“The more things change, the more they stay the same.”  J.A. Karr

I have a dear friend who was diagnosed with Type 1 diabetes as a child.  I have learned more from her about caring for patients with diabetes than from any other single source.  She is an expert at every aspect of being diabetic.  It’s not just about the food, in case you’re wondering.  It’s about taking care of your insulin pump and your toes.  It’s about protecting your sleep.  It’s about getting the right amount of exercise, and learning to ride the waves of blood sugar ups and downs due to a sinus infection.  It’s about accepting the fact that seeing the doctor for that sinus infection does not take the place of regularly scheduled appointments for diabetes care and medication refills.  It’s about helping friends and relatives to understand that accepting or declining to eat a special treat or a second helping has everything to do with health, and nothing to do with friendship.  And it’s about understanding that these examples are just the tip of the iceberg.  Having a chronic disease affects absolutely every aspect of your life.

In case you’re wondering, diabetes is not the only chronic condition that falls into this category.  All chronic conditions are better managed with careful, ongoing vigilance.  Which problems can be considered chronic?  Anything that isn’t expected to resolve any time soon.  Like high blood pressure, arthritis, asthma, colitis, and obesity.  And eczema, lupus, HIV, psoriasis, emphysema, anxiety, depression, celiac, and nut allergies.  There are a great many chronic conditions.

At this time of year, when the days get shorter and the weather gets cooler, my diabetic friend prepares to make a number of changes.  In the warm weather she takes her rambunctious dog for a long walk virtually every day, and often twice, morning and afternoon.  But by late fall, in anticipation of those long weeks when the weather is simply uncooperative, she switches to her treadmill.  The dog will have to be content to run free in a snowy yard surrounded by an invisible electronic fence, so my friend’s to-do list probably includes a fresh battery for her dog’s collar.

I myself look forward to walking at least 2 miles a day during the months that I arrive home from work in daylight.  I also enjoy yoga, but that is usually a cold-weather activity.  It’s not that I don’t enjoy yoga classes in the summer; it’s just that I crave the sunlight.  I always want to be outside if I have a choice.  So, along with gardening, walking is my main summer activity.  Yoga is my main winter activity.  Routines developed for the summer will not serve in the winter.

Another friend has a son with a different chronic condition.  His illness is in remission, but it takes a lot of medicine, and that medicine has to be taken on a very particular schedule.  Last year, when he went off to college for the first time, it took a fair amount of thinking to figure out how to structure his classes and activities so he wouldn’t miss his meds.  This year, with a new part-time commitment, he has had to make a few additional changes to keep things on track.  “It’s all about the pill counters,” he would tell you.  He worked it out before he left for school.

With every season, we must once again become conscious of the coming changes.  This is true not just for those of us with chronic conditions.  We all benefit greatly from rethinking how our eating and activity patterns will change, and then preparing.  With fall comes the ripening of produce with a higher carbohydrate content, such as squash, beets, and potatoes.  Before the age of refrigeration, these foods were harvested, stored and then expected to get us through the winter.  Eating foods with a higher carbohydrate content is sort of the default setting for winter.  It makes sense if you think about the cycle of the seasons.  Centuries ago, food was harder to come by in the winter.  Carbohydrate-rich foods helped us survive.  If we don’t want to eat that way, we have to make plans and compensate.

Recently, my sister was telling me about her neighbor with a vegan daughter who has just moved back home following many years abroad.  Her diet contains no animal products whatsoever, not even eggs or dairy, and consists mainly of produce, nuts, beans, and whole grains.  The daughter generously offered to take on the task of preparing all the family’s meals, but that is turning out to have some unintended consequences for the neighbor, who is highly sensitive to the amount of grain in this diet.  So now they are working on a better solution for both of them, trying to be conscious of what is actually being cooked, and figuring out substitutions where necessary.

Changes to our environment  always change the routines of how we care for ourselves.  Figure into this equation a chronic condition that affects every aspect of one’s life, and you begin to realize how thoroughly seasonal change affects us.  At this time of year many things are changing, and they all have a myriad of consequences.  Acknowledging those changes, and making plans to address them now, ahead of time, will noticeably improve your ability to take good care of yourself.

Change requires us continually to reassess, to ask ourselves how best to maintain our health.  Seasons pass one into the next, children move in and out, people become ill and then heal.  Change is the one constant.