Cardiovascular disease, also known as heart disease, is the single greatest cause of death among Americans, and people with diabetes are two to four times more likely to die from it.

There are a number of things you can do to help reduce your chances of developing heart disease if you’re living with diabetes. The first step is to sit down with your doctor and talk about how to best manage the condition in a way that will decrease your risk. Use the following list of questions at your next medical appointment as a tool to help get the conversation started.

Your doctor knows better than anyone which specific risk factors your diabetes might be affecting. The main risk factors for heart disease linked to diabetes are high blood pressure, high cholesterol, imbalanced blood sugar levels, obesity, and living a sedentary lifestyle.

Once you and your doctor identify your main risk factors for heart disease, you can work together to create an action plan that will help minimize these risks and keep your heart healthy.

If you’re not currently monitoring your blood sugar and blood pressure at home, it’s a good idea to talk to your doctor about whether you should start. Home monitors for both blood sugar and blood pressure are widely available in pharmacies and online. It’s also possible that your health insurance provider may help cover some of the cost.

Talk to your doctor about which devices might work best for you, and establish a self-check schedule to ensure that you’re collecting information in the most effective way possible. Once you start checking yourself at home, keep a daily journal of your levels and bring it in to your next appointment so that you and your doctor can review it together.

One of the most crucial changes that people with diabetes can make to reduce their risk of heart disease is to modify their diet. If your diet is high in sodium, trans fat, saturated fat, or sugar, you’re significantly increasing your chances of developing heart disease. Even if you haven’t been eating as well as you should be, talk to your doctor honestly about your current diet and discuss how you can craft a meal plan that will help make you less susceptible to heart disease.

Staying physically active is another important step you can take to lower your chances of developing heart disease. Exercising helps to lower your blood pressure and normalize your blood sugar levels, decreasing your chances of having a heart attack or stroke.

Ask your doctor what types of physical activity might be best suited to your personal needs, and work together to develop a fitness routine that will encourage you to get off the couch and get moving. Aim to get at least two-and-a-half hours of moderate-intensity aerobic exercise every week. This could be anything from going for a brisk walk to working in your garden.

It’s also a good idea to check with your doctor if there are any exercises that you should avoid due to any existing medical conditions or mobility restrictions you may have.

High levels of stress can increase your risk of developing heart disease. If you’re prone to stress or anxiety, ask your doctor to suggest some stress-reduction techniques you can use when you’re feeling tense. There are a number of easy breathing exercises you can practice to help reduce stress. Your doctor may also recommend more advanced strategies like meditation or progressive muscle relaxation.

By taking a few minutes every day to de-stress and relax, you’ll not only help protect yourself against heart disease, but you’ll also help foster a general sense of calmness and well-being.

If you’re not currently on medication for your diabetes, it’s worth talking to your doctor about whether there are any that might be right for you. For many people with type 2 diabetes, a healthy diet and regular exercise is the best option. But if you feel like you would benefit from introducing medication into your self-care routine, you should discuss it with your doctor. Even if you’re considering taking over-the-counter supplements or vitamins, you should always consult your doctor beforehand to make sure they won’t interfere with any other treatments you’re currently taking.

It’s a good idea to be aware of the symptoms related to heart disease so that you can take action immediately if you think you might be experiencing one or more of them. Ask your doctor which symptoms you should look out for, and what each of those symptoms mean in terms of your general health. A few common symptoms of heart disease include chest pain, pain in your left arm, pain in your jaw, excessive sweating, fatigue, and nausea.

Keep in mind that this discussion guide is only a reference point. You should feel comfortable asking your doctor anything about how your diabetes might be affecting your risk of heart disease. Remember that your doctor isn’t going to judge you. Even if you’re hesitant about discussing certain topics, being open and honest with your doctor will help them properly address your concerns.