A this time of year, many people start wondering why they were doing such a great job staying active a few months ago, but haven’t been doing much of anything recently. If this describes you, then this post is yours.

To prepare for this time of year, when the days are short and the weather is cold, a close friend of mine, diagnosed with type 1 diabetes as a child, makes a number of changes. Exercise is important for everyone, but it’s an essential daily variable in my friend’s blood sugar control. While she takes her rambunctious golden retriever for long walks every day, and often twice, in warm weather, she switches to a treadmill in late autumn when the weather becomes uncooperative. All winter, her dog runs free in a snowy yard surrounded by an invisible fence, so my friend’s prep list may also include a fresh battery for her dog’s collar.

This friend of mine has taught me more about caring for patients with diabetes than absolutely anyone else. She is an expert at every aspect of being diabetic, and it’s not just about the food and exercise. It’s about insulin pumps, toes, protected sleep, and knowing how to ride the blood sugar ups-and-downs caused by a sinus infection. It’s about knowing that seeing the doctor for that sinus infection does not take the place of appointments for routine diabetes care and medication refills. It’s about helping friends and relatives understand that declining a slice of cake has everything to do with good health, and nothing to do with love and friendship. And it’s about understanding that these examples are just the tip of the iceberg.

Having a chronic illness affects absolutely every aspect of your life. Of course diabetes is not the only chronic condition. All chronic conditions, and there are many, require vigilance. High blood pressure, arthritis, asthma, colitis, eczema, lupus, HIV, psoriasis, emphysema, anxiety, depression, celiac, nut allergies, to name a few. There are a great many chronic conditions.

I have another friend whose son has a chronic illness. Luckily it’s in remission, but he still takes a lot of medicine, and that medicine has to be taken on a very particular schedule. When he left for college for the first time, it took a lot of planning to figure out how to structure his classes and activities so he wouldn’t miss his meds. The next year, with the addition of a new project, he had to make a few more changes to keep things on track. “It’s all about the pill counters,” he said, and he had it all worked it out before he left for school.

With each and every change in the seasons, we must once again prepare, and this is true not just for those of us with chronic conditions, but for everyone. We all benefit from thinking in advance about how our eating and activity patterns will change. I think about the different kinds of food we eat in the fall, with the ripening of vegetables with a higher carbohydrate content, like squash, beets, and potatoes. Before the age of refrigeration and global transport, these were the foods that got 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.

My sister once told me about a neighbor of hers whose daughter who had just moved back home after years away. The vegan daughter’s diet consisted of fruits, vegetables, nuts, seeds, beans, and whole grains. The daughter generously offered to take on the task of preparing all the family meals, but that had some unintended consequences for her mom, who was unable to tolerate the amount of grain her daughter eats. So they sat down together to plan a set of menus that would meet their needs better.

My own plan, exercise-wise, is to walk at least two miles a day, but only in the months that I arrive home from work in daylight. I usually add a little bit of yoga every morning, too, but I leave the hour-long classes for wintertime. It’s not that I don’t like taking yoga in the summer, it’s just that I crave the sunlight; I want to be outside if I have a chance. So walking is my main summer activity, and yoga is my main winter activity. Routines developed for summertime will not serve in winter.

Change continually requires us to reassess, and changes to our environments always affect routines. Figure into this equation a chronic condition that affects every aspect of your life, and you begin to realize how thoroughly we are all affected by the seasons. As the seasons pass, many things change, and each change has a myriad of consequences. Acknowledging how those changes affect your health, and preparing ahead, improves your ability to take better care of yourself.

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