How does smoking impact somebody with diabetes?

So an important aspect in the management of diabetic foot problems is around smoking. People who smoke and have diabetes have two reasons to cause artery diseases. So diabetes causes artery disease and smoking causes artery disease and people who have diabetes and smoke therefore have a very high, very much increased risk of artery blockages. And what we have found is that if we are able to improve the circulation to someone's foot, improve the artery flow in someone's foot who has diabetes and a foot ulcer, if someone continues to smoke, then there's a very much increased risk that those arteries will become blocked off very soon afterwards. It's not uncommon that someone is subjected to a five, six hour operation to do a bypass graft to take blood down to the foot. But if that person continues to smoke, that bypass graft can get blocked off again within weeks of it being done, and makes a fairly high risk and long operation essentially a waste of time. And the same applies to if someone has an angiogram, an angioplasty, a balloon put down the artery from the groin to improve the circulation. If someone continues to smoke, those arteries can block off again very quickly in weeks. So it's very important for sake of trying to preserve a limb and to avoid an amputation to stop smoking if you develop a foot ulcer.