Feeling chilly when you’re outside in the cold is one thing, but if you’re always shivering when everyone else says they’re toasty, then it may indicate other underlying conditions. Margarita R. Rohr, MD, speaks with Health about possible reasons why you’re always cold, and how you may be able to remedy it.

Being underweight, a lack of sleep, and dehydration can all leave you chilly, but other possibilities, such as poor circulation, iron deficiency anemia, and hypothyroidism, are difficult to determine without the help of a doctor’s visit.

Diabetes may also be a cause, according to Dr. Rohr. When it’s not kept in check, diabetes can lead to nerve damage in the hands and feet—a symptom that develops gradually and may go undetected.

“When this develops, you experience numbness and sometimes pain in the hands and feet, and since these nerves are also responsible for sending messages to the brain regarding temperature sensation, your hands and feet may feel cold,” Dr. Rohr says. “Other causes may include cardiovascular disease, which causes your heart to not pump as effectively, or smoking, which constricts blood vessels.”

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