I have a 93' C3500 with the 6.5 Turbo Diesel with 97,000 miles that I bought used recently. When I first start it in the morning it misses pretty bad and smokes a lot but once its warmed up (about 10 mins of idling) it runs perfectly fine. If you turn it off and start it again while it is warm it starts perfect(even within a few hours of being turned off). I've been told by a lot of people that it is probably the injector pump or the injectors. Before I purchased the truck the previous owner put new injectors in it.