In patients with established diabetes, nicotine exposure may paradoxically increase the incidence of severe hypoglycemia in insulin-treated patients [86], possibly via reduced clearance of subcutaneous insulin and enhancement of insulin action [87]. In addition, the kinetics of pulmonary absorption of inhaled insulin increase substantially in the smoking versus the nonsmoking state [88]. In diabetes care, smoking cessation is crucial to facilitating glycemic control and limiting the development of complications