes, and the American Diabetes Association Standards of Care on tobacco, are listed in Appendix A and B.)

Illustration: Chapter 43 illustrated summary. Habits worth rethinking include tobacco, alcohol, sugary drinks and mixers, and frequent fried or processed foods.

Chapter 43 Habits worth rethinking include tobacco, alcohol, sugary drinks and mixers, and frequent fried or processed foods. Water and unsweetened tea or coffee are illustrated alternatives. Seek quitting support and doctor-guided choices; alcohol can make plasma glucose unpredictable.

Chapter at a glance: an AI-generated illustration to be read with the chapter, not instead of it. The people shown are not real.