Give laboratory investigations for jaundice with findings and values in pdf format
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Running Command
mkdir -p /home/daytona/workspace/jaundice-pdf && ls /home/daytona/workspace/jaundice-pdf/
Writing File
~/jaundice-pdf/generate_pdf.py
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import inch, cm
from reportlab.platypus import (
SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
HRFlowable, KeepTogether
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
OUTPUT = "/home/daytona/workspace/jaundice-pdf/Jaundice_Laboratory_Investigations.pdf"
doc = SimpleDocTemplate(
OUTPUT,
pagesize=A4,
rightMargin=2*cm,
leftMargin=2*cm,
topMargin=2*cm,
bottomMargin=2*cm,
title="Laboratory Investigations for Jaundice",
author="Orris Medical Reference"
)
styles = getSampleStyleSheet()
# Custom styles
title_style = ParagraphStyle(
'CustomTitle',
parent=styles['Title'],
fontSize=22,
textColor=colors.HexColor('#1a3a5c'),
spaceAfter=6,
alignment=TA_CENTER,
fontName='Helvetica-Bold'
)
subtitle_style = ParagraphStyle(
'Subtitle',
parent=styles['Normal'],
fontSize=11,
textColor=colors.HexColor('#4a4a4a'),
spaceAfter=12,
alignment=TA_CENTER,
fontName='Helvetica'
)
h1_style = ParagraphStyle(
'H1',
parent=styles['Heading1'],
fontSize=14,
textColor=colors.white,
backColor=colors.HexColor('#1a3a5c'),
spaceBefore=14,
spaceAfter=6,
fontName='Helvetica-Bold',
leftIndent=-8,
rightIndent=-8,
leading=20,
borderPad=5
)
h2_style = ParagraphStyle(
'H2',
parent=styles['Heading2'],
fontSize=12,
textColor=colors.HexColor('#1a3a5c'),
spaceBefore=10,
spaceAfter=4,
fontName='Helvetica-Bold',
borderWidth=0,
borderPadding=0
)
body_style = ParagraphStyle(
'Body',
parent=styles['Normal'],
fontSize=9.5,
textColor=colors.HexColor('#222222'),
spaceAfter=4,
leading=14,
alignment=TA_JUSTIFY
)
note_style = ParagraphStyle(
'Note',
parent=styles['Normal'],
fontSize=8.5,
textColor=colors.HexColor('#555555'),
spaceAfter=4,
leading=12,
leftIndent=10,
italicName='Helvetica-Oblique'
)
footer_style = ParagraphStyle(
'Footer',
parent=styles['Normal'],
fontSize=8,
textColor=colors.HexColor('#777777'),
alignment=TA_CENTER
)
# Table header style
def make_table_header():
return TableStyle([
('BACKGROUND', (0,0), (-1,0), colors.HexColor('#1a3a5c')),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,0), 9),
('ALIGN', (0,0), (-1,0), 'CENTER'),
('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
('FONTSIZE', (0,1), (-1,-1), 8.5),
('ROWBACKGROUNDS', (0,1), (-1,-1), [colors.HexColor('#f0f4fa'), colors.white]),
('GRID', (0,0), (-1,-1), 0.5, colors.HexColor('#c0cce0')),
('TOPPADDING', (0,0), (-1,-1), 5),
('BOTTOMPADDING', (0,0), (-1,-1), 5),
('LEFTPADDING', (0,0), (-1,-1), 6),
('RIGHTPADDING', (0,0), (-1,-1), 6),
('WORDWRAP', (0,0), (-1,-1), True),
])
def h1(text):
# Use a table cell for colored header background spanning full width
data = [[Paragraph(f'<font color="white"><b>{text}</b></font>', ParagraphStyle(
'H1Inner', parent=styles['Normal'], fontSize=13,
textColor=colors.white, fontName='Helvetica-Bold', leading=18
))]]
t = Table(data, colWidths=[17*cm])
t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), colors.HexColor('#1a3a5c')),
('TOPPADDING', (0,0), (-1,-1), 7),
('BOTTOMPADDING', (0,0), (-1,-1), 7),
('LEFTPADDING', (0,0), (-1,-1), 10),
]))
return t
content = []
# ── TITLE PAGE ──────────────────────────────────────────────────────────────
content.append(Spacer(1, 0.5*inch))
content.append(Paragraph("Laboratory Investigations for Jaundice", title_style))
content.append(Paragraph("Findings, Reference Values & Diagnostic Interpretation", subtitle_style))
content.append(HRFlowable(width="100%", thickness=2, color=colors.HexColor('#1a3a5c'), spaceAfter=8))
content.append(Paragraph(
"Based on: Harrison's Principles of Internal Medicine 22E, Guyton & Hall Medical Physiology, "
"Harper's Illustrated Biochemistry 32nd Ed, Tietz Textbook of Laboratory Medicine 7th Ed",
note_style
))
content.append(Spacer(1, 0.2*inch))
# ── SECTION 1: OVERVIEW ─────────────────────────────────────────────────────
content.append(h1("1. Overview of Jaundice"))
content.append(Spacer(1, 6))
content.append(Paragraph(
"<b>Jaundice (icterus)</b> is yellow discoloration of skin, mucous membranes, and sclera caused by bilirubin "
"deposition. It is clinically apparent when plasma bilirubin reaches <b>2–3 mg/dL</b> (34–51 µmol/L). "
"Normal total serum bilirubin is <b>0.3–1.0 mg/dL</b> (5–17 µmol/L).",
body_style
))
content.append(Paragraph(
"The initial diagnostic step is to determine whether hyperbilirubinemia is predominantly "
"<b>unconjugated (indirect)</b> or <b>conjugated (direct)</b>, and whether other liver test "
"abnormalities are present. This guides the differential diagnosis into three categories:",
body_style
))
cat_data = [
["Type", "Bilirubin Fraction", "Key Mechanism", "Examples"],
["Prehepatic\n(Hemolytic)", "Unconjugated ↑↑", "Overproduction of bilirubin exceeds hepatic conjugation capacity",
"Haemolytic anaemia, sickle cell, thalassaemia, G6PD deficiency"],
["Hepatic\n(Hepatocellular)", "Both ↑ (conjugated predominant)", "Impaired uptake, conjugation, or excretion by hepatocytes",
"Viral hepatitis, alcoholic hepatitis, cirrhosis, drug toxicity, Wilson's, autoimmune"],
["Posthepatic\n(Cholestatic/Obstructive)", "Conjugated ↑↑", "Obstruction to bile flow - intra- or extrahepatic",
"Choledocholithiasis, pancreatic cancer, cholangiocarcinoma, PSC, PBC"],
]
cat_table = Table(cat_data, colWidths=[2.8*cm, 3.2*cm, 5.5*cm, 5.5*cm])
cat_table.setStyle(make_table_header())
content.append(cat_table)
content.append(Spacer(1, 6))
# ── SECTION 2: BILIRUBIN ────────────────────────────────────────────────────
content.append(h1("2. Serum Bilirubin"))
content.append(Spacer(1, 6))
content.append(Paragraph(
"Measured by the <b>van den Bergh reaction</b>. Direct (conjugated) bilirubin reacts directly; "
"total bilirubin reacts after addition of methanol. Indirect = Total − Direct.",
body_style
))
bili_data = [
["Test", "Normal Value", "Prehepatic Jaundice", "Hepatocellular Jaundice", "Obstructive Jaundice"],
["Total Serum Bilirubin", "0.3–1.0 mg/dL\n(5–17 µmol/L)", "↑↑ (rarely >5 mg/dL)", "↑↑↑ (variable)", "↑↑↑ (can be very high)"],
["Direct (Conjugated)\nBilirubin", "<0.25 mg/dL\n(<4.3 µmol/L)", "Normal / minimal ↑", "↑↑", "↑↑↑"],
["Indirect (Unconjugated)\nBilirubin", "0.2–0.7 mg/dL\n(3.4–12 µmol/L)", "↑↑↑ (predominant)", "↑", "Normal / slight ↑"],
["Direct Bilirubin\n% of Total", "<30%", "<20% (indirect predominates)", "30–60%", ">50% (direct predominates)"],
]
bili_table = Table(bili_data, colWidths=[3.0*cm, 3.0*cm, 3.0*cm, 3.5*cm, 3.5*cm])
bili_table.setStyle(make_table_header())
content.append(bili_table)
content.append(Paragraph(
"<i>Note: In hemolysis, serum bilirubin rarely exceeds 5 mg/dL (86 µmol/L) unless coexistent renal/hepatocellular dysfunction. "
"Crigler-Najjar type I: bilirubin >20 mg/dL; Gilbert's syndrome: mild unconjugated elevation (typically 1–3 mg/dL).</i>",
note_style
))
content.append(Spacer(1, 6))
# ── SECTION 3: URINE TESTS ──────────────────────────────────────────────────
content.append(h1("3. Urine Bilirubin and Urobilinogen"))
content.append(Spacer(1, 6))
content.append(Paragraph(
"Only conjugated (water-soluble) bilirubin is filtered by the kidneys and appears in urine. "
"Unconjugated bilirubin is albumin-bound and cannot be excreted in urine. Urobilinogen is "
"produced in the gut from conjugated bilirubin by bacteria; a portion is reabsorbed and excreted in urine.",
body_style
))
urine_data = [
["Test", "Normal", "Prehepatic\n(Haemolytic)", "Hepatocellular", "Obstructive\n(Cholestatic)"],
["Urine Bilirubin", "Absent / Negative", "Absent\n(unconjugated - not filtered)", "Present +++\n(bilirubinuria)", "Present +++\n(bilirubinuria)"],
["Urine Urobilinogen", "0.1–1.0 mg/dL\n(<17 µmol/L); or 1–4 mg/24h", "↑↑↑ Markedly elevated\n(increased gut production)", "↑ Elevated\n(reduced hepatic reuptake)", "Absent / Trace\n(no bilirubin reaches gut)"],
["Urine Colour", "Normal pale yellow", "Normal or dark\n(urobilinogen excess)", "Dark (tea-coloured)\nbilirubinuria", "Dark (tea-coloured)\nbilirubinuria"],
["Stool Colour", "Normal brown", "Normal / darker\n(excess stercobilin)", "Pale / normal", "Pale clay-coloured\n(acholic stools)\n- absent stercobilin"],
["Foam Test (shake urine)", "White foam", "White foam", "Yellow foam", "Yellow foam\n(conjugated bilirubin)"],
]
urine_table = Table(urine_data, colWidths=[3.0*cm, 2.8*cm, 3.2*cm, 3.2*cm, 3.8*cm])
urine_table.setStyle(make_table_header())
content.append(urine_table)
content.append(Paragraph(
"<i>Key rule: Bilirubinuria (positive urine bilirubin) with absent urobilinogen = complete biliary obstruction. "
"Absent urine bilirubin with increased urobilinogen = haemolytic jaundice.</i>",
note_style
))
content.append(Spacer(1, 6))
# ── SECTION 4: LIVER ENZYMES ────────────────────────────────────────────────
content.append(h1("4. Liver Function Tests (LFTs) / Enzyme Panel"))
content.append(Spacer(1, 6))
content.append(Paragraph(
"Enzyme tests are critical for distinguishing <b>hepatocellular</b> from <b>cholestatic</b> disease. "
"Hepatocellular disease: aminotransferases (ALT/AST) rise disproportionately to ALP. "
"Cholestatic disease: ALP rises disproportionately to aminotransferases.",
body_style
))
enzyme_data = [
["Test", "Normal Range", "Prehepatic", "Hepatocellular", "Cholestatic/Obstructive", "Clinical Significance"],
["ALT\n(Alanine Aminotransferase)\nSGPT", "7–56 U/L\n(Males slightly higher)", "Normal", "↑↑↑↑\n>500 U/L in acute viral hepatitis;\n>1000 U/L in drug toxicity/ischaemia",
"Normal or mild ↑\n(<3× ULN)", "Hepatocyte injury marker; more specific for liver than AST"],
["AST\n(Aspartate Aminotransferase)\nSGOT", "10–40 U/L", "Normal", "↑↑↑\nAST:ALT ratio <1 (viral);\n>2:1 suggests alcoholic hepatitis",
"Normal or mild ↑", "Less specific (also from heart, muscle, RBCs); AST:ALT >2 = alcoholic hepatitis"],
["ALP\n(Alkaline Phosphatase)", "44–147 U/L\n(adult)", "Normal", "↑ (1–3× ULN)", "↑↑↑↑\n>4× ULN; may reach 1000+ U/L",
"Elevated in bone disease too; confirm with GGT to establish liver origin"],
["GGT\n(Gamma-Glutamyl\nTransferase)", "9–48 U/L", "Normal", "↑", "↑↑↑\n(mirrors ALP; confirms liver source)",
"Sensitive marker of cholestasis; elevated with alcohol use; not elevated in bone disease"],
["5'-Nucleotidase", "2–15 U/L", "Normal", "Mild ↑", "↑↑↑\n(parallels ALP from liver)", "Confirms hepatic origin of ALP elevation; not affected by bone"],
["LDH\n(Lactate Dehydrogenase)", "140–280 U/L", "↑↑ (haemolysis)", "↑↑ (hepatocellular damage)", "Normal / mild ↑",
"Non-specific; markedly elevated in haemolysis and ischaemic hepatitis"],
]
enzyme_table = Table(enzyme_data, colWidths=[2.7*cm, 2.5*cm, 2.0*cm, 3.8*cm, 3.0*cm, 3.0*cm])
enzyme_table.setStyle(make_table_header())
content.append(enzyme_table)
content.append(Spacer(1, 6))
# ── SECTION 5: SYNTHETIC FUNCTION ───────────────────────────────────────────
content.append(h1("5. Tests of Hepatic Synthetic Function"))
content.append(Spacer(1, 6))
synth_data = [
["Test", "Normal Range", "Finding in Hepatic Jaundice", "Clinical Significance"],
["Serum Albumin", "3.5–5.0 g/dL\n(35–50 g/L)", "↓ in chronic disease\n(cirrhosis, cancer)\nNormal in acute hepatitis", "Low albumin = chronic/severe disease (t½ ~20 days). Normal = acute process (viral hepatitis, choledocholithiasis)."],
["Prothrombin Time (PT)\n/ INR", "PT: 11–13 sec\nINR: 0.8–1.2", "↑ PT / ↑ INR in hepatocellular damage or prolonged cholestasis (fat-soluble vit. K malabsorption)",
"Failure to correct PT with parenteral Vitamin K = severe hepatocellular injury. Correction = obstructive aetiology with Vit. K deficiency."],
["aPTT", "25–35 sec", "↑ in severe hepatic failure", "Reflects clotting factor deficiency from liver dysfunction"],
["Total Protein", "6.0–8.3 g/dL", "May be low in cirrhosis; elevated globulins in autoimmune/chronic disease", "Globulin fraction ↑ in autoimmune hepatitis and cirrhosis"],
["Serum Ammonia", "15–45 µg/dL\n(11–32 µmol/L)", "↑ in severe hepatocellular failure", "Marker of hepatic encephalopathy risk; not routinely used for jaundice work-up"],
]
synth_table = Table(synth_data, colWidths=[3.2*cm, 3.2*cm, 4.2*cm, 6.4*cm])
synth_table.setStyle(make_table_header())
content.append(synth_table)
content.append(Spacer(1, 6))
# ── SECTION 6: HAEMATOLOGY ──────────────────────────────────────────────────
content.append(h1("6. Haematological Investigations"))
content.append(Spacer(1, 6))
content.append(Paragraph(
"Particularly important to identify <b>prehepatic (haemolytic)</b> jaundice.",
body_style
))
haem_data = [
["Test", "Normal Range", "Prehepatic\n(Haemolytic)", "Hepatocellular", "Cholestatic"],
["Haemoglobin (Hb)", "M: 13.5–17.5 g/dL\nF: 12.0–15.5 g/dL", "↓ (anaemia)\noften normocytic/\nmacrocytic", "Normal (unless end-stage cirrhosis)", "Normal"],
["Reticulocyte Count", "0.5–1.5% (of RBCs)\nor 25,000–75,000/µL", "↑↑ (>2–3%)\nbonemarrow compensation", "Normal", "Normal"],
["Peripheral Blood Film", "Normal morphology", "Spherocytes (hereditary spherocytosis), sickle cells, target cells, fragmented RBCs (microangiopathy)",
"May show target cells, burr cells (uraemia) in cirrhosis", "Normal"],
["Serum Haptoglobin", "30–200 mg/dL", "↓↓ or absent\n(consumed by free Hb)", "May be low in cirrhosis", "Normal"],
["Serum Free Haemoglobin", "<5 mg/dL", "↑ (in intravascular haemolysis)", "Normal", "Normal"],
["Coombs Test\n(Direct Antiglobulin)", "Negative", "Positive in immune\nhaemolytic anaemia;\nNegative in non-immune", "Negative", "Negative"],
["WBC Count", "4,000–11,000/µL", "Normal or ↑ (if infection)", "↑ in viral hepatitis (lymphocytosis); ↑ in bacterial cholangitis", "↑ in cholangitis"],
["Platelet Count", "150,000–400,000/µL", "Normal / ↓ (hypersplenism)", "↓ in cirrhosis\n(hypersplenism, thrombopoietin ↓)", "Usually normal"],
["ESR / CRP", "ESR: M <15, F <20 mm/h\nCRP: <5 mg/L", "↑ in haemolysis/underlying condition", "↑ in acute hepatitis", "↑ in cholangitis/malignancy"],
]
haem_table = Table(haem_data, colWidths=[3.0*cm, 3.0*cm, 3.5*cm, 3.5*cm, 3.0*cm])
haem_table.setStyle(make_table_header())
content.append(haem_table)
content.append(Spacer(1, 6))
# ── SECTION 7: SPECIFIC MARKERS ─────────────────────────────────────────────
content.append(h1("7. Specific / Additional Investigations"))
content.append(Spacer(1, 6))
spec_data = [
["Test", "Normal / Reference", "Finding & Significance"],
["Hepatitis Serology\n(HBsAg, Anti-HBc, Anti-HAV IgM,\nHCV Ab, HEV IgM)", "Negative / Non-reactive",
"Positive serology identifies viral aetiology. HBsAg +ve = active HBV. Anti-HAV IgM = acute HAV. Anti-HCV +ve = HCV exposure (confirm with HCV RNA)."],
["HCV RNA / HBV DNA\n(Viral Load)", "Undetectable (PCR negative)",
"Quantifies viral replication; used for treatment monitoring; HBV DNA >20,000 IU/mL = high replication."],
["EBV / CMV Serology &\nMonospot Test", "Negative",
"EBV (Epstein-Barr) and CMV are uncommon causes of viral hepatitis with jaundice; monospot positive in infectious mononucleosis."],
["Antinuclear Antibody (ANA)\nSmooth Muscle Ab (SMA)\nAnti-LKM-1", "Negative (<1:40 titre)",
"Autoimmune hepatitis: ANA and/or SMA positive (type 1); Anti-LKM-1 positive (type 2). Titres >1:80 significant."],
["Antimitochondrial Ab (AMA)", "Negative",
"Positive (titre >1:40) in >95% of Primary Biliary Cholangitis (PBC) cases. Highly specific."],
["Serum Ceruloplasmin", "20–60 mg/dL", "↓ (<20 mg/dL) in Wilson's disease. Normal or elevated in other conditions (acute-phase reactant)."],
["Serum Copper\n24-hr Urine Copper", "Serum: 70–140 µg/dL\nUrine: <40 µg/24h",
"Wilson's disease: serum copper ↑, urine copper >100 µg/24h (>250 µg/24h diagnostic). Liver copper >250 µg/g dry weight on biopsy."],
["Serum Ferritin\nTransferrin Saturation", "Ferritin: M 12–300 ng/mL;\nF 12–150 ng/mL\nSaturation: 20–45%",
"Hereditary haemochromatosis: ferritin markedly elevated (often >1000 ng/mL); transferrin saturation >45–50%. Also elevated in alcoholic liver disease."],
["Alpha-1 Antitrypsin (A1AT)", "80–200 mg/dL", "↓ in A1AT deficiency - causes neonatal cholestasis and adult liver disease."],
["AFP (Alpha-Feto Protein)", "<10 ng/mL", "↑↑↑ in Hepatocellular Carcinoma (HCC). Also mildly elevated in viral hepatitis (regeneration). Levels >400 ng/mL highly suggestive of HCC."],
["CA 19-9", "<37 U/mL", "↑↑ in cholangiocarcinoma and pancreatic cancer - obstructive jaundice with malignancy."],
["Serum Lipase / Amylase", "Lipase: 0–60 U/L\nAmylase: 30–110 U/L",
"↑ in pancreatitis - a cause of obstructive jaundice (oedema of pancreatic head compressing common bile duct)."],
["Blood Culture", "No growth",
"Positive in ascending cholangitis (Charcot's triad: fever, jaundice, RUQ pain). Common organisms: E. coli, Klebsiella, Enterococcus."],
["Serum Glucose", "Fasting: 70–100 mg/dL\n(3.9–5.6 mmol/L)", "↓ Hypoglycaemia in fulminant hepatic failure (impaired gluconeogenesis/glycogenolysis)."],
["Serum Electrolytes\n(Na, K, Cr, Urea)", "Na: 136–145 mEq/L\nK: 3.5–5.0 mEq/L\nCr: 0.6–1.2 mg/dL",
"Hyponatraemia in advanced cirrhosis/ascites. Elevated creatinine in hepatorenal syndrome complicating severe liver disease."],
]
spec_table = Table(spec_data, colWidths=[4.0*cm, 3.8*cm, 9.2*cm])
spec_table.setStyle(make_table_header())
content.append(spec_table)
content.append(Spacer(1, 6))
# ── SECTION 8: SUMMARY COMPARISON TABLE ─────────────────────────────────────
content.append(h1("8. Summary: Differential Laboratory Profile of Jaundice"))
content.append(Spacer(1, 6))
summary_data = [
["Investigation", "Prehepatic\n(Haemolytic)", "Hepatocellular\n(Hepatic)", "Posthepatic\n(Obstructive/Cholestatic)"],
["Total Bilirubin", "↑↑ (rarely >5 mg/dL)", "↑↑↑ (variable)", "↑↑↑ (often very high)"],
["Direct (Conjugated) Bilirubin", "Normal / minimal ↑", "↑↑", "↑↑↑ (predominant)"],
["Indirect (Unconjugated) Bilirubin", "↑↑↑ (predominant)", "↑", "Normal / mild ↑"],
["ALT / AST", "Normal", "↑↑↑↑ (>10× ULN in acute hepatitis)", "Normal or mild ↑ (<3× ULN)"],
["Alkaline Phosphatase (ALP)", "Normal", "↑ (1–3× ULN)", "↑↑↑↑ (>4× ULN)"],
["GGT", "Normal", "↑ (especially alcohol)", "↑↑↑↑"],
["Serum Albumin", "Normal", "↓ in chronic disease", "May be ↓ in prolonged obstruction"],
["Prothrombin Time", "Normal", "↑ (severe hepatocellular damage;\ndoes NOT correct with Vit K)", "↑ if prolonged (corrects with Vit K injection)"],
["Urine Bilirubin", "Absent", "Present +++", "Present +++"],
["Urine Urobilinogen", "↑↑↑", "↑ or normal", "Absent / trace"],
["Stool Colour", "Normal / dark", "Normal or pale", "Pale / clay-coloured (acholic)"],
["Haemoglobin", "↓ (anaemia)", "Normal (may ↓ in cirrhosis)", "Normal"],
["Reticulocyte Count", "↑↑ (>2%)", "Normal", "Normal"],
["Haptoglobin", "↓↓ or absent", "Normal or ↓ in cirrhosis", "Normal"],
["LDH", "↑↑ (haemolysis)", "↑", "Normal / mild ↑"],
["Blood Film", "Abnormal RBC morphology\n(spherocytes, sickle cells, etc.)", "Normal / target cells in cirrhosis", "Normal"],
]
summary_table = Table(summary_data, colWidths=[4.0*cm, 4.0*cm, 4.5*cm, 4.5*cm])
summary_table.setStyle(make_table_header())
content.append(summary_table)
content.append(Spacer(1, 6))
# ── SECTION 9: ADDITIONAL WORKUP ────────────────────────────────────────────
content.append(h1("9. Further Investigations Based on Clinical Diagnosis"))
content.append(Spacer(1, 6))
further_data = [
["Suspected Diagnosis", "Key Laboratory Tests", "Imaging / Procedures"],
["Viral Hepatitis A", "Anti-HAV IgM positive; total bilirubin ↑; ALT/AST ↑↑↑", "Ultrasound abdomen (hepatomegaly)"],
["Viral Hepatitis B", "HBsAg +, HBeAg, HBV DNA quantitative, Anti-HBc IgM (acute)", "Ultrasound liver; fibroscan if chronic"],
["Viral Hepatitis C", "Anti-HCV Ab; HCV RNA (PCR); genotyping for treatment", "Liver biopsy / fibroscan for fibrosis staging"],
["Alcoholic Hepatitis", "AST:ALT ratio >2:1; GGT ↑↑; MCV ↑ (macrocytosis); CDT ↑; Maddrey discriminant function", "Ultrasound; liver biopsy in selected cases"],
["Primary Biliary Cholangitis", "AMA +ve (>95%); ALP ↑↑↑; GGT ↑; IgM ↑", "Liver biopsy (granulomatous cholangitis)"],
["Autoimmune Hepatitis", "ANA, SMA, Anti-LKM-1 +ve; IgG ↑↑; ALT/AST ↑↑", "Liver biopsy (interface hepatitis)"],
["Wilson's Disease", "Ceruloplasmin ↓; serum copper ↑; 24h urine copper ↑; Kayser-Fleischer rings on slit lamp", "MRI brain; liver biopsy"],
["Haemochromatosis", "Ferritin ↑↑↑; transferrin saturation >45%; HFE gene mutation", "MRI liver (iron quantification); liver biopsy"],
["Choledocholithiasis", "Conjugated bilirubin ↑; ALP ↑↑; GGT ↑↑; amylase/lipase if pancreatitis", "MRCP (first line); ERCP (therapeutic)"],
["Pancreatic Cancer", "CA 19-9 ↑↑; ALP ↑↑↑; conjugated bilirubin ↑↑↑; albumin ↓ (weight loss)", "CT abdomen/chest; ERCP/EUS; tissue biopsy"],
["Cholangiocarcinoma", "CA 19-9 ↑; CEA ↑ (occasionally); ALP ↑↑↑", "MRCP; PET-CT; bile duct brush cytology"],
["Haemolytic Anaemia", "Unconjugated bilirubin ↑↑; Hb ↓; reticulocytes ↑↑; Coombs test; haptoglobin ↓; blood film", "Peripheral blood smear; bone marrow if needed"],
["Primary Sclerosing Cholangitis", "ALP ↑↑↑; GGT ↑↑↑; pANCA +ve in ~80%; IgG4 (to exclude IgG4-SC)", "MRCP (beaded bile ducts); colonoscopy (associated IBD)"],
["Hepatocellular Carcinoma", "AFP ↑↑↑ (>400 ng/mL suggestive); ALP ↑; LFTs deranged", "Triphasic CT or MRI; CEUS; liver biopsy"],
]
further_table = Table(further_data, colWidths=[3.5*cm, 6.8*cm, 6.7*cm])
further_table.setStyle(make_table_header())
content.append(further_table)
content.append(Spacer(1, 6))
# ── SECTION 10: NOTES ON VALUES ─────────────────────────────────────────────
content.append(h1("10. Key Diagnostic Thresholds & Notes"))
content.append(Spacer(1, 6))
notes = [
"<b>Jaundice becomes clinically visible</b> at serum bilirubin ≥2–3 mg/dL (34–51 µmol/L).",
"<b>Isolated unconjugated hyperbilirubinemia</b> with no other liver test abnormality strongly suggests haemolysis or Gilbert's syndrome.",
"<b>AST:ALT ratio >2:1</b> (especially >3:1) strongly suggests alcoholic liver disease.",
"<b>ALP >4× ULN</b> with proportionally lesser aminotransferase elevation = cholestatic pattern.",
"<b>Prothrombin time correction with Vitamin K</b>: corrects in obstructive jaundice (Vit K malabsorption); does NOT correct in hepatocellular failure (synthetic dysfunction).",
"<b>Low albumin</b> suggests chronic liver disease (albumin t½ ~20 days); normal albumin in acute processes.",
"<b>Positive urine bilirubin + absent urobilinogen</b> = complete biliary obstruction.",
"<b>Increased urine urobilinogen + absent urine bilirubin</b> = haemolytic jaundice.",
"<b>AMA positivity (>1:40)</b> is >95% specific for Primary Biliary Cholangitis.",
"<b>Crigler-Najjar type I</b>: bilirubin often >20 mg/dL, life-threatening kernicterus in neonates.",
"<b>Gilbert's syndrome</b>: mild unconjugated elevation typically 1–3 mg/dL; incidence 3–7% of population; benign.",
"<b>Hypoglycaemia</b> in jaundiced patient = ominous sign of fulminant hepatic failure.",
]
for note in notes:
content.append(Paragraph(f"• {note}", body_style))
content.append(Spacer(1, 8))
# ── REFERENCES ───────────────────────────────────────────────────────────────
content.append(HRFlowable(width="100%", thickness=1, color=colors.HexColor('#c0cce0'), spaceBefore=6, spaceAfter=6))
content.append(Paragraph("<b>References</b>", h2_style))
refs = [
"1. Friedman LS. Jaundice. In: <i>Harrison's Principles of Internal Medicine, 22nd Ed.</i> McGraw Hill; 2025. Ch. 52.",
"2. Guyton AC, Hall JE. <i>Guyton and Hall Textbook of Medical Physiology, 14th Ed.</i> Elsevier; 2020.",
"3. Murray RK, et al. <i>Harper's Illustrated Biochemistry, 32nd Ed.</i> McGraw Hill; 2023.",
"4. McPherson RA, Pincus MR. <i>Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd Ed.</i> Elsevier; 2017.",
"5. Rifai N, et al. <i>Tietz Textbook of Laboratory Medicine, 7th Ed.</i> Elsevier; 2023.",
]
for ref in refs:
content.append(Paragraph(ref, note_style))
content.append(Spacer(1, 6))
content.append(Paragraph(
"Generated by Orris Medical Reference • July 2026 • For educational use only. Always correlate with clinical findings.",
footer_style
))
# Build
doc.build(content)
print(f"PDF created: {OUTPUT}")
Running Command
cd /home/daytona/workspace/jaundice-pdf && python generate_pdf.py
Running Command
ls -lh /home/daytona/workspace/jaundice-pdf/Jaundice_Laboratory_Investigations.pdf
Your PDF is ready for download:
Jaundice Laboratory Investigations
PDF Document · PDF
What's inside the PDF (10 sections):
-
Overview - Definition, clinical threshold (bilirubin ≥2–3 mg/dL), classification into prehepatic / hepatic / posthepatic
-
Serum Bilirubin - Total, direct (conjugated), indirect (unconjugated) with normal values and findings in each jaundice type; van den Bergh reaction explained
-
Urine Bilirubin & Urobilinogen - Full dipstick interpretation table including stool colour, foam test, and the diagnostic rules (e.g., bilirubinuria + absent urobilinogen = complete obstruction)
-
Liver Enzymes (LFTs) - ALT, AST, ALP, GGT, 5'-nucleotidase, LDH with normal ranges and pattern recognition (hepatocellular vs cholestatic)
-
Hepatic Synthetic Function - Albumin, PT/INR, aPTT, total protein, ammonia - including the Vitamin K correction test
-
Haematology - Hb, reticulocytes, peripheral film, haptoglobin, Coombs test, LDH - for identifying haemolytic jaundice
-
Specific Markers - Viral hepatitis serology, AMA, ANA/SMA, ceruloplasmin, ferritin, AFP, CA 19-9, blood cultures, and more
-
Summary Comparison Table - All 17 key parameters side by side for prehepatic / hepatic / cholestatic jaundice
-
Condition-Specific Workup - 14 diagnoses (viral hepatitis A/B/C, alcoholic hepatitis, PBC, Wilson's, haemochromatosis, choledocholithiasis, pancreatic cancer, HCC, etc.) with their key tests and imaging
-
Key Diagnostic Thresholds - 12 high-yield clinical rules for interpretation
Sources: Harrison's 22E, Guyton & Hall, Harper's Biochemistry 32E, Tietz Lab Medicine 7E.
Laboratory investigations for diabetes with values in pdf form
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~/jaundice-pdf/generate_diabetes_pdf.py
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import inch, cm
from reportlab.platypus import (
SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
HRFlowable, KeepTogether, PageBreak
)
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
OUTPUT = "/home/daytona/workspace/jaundice-pdf/Diabetes_Laboratory_Investigations.pdf"
doc = SimpleDocTemplate(
OUTPUT,
pagesize=A4,
rightMargin=1.8*cm,
leftMargin=1.8*cm,
topMargin=2*cm,
bottomMargin=2*cm,
title="Laboratory Investigations for Diabetes Mellitus",
author="Orris Medical Reference"
)
styles = getSampleStyleSheet()
W = 17.4*cm # usable width
# ── Styles ───────────────────────────────────────────────────────────────────
title_style = ParagraphStyle('CT', parent=styles['Title'],
fontSize=22, textColor=colors.HexColor('#0d3b6e'), spaceAfter=4,
alignment=TA_CENTER, fontName='Helvetica-Bold')
subtitle_style = ParagraphStyle('CS', parent=styles['Normal'],
fontSize=10.5, textColor=colors.HexColor('#444444'), spaceAfter=10,
alignment=TA_CENTER, fontName='Helvetica')
h2_style = ParagraphStyle('H2', parent=styles['Normal'],
fontSize=11, textColor=colors.HexColor('#0d3b6e'), spaceBefore=8,
spaceAfter=3, fontName='Helvetica-Bold')
body_style = ParagraphStyle('Body', parent=styles['Normal'],
fontSize=9, textColor=colors.HexColor('#222222'), spaceAfter=4,
leading=13, alignment=TA_JUSTIFY)
note_style = ParagraphStyle('Note', parent=styles['Normal'],
fontSize=8, textColor=colors.HexColor('#555555'), spaceAfter=3,
leading=11, leftIndent=8, fontName='Helvetica-Oblique')
footer_style = ParagraphStyle('Footer', parent=styles['Normal'],
fontSize=7.5, textColor=colors.HexColor('#888888'), alignment=TA_CENTER)
bullet_style = ParagraphStyle('Bullet', parent=styles['Normal'],
fontSize=9, textColor=colors.HexColor('#222222'), spaceAfter=3,
leading=13, leftIndent=12)
NAVY = colors.HexColor('#0d3b6e')
LTBLUE = colors.HexColor('#ddeeff')
STRIPE1 = colors.HexColor('#eef4fb')
STRIPE2 = colors.white
GRIDCLR = colors.HexColor('#b0c8e8')
def h1(text):
inner = ParagraphStyle('H1i', parent=styles['Normal'],
fontSize=12, textColor=colors.white, fontName='Helvetica-Bold', leading=17)
t = Table([[Paragraph(text, inner)]], colWidths=[W])
t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), NAVY),
('TOPPADDING', (0,0), (-1,-1), 7),
('BOTTOMPADDING', (0,0), (-1,-1), 7),
('LEFTPADDING', (0,0), (-1,-1), 10),
]))
return t
def tbl(data, widths, row_heights=None):
t = Table(data, colWidths=widths, rowHeights=row_heights)
t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,0), NAVY),
('TEXTCOLOR', (0,0), (-1,0), colors.white),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,0), 8.5),
('ALIGN', (0,0), (-1,0), 'CENTER'),
('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
('FONTSIZE', (0,1), (-1,-1), 8),
('ROWBACKGROUNDS', (0,1), (-1,-1), [STRIPE1, STRIPE2]),
('GRID', (0,0), (-1,-1), 0.4, GRIDCLR),
('TOPPADDING', (0,0), (-1,-1), 4),
('BOTTOMPADDING', (0,0), (-1,-1), 4),
('LEFTPADDING', (0,0), (-1,-1), 5),
('RIGHTPADDING', (0,0), (-1,-1), 5),
('WORDWRAP', (0,0), (-1,-1), True),
]))
return t
content = []
# ── TITLE ────────────────────────────────────────────────────────────────────
content.append(Spacer(1, 0.4*inch))
content.append(Paragraph("Laboratory Investigations for Diabetes Mellitus", title_style))
content.append(Paragraph("Diagnostic Criteria, Monitoring Tests, Complication Markers & Reference Values", subtitle_style))
content.append(HRFlowable(width="100%", thickness=2, color=NAVY, spaceAfter=6))
content.append(Paragraph(
"Sources: Harrison's Principles of Internal Medicine 22E • Henry's Clinical Diagnosis & "
"Management by Laboratory Methods 23E • Tietz Textbook of Laboratory Medicine 7E • "
"ADA Standards of Medical Care in Diabetes 2024 • Katzung's Basic & Clinical Pharmacology 16E",
note_style))
content.append(Spacer(1, 0.15*inch))
# ── SECTION 1: CLASSIFICATION ────────────────────────────────────────────────
content.append(h1("1. Classification of Diabetes Mellitus"))
content.append(Spacer(1, 5))
cls_data = [
["Type", "Key Features", "Pathophysiology"],
["Type 1 DM\n(T1DM)", "Usually onset <30 yrs; lean; absolute insulin deficiency; prone to DKA; autoimmune markers +ve",
"Autoimmune destruction of pancreatic β-cells; HLA-DR3/DR4 association; GAD65, IA-2, ZnT8, IAA autoantibodies"],
["Type 2 DM\n(T2DM)", "Most common (>90%); onset usually >40 yrs (earlier in obesity); insulin resistance + relative insulin deficiency; rarely DKA",
"Progressive insulin secretory failure on background of insulin resistance; strong genetic + lifestyle component"],
["Gestational DM\n(GDM)", "Diagnosed during pregnancy (24–28 weeks); resolves postpartum in most; ↑ risk of future T2DM",
"Hormonal insulin resistance of pregnancy; placental hormones (hPL, progesterone, cortisol)"],
["Other Specific\nTypes", "MODY, drug-induced (steroids, antipsychotics), pancreatic disease, endocrinopathies (Cushing's, acromegaly)",
"Monogenic defects in β-cell function; exocrine pancreatic disease; drug/chemical-induced; endocrine disorders"],
["LADA\n(Latent Autoimmune\nDiabetes in Adults)", "Adult onset; initially resembles T2DM; slowly progressive β-cell destruction",
"GAD65 antibodies positive; 5–10% of adults clinically diagnosed as T2DM; ultimately requires insulin"],
]
content.append(tbl(cls_data, [2.5*cm, 7.2*cm, 7.7*cm]))
content.append(Spacer(1, 6))
# ── SECTION 2: DIAGNOSTIC CRITERIA ──────────────────────────────────────────
content.append(h1("2. Diagnostic Criteria (ADA 2024)"))
content.append(Spacer(1, 5))
content.append(Paragraph(
"Any <b>ONE</b> of the following criteria is sufficient. In the absence of unequivocal hyperglycemia, "
"diagnosis requires <b>two abnormal test results</b> from the same sample or two separate test samples.",
body_style))
diag_data = [
["Test", "Diabetes\n(Diagnostic)", "Prediabetes\n(At-Risk)", "Normal", "Notes"],
["Fasting Plasma\nGlucose (FPG)", "≥126 mg/dL\n(≥7.0 mmol/L)", "100–125 mg/dL\n(IFG)\n(5.6–6.9 mmol/L)",
"<100 mg/dL\n(<5.6 mmol/L)", "Fast ≥8 hours; no caloric intake. Large biological variation - repeat if near threshold."],
["2-Hour Plasma\nGlucose (75 g OGTT)", "≥200 mg/dL\n(≥11.1 mmol/L)", "140–199 mg/dL\n(IGT)\n(7.8–11.0 mmol/L)",
"<140 mg/dL\n(<7.8 mmol/L)", "75 g anhydrous glucose in water. Patient seated; no smoking. Perform 7–9 AM after 10–16h fast."],
["HbA1c\n(Glycated Haemoglobin)", "≥6.5%\n(≥48 mmol/mol)", "5.7–6.4%\n(39–47 mmol/mol)",
"<5.7%\n(<39 mmol/mol)", "NGSP-certified, DCCT-standardised lab method. NOT valid in haemoglobinopathies, haemolysis, recent transfusion."],
["Random Plasma\nGlucose", "≥200 mg/dL\n(≥11.1 mmol/L)\n+ classic symptoms", "N/A", "N/A",
"Symptoms: polyuria, polydipsia, unexplained weight loss. This criterion alone is sufficient IF classic symptoms present."],
]
content.append(tbl(diag_data, [2.8*cm, 2.8*cm, 3.0*cm, 2.8*cm, 6.0*cm]))
content.append(Paragraph(
"<i>IFG = Impaired Fasting Glucose; IGT = Impaired Glucose Tolerance; OGTT = Oral Glucose Tolerance Test</i>",
note_style))
content.append(Spacer(1, 6))
# ── SECTION 3: GESTATIONAL DM ────────────────────────────────────────────────
content.append(h1("3. Gestational Diabetes (GDM) Screening & Diagnostic Values"))
content.append(Spacer(1, 5))
content.append(Paragraph(
"Screen all women at 24–28 weeks gestation. Women with risk factors for pre-existing T2DM "
"should be screened at first prenatal visit. Two approaches are accepted:",
body_style))
gdm_data = [
["Approach", "Test", "Time Point", "Threshold for GDM Diagnosis"],
["One-Step IADPSG\n(recommended internationally)\n75 g OGTT",
"Plasma glucose\n(any ONE value met\nor exceeded = GDM)",
"Fasting\n1 hour\n2 hour",
"≥92 mg/dL (5.1 mmol/L)\n≥180 mg/dL (10.0 mmol/L)\n≥153 mg/dL (8.5 mmol/L)"],
["Two-Step NIH/ACOG\n(used in USA)\nStep 1: 50 g GCT (non-fasting)",
"Plasma glucose at 1h\n(if positive, proceed\nto Step 2)",
"1 hour",
"≥130 mg/dL (7.2) or\n≥135 mg/dL (7.5) or\n≥140 mg/dL (7.8 mmol/L)\n[threshold varies by institution]"],
["Step 2: 100 g OGTT\n(fasting)\n≥2 values met = GDM",
"Carpenter/Coustan\nNDDG",
"Fasting / 1h / 2h / 3h\nFasting / 1h / 2h / 3h",
"95 / 180 / 155 / 140 mg/dL\n105 / 190 / 165 / 145 mg/dL"],
]
content.append(tbl(gdm_data, [3.5*cm, 3.5*cm, 2.5*cm, 7.9*cm]))
content.append(Spacer(1, 6))
# ── SECTION 4: GLYCAEMIC MONITORING ─────────────────────────────────────────
content.append(h1("4. Glycaemic Monitoring Tests"))
content.append(Spacer(1, 5))
gly_data = [
["Test", "Reference / Target Values", "Frequency / Use", "Notes"],
["HbA1c\n(Glycated Haemoglobin)", "Target: <7.0% (53 mmol/mol) for most adults\n<6.5% for selected patients\n<8.0% for elderly/frail\nNormal (non-diabetic): <5.7%",
"Every 3 months if not at target;\nEvery 6 months if stable at goal",
"Reflects average BG over ~3 months (erythrocyte lifespan ~120 days). Unreliable in haemolytic anaemia, sickle cell, recent transfusion, iron deficiency."],
["Fasting Plasma\nGlucose (FPG)", "Normal: 70–99 mg/dL (3.9–5.5 mmol/L)\nTarget in DM: 80–130 mg/dL (4.4–7.2 mmol/L)",
"Regular self-monitoring;\nroutine labs", "8-hour fast required. High day-to-day biological variation."],
["Postprandial\nGlucose (2h PPG)", "Normal: <140 mg/dL (<7.8 mmol/L)\nTarget in DM: <180 mg/dL (<10.0 mmol/L)",
"2 hours after start of meal; especially useful in T2DM",
"Better predictor of HbA1c than FPG alone; important in gestational DM management."],
["Time-in-Range\n(TIR) - CGM", "Target: >70% time in range 70–180 mg/dL\nTime below 70: <4%\nTime below 54: <1%\nTime above 180: <25%",
"Continuous Glucose Monitor (CGM); real-time data",
"Used with CGM devices. Emerging gold-standard for glycaemic assessment alongside HbA1c."],
["Fructosamine\n(Glycated Serum Protein)", "Normal: 205–285 µmol/L\nDiabetes (poorly controlled): >285 µmol/L",
"Used when HbA1c unreliable;\nreflects ~2–3 week average BG",
"Useful in haemolytic anaemia, haemoglobinopathies. Affected by serum protein levels (albumin must be ≥3 g/dL)."],
["1,5-Anhydroglucitol\n(1,5-AG)", "Normal: 10.7–32.0 µg/mL (M);\n6.8–29.3 µg/mL (F)\nLow in poorly controlled DM",
"Reflects postprandial hyperglycaemia over preceding 1–2 weeks",
"Rapidly decreases when BG exceeds renal threshold (~180 mg/dL). Falsely low with SGLT2 inhibitors."],
["Urine Glucose\n(Glucosuria)", "Normal: Absent / Negative\n(<15 mg/dL by dipstick)",
"Qualitative screening only; not for monitoring",
"Appears when BG exceeds renal threshold ~180 mg/dL. Unreliable - NOT used for diagnosis or monitoring."],
]
content.append(tbl(gly_data, [3.0*cm, 4.0*cm, 3.2*cm, 7.2*cm]))
content.append(Spacer(1, 6))
# ── SECTION 5: AUTOANTIBODIES & TYPING ──────────────────────────────────────
content.append(h1("5. Autoantibody Tests (Type 1 DM Diagnosis & Typing)"))
content.append(Spacer(1, 5))
content.append(Paragraph(
"Islet autoantibodies are present in <b>85–90%</b> of individuals with immune-mediated (Type 1) diabetes at initial diagnosis. "
"Multiple autoantibodies predict near 100% progression to T1DM in high-risk individuals.",
body_style))
ab_data = [
["Autoantibody", "Sensitivity in T1DM", "Specificity", "Clinical Use"],
["GAD65\n(Anti-glutamic acid decarboxylase)", "~80%", "High (>98% in controls)", "Most commonly used; also found in LADA (5–10% of T2DM). Persists longest."],
["IA-2A\n(Insulinoma-associated protein 2)", "~60–70%", "High", "Predicts rapid progression to T1DM; combined with GADA gives better predictive value."],
["IAA\n(Insulin Autoantibodies)", "~50% at diagnosis\nHigher in young children",
"Good (lower specificity if patient already on insulin)", "NOT useful after insulin therapy started. Most specific predictor in children <5 years."],
["ZnT8A\n(Zinc Transporter 8)", "~60–80% at onset", "High (>98%)", "Detected in ~26% of T1DM patients negative for other antibodies. FDA-approved (2014)."],
["ICA\n(Islet Cell Antibodies)", "~80% at onset\n(older assay)", "Good", "Indirect immunofluorescence method; largely replaced by more specific assays above."],
["C-Peptide", "Low/undetectable in T1DM:\n<0.2 nmol/L (fasting)\nNormal T2DM: 0.5–3.0 nmol/L",
"N/A", "Differentiates T1DM (low/absent) from T2DM (preserved). Useful to assess residual β-cell function. Stimulated C-peptide with glucagon >0.6 nmol/L = adequate reserve."],
["Serum Insulin\n(Fasting)", "T1DM: Low/Undetectable\nT2DM: Normal/High (early) → Low (late)\nNormal fasting: 2–25 µIU/mL (14–174 pmol/L)",
"N/A", "Not routinely used for diagnosis. HOMA-IR = (Fasting insulin × Fasting glucose) / 405 – index of insulin resistance."],
]
content.append(tbl(ab_data, [3.2*cm, 3.0*cm, 2.8*cm, 8.4*cm]))
content.append(Spacer(1, 6))
# ── SECTION 6: ACUTE COMPLICATIONS ──────────────────────────────────────────
content.append(h1("6. Labs for Acute Diabetic Complications"))
content.append(Spacer(1, 5))
acute_data = [
["Test", "DKA\n(Diabetic Ketoacidosis)", "HHS\n(Hyperosmolar Hyperglycaemic State)", "Hypoglycaemia"],
["Plasma Glucose", "250–600 mg/dL\n(13.9–33.3 mmol/L)", ">600 mg/dL (often 900–1200)\n(>33.3 mmol/L)", "<70 mg/dL (<3.9 mmol/L)\nSevere: <54 mg/dL (<3.0)"],
["Arterial pH", "<7.30 (acidosis)\nSevere DKA: <7.00", "Normal to slightly low\n(7.35–7.45)", "Normal"],
["Serum Bicarbonate", "<18 mEq/L\nSevere: <10 mEq/L", ">18 mEq/L (usually normal)", "Normal"],
["Anion Gap", "↑↑ (>12 mEq/L)\nHigh anion gap metabolic acidosis", "Normal or mildly ↑\n(8–16 mEq/L)", "Normal"],
["Serum Ketones\n(β-hydroxybutyrate)", "Markedly elevated\n>3.0 mmol/L (often >5)\nNormal: <0.3 mmol/L", "Absent or trace\n(<0.3 mmol/L)", "Normal or low\n(fasting hypoglycaemia)"],
["Urine Ketones\n(Dipstick)", "Large / 3+", "Absent to trace", "Normal"],
["Serum Osmolality", "290–320 mOsm/kg\n(Normal: 275–295)", ">320 mOsm/kg\n(often 350–380)", "Normal"],
["Serum Sodium (Na⁺)", "May be low, normal, or high\n(corrected Na+ = Na + 1.6 × [(Glu-100)/100])", "Normal to high\n(130–150 mEq/L)", "Normal"],
["Serum Potassium (K⁺)", "Initially normal/high (shift from ICF)\nthen falls rapidly with insulin Rx\n(Monitor closely!)", "May be normal to high", "Normal"],
["Serum Creatinine\n& BUN", "May be ↑ (dehydration)\nCreatinine: 0.6–1.2 mg/dL (normal)", "↑↑ (severe dehydration)\nBUN often >30 mg/dL", "Normal"],
["CBC / WBC", "Leukocytosis (stress response)\n10,000–25,000/µL (not always infection)", "Leukocytosis", "Normal"],
["Phosphate", "Initially normal/high → falls with treatment\nMonitor during Rx", "May be mildly low", "Normal"],
["Lactate", "May be mildly elevated; exclude lactic acidosis\n(Normal: 0.5–2.0 mmol/L)", "Normal", "Low if insulin-induced"],
["Serum Insulin\n& C-Peptide", "Low/undetectable (T1DM)\nOr inappropriately low for glucose level", "Present (T2DM)", "Low = exogenous; High = endogenous overproduction (insulinoma)"],
]
content.append(tbl(acute_data, [3.2*cm, 4.8*cm, 4.6*cm, 4.8*cm]))
content.append(Spacer(1, 6))
# ── SECTION 7: CHRONIC COMPLICATIONS ────────────────────────────────────────
content.append(h1("7. Monitoring for Chronic Complications"))
content.append(Spacer(1, 5))
comp_data = [
["Complication /\nSystem", "Test", "Normal Value", "Abnormal / Action Threshold", "Frequency"],
["Diabetic\nNephropathy\n(DKD)",
"Urine Albumin-to-Creatinine Ratio (UACR)\nSpot urine (morning preferred)",
"<30 mg/g (normoalbuminuria)",
"30–300 mg/g = Moderately ↑ albuminuria (microalbuminuria)\n>300 mg/g = Severely ↑ albuminuria (macroalbuminuria/overt nephropathy)",
"Annually from T1DM diagnosis ≥5 yrs;\nannually from T2DM diagnosis"],
["Diabetic\nNephropathy",
"eGFR (Serum Creatinine\n+ CKD-EPI or MDRD formula)",
">60 mL/min/1.73m²",
"CKD Stage 3: eGFR 30–59\nCKD Stage 4: eGFR 15–29\nCKD Stage 5: <15 (ESRD)",
"Annually; more frequent if eGFR <60"],
["Diabetic\nNephropathy",
"24-hr Urine Albumin\n(alternative to spot UACR)",
"<30 mg/24h",
"30–300 mg/24h = microalbuminuria\n>300 mg/24h = macroalbuminuria",
"If UACR unreliable"],
["Lipid Panel\n(Dyslipidaemia)",
"Total Cholesterol\nLDL-C\nHDL-C\nTriglycerides\nNon-HDL-C",
"TC: <200 mg/dL\nLDL: <100 mg/dL\nHDL: >40 (M), >50 (F) mg/dL\nTG: <150 mg/dL\nNon-HDL: <130 mg/dL",
"LDL target in DM: <70 mg/dL (high CV risk)\nLDL <55 mg/dL (very high CV risk)\nTG >500 = pancreatitis risk\nHDL <40(M)/<50(F) = risk",
"At diagnosis, then annually (or more often if on statin therapy)"],
["Liver\n(NAFLD/NASH)",
"ALT, AST\nHepatic steatosis (FIB-4 score)",
"ALT: 7–56 U/L\nAST: 10–40 U/L",
"ALT/AST ↑ in fatty liver disease; FIB-4 >2.67 = advanced fibrosis risk",
"At diagnosis and periodically (especially on statins/thiazolidinediones)"],
["Diabetic\nRetinopathy",
"Dilated fundoscopy\n(no specific blood test)\nHbA1c as surrogate",
"No retinopathy",
"HbA1c ↑ correlates with retinopathy risk;\nannual ophthalmology referral after 5 yrs T1DM;at diagnosis T2DM",
"Annually"],
["Diabetic\nNeuropathy",
"Nerve conduction studies\n(clinical assessment primary)\nThyroid screen (to exclude hypothyroid neuropathy)",
"Normal NCS",
"Reduced nerve conduction velocity;\nTSH elevated if hypothyroid",
"Annually from diagnosis"],
["Thyroid\n(associated autoimmunity\nin T1DM)",
"TSH\nFree T4\nAnti-TPO antibodies",
"TSH: 0.4–4.0 mIU/L\nFT4: 0.8–1.8 ng/dL",
"TSH ↑ = hypothyroidism (Hashimoto's)\nAnti-TPO +ve = autoimmune thyroid disease",
"At diagnosis in T1DM; then every 1–2 yrs"],
["Coeliac Disease\n(associated with T1DM)",
"Anti-tissue transglutaminase IgA (tTG-IgA)\nTotal serum IgA (to exclude IgA deficiency)",
"tTG-IgA: Negative (<4 U/mL)\nTotal IgA: 70–400 mg/dL",
"tTG-IgA >10× ULN = diagnostic of coeliac;\nIf IgA deficient, use IgG-based tests",
"At T1DM diagnosis; repeat if symptoms"],
["Cardiovascular\nRisk",
"hs-CRP\nHomocysteine\nECG",
"hs-CRP: <1.0 mg/L (low risk)\n1.0–3.0 (intermediate)\n>3.0 (high)\nHomocysteine: 5–15 µmol/L",
"hs-CRP >3.0 mg/L = high CV risk\nHomocysteine >15 = hyperhomocysteinaemia (B12/folate deficiency)",
"At baseline; periodically based on risk"],
["Blood Pressure\n& Electrolytes",
"Serum Na, K, Cl, CO₂\nSerum Creatinine/eGFR\nUrine K (if on ACEi/ARB)",
"Na: 136–145 mEq/L\nK: 3.5–5.0 mEq/L\nCr: 0.6–1.2 mg/dL",
"Hyperkalaemia (K >5.5) with ACEi/ARB + DKD;\nHyponatraemia in SIADH",
"Baseline; annually; more frequent if on renin-angiotensin drugs"],
]
content.append(tbl(comp_data, [2.8*cm, 3.2*cm, 3.2*cm, 5.0*cm, 3.2*cm]))
content.append(Spacer(1, 6))
# ── SECTION 8: ROUTINE PANEL ────────────────────────────────────────────────
content.append(h1("8. Routine Laboratory Panel for All Diabetic Patients"))
content.append(Spacer(1, 5))
routine_data = [
["Investigation", "Normal Reference Range", "Finding in DM / Significance"],
["Fasting Plasma Glucose (FPG)", "70–99 mg/dL (3.9–5.5 mmol/L)", "↑ for diagnosis and monitoring; target 80–130 mg/dL in treated DM"],
["HbA1c", "Non-diabetic: <5.7% (<39 mmol/mol)\nPrediabetes: 5.7–6.4%\nTarget in treated DM: <7%", "Primary long-term glycaemic control marker; every 3–6 months"],
["Urine UACR\n(spot urine)", "Normal: <30 mg/g creatinine", "Microalbuminuria 30–300; macroalbuminuria >300; indicates DKD onset"],
["eGFR\n(estimated GFR)", ">60 mL/min/1.73m²", "Tracks DKD progression; guides dosing of metformin and other renally-cleared drugs"],
["Serum Creatinine", "M: 0.7–1.3 mg/dL\nF: 0.6–1.1 mg/dL", "↑ in DKD; required to calculate eGFR"],
["BUN (Blood Urea Nitrogen)", "8–20 mg/dL", "↑ in DKD and dehydration (DKA/HHS)"],
["Serum Electrolytes\n(Na, K, Cl, HCO₃)", "Na 136–145; K 3.5–5.0;\nCl 98–106; HCO₃ 22–29 mEq/L", "K⁺ and HCO₃ critical in DKA; Na⁺ in HHS; K⁺ monitoring on ACEi/ARB"],
["Lipid Panel\n(Total-C, LDL, HDL, TG)", "TC <200; LDL <100; HDL >40(M)/>50(F); TG <150 mg/dL", "Dyslipidaemia common in T2DM; TG ↑↑ = insulin resistance; LDL target <70 (high risk)"],
["Liver Function Tests\n(ALT, AST, ALP, GGT)", "ALT 7–56; AST 10–40;\nALP 44–147; GGT 9–48 U/L", "Fatty liver common in T2DM; monitor on statins and thiazolidinediones; pioglitazone may ↑ ALT"],
["CBC (Full Blood Count)", "Hb M 13.5–17.5, F 12–15.5 g/dL\nWBC 4–11 × 10³/µL\nPlatelets 150–400 × 10³/µL", "Anaemia of CKD; leukocytosis in infections; macrocytosis if B12/folate deficient"],
["Thyroid Function\n(TSH)", "TSH: 0.4–4.0 mIU/L", "Hypothyroidism worsens glycaemic control and dyslipidaemia; mandatory in T1DM"],
["Serum Uric Acid", "M: 3.5–7.2 mg/dL\nF: 2.6–6.0 mg/dL", "↑ in insulin resistance/MetS; associated with DKD progression and gout"],
["Serum Vitamin B12", "200–900 pg/mL (148–664 pmol/L)", "↓ with long-term metformin use; causes neuropathy - check annually in patients on metformin"],
["Urine Dipstick\n(Glucose, Ketones, Protein)", "All negative / trace", "Glucosuria at BG >180 mg/dL; ketonuria in DKA; proteinuria in DKD"],
["Blood Pressure\n(office/home)", "Normal: <130/80 mmHg\nTarget in DM: <130/80 mmHg", "Hypertension in >70% of T2DM; BP control reduces CV and renal events"],
["BMI / Waist Circumference", "BMI 18.5–24.9 kg/m²\nWaist: M <94cm, F <80cm (European)", "Obesity central to T2DM pathogenesis; target weight loss in overweight/obese"],
]
content.append(tbl(routine_data, [3.5*cm, 4.2*cm, 9.7*cm]))
content.append(Spacer(1, 6))
# ── SECTION 9: INSULIN RESISTANCE ───────────────────────────────────────────
content.append(h1("9. Insulin Resistance & Beta-Cell Function Tests"))
content.append(Spacer(1, 5))
ir_data = [
["Test", "Formula / Normal Value", "Interpretation"],
["HOMA-IR\n(Homeostatic Model\nAssessment - Insulin Resistance)",
"HOMA-IR = (Fasting insulin µIU/mL × Fasting glucose mg/dL) / 405\nNormal: <1.9\nInsulin resistance: >2.9",
"Simple estimate of insulin resistance from fasting insulin and glucose. Used in research; not routinely used clinically. Requires accurate fasting insulin assay."],
["HOMA-β\n(Beta-Cell Function)",
"HOMA-β = (20 × Fasting insulin µIU/mL) / (Fasting glucose mmol/L − 3.5)\nNormal: 100%",
"Reflects residual β-cell secretory capacity. Progressively declines in T2DM. <50% suggests significant β-cell loss."],
["Fasting C-Peptide",
"Normal: 0.5–3.0 nmol/L (1.5–9.0 ng/mL)\nT1DM: <0.2 nmol/L\nT2DM/Insulin resistance: Normal/↑",
"Equimolar with insulin; not affected by exogenous insulin. Best test to assess endogenous insulin secretion. Stimulated (glucagon) C-peptide >0.6 nmol/L = adequate reserve."],
["Fasting Insulin",
"Normal fasting: 2–25 µIU/mL (14–174 pmol/L)\nInsulin resistance: >25 µIU/mL (fasting)",
"Elevated fasting insulin = insulin resistance (in absence of hypoglycaemia). If low + hypoglycaemia = exogenous insulin or insulinoma requires further workup."],
["Proinsulin",
"Normal: <13.5 pmol/L\nFasting: <20% of total immunoreactive insulin",
"↑ in insulinoma, β-cell dysfunction. Disproportionate proinsulin >25% total = β-cell dysfunction in T2DM."],
["Hyperinsulinaemic\nEuglycaemic Clamp",
"Gold standard for insulin resistance\nGIR (Glucose Infusion Rate) measures insulin sensitivity",
"Research tool only - not used clinically. GIR <4 mg/kg/min = insulin resistance."],
]
content.append(tbl(ir_data, [3.2*cm, 4.5*cm, 9.7*cm]))
content.append(Spacer(1, 6))
# ── SECTION 10: KETONE TESTING ───────────────────────────────────────────────
content.append(h1("10. Ketone Testing in Diabetes"))
content.append(Spacer(1, 5))
ket_data = [
["Test", "Method", "Normal", "DKA Range", "Notes"],
["Blood β-hydroxybutyrate\n(BOHB)", "Point-of-care meter\nor laboratory",
"<0.3 mmol/L", ">3.0 mmol/L\n(often 5–10 mmol/L in severe DKA)",
"PREFERRED method. Highest sensitivity and specificity for DKA. Falls with successful treatment. Does NOT cross-react with acetone."],
["Urine Ketones\n(Acetotest / Dipstick)", "Dipstick (nitroprusside reaction)",
"Negative", "Large / 3+",
"Detects acetoacetate and acetone ONLY - not β-hydroxybutyrate. May remain positive even as DKA improves (BOHB converts to AcAc). NOT used to monitor treatment."],
["Serum Ketones\n(Acetest tablets)", "Nitroprusside reaction",
"Negative", "Strongly positive",
"Same limitation as urine - does not detect BOHB. Largely replaced by blood BOHB meters."],
["Anion Gap\n(indirect ketosis marker)", "Na − (Cl + HCO₃)\nNormal: 8–12 mEq/L",
"8–12 mEq/L", ">12 mEq/L\n(often >20 in DKA)",
"Used alongside pH and bicarbonate to monitor DKA severity and recovery. Should normalise as DKA resolves."],
]
content.append(tbl(ket_data, [3.0*cm, 2.8*cm, 2.2*cm, 3.2*cm, 6.2*cm]))
content.append(Spacer(1, 6))
# ── SECTION 11: SUMMARY QUICK-REFERENCE ─────────────────────────────────────
content.append(h1("11. Quick-Reference Summary: Key Values at a Glance"))
content.append(Spacer(1, 5))
qr_data = [
["Parameter", "Normal", "Prediabetes", "Diabetes / Target in DM"],
["Fasting Plasma Glucose", "<100 mg/dL\n<5.6 mmol/L", "100–125 mg/dL\n5.6–6.9 mmol/L", "≥126 mg/dL (diagnosis)\nTarget in treated: 80–130 mg/dL"],
["2-hr OGTT Glucose", "<140 mg/dL\n<7.8 mmol/L", "140–199 mg/dL\n7.8–11.0 mmol/L", "≥200 mg/dL (diagnosis)\nTarget in treated: <180 mg/dL (PPG)"],
["HbA1c", "<5.7%\n<39 mmol/mol", "5.7–6.4%\n39–47 mmol/mol", "≥6.5% (diagnosis)\nTarget in treated: <7% (<53 mmol/mol)"],
["Random Glucose", "<140 mg/dL", "N/A", "≥200 mg/dL + symptoms (diagnosis)"],
["Urine UACR", "<30 mg/g", "N/A", "30–300 = microalbuminuria\n>300 = macroalbuminuria"],
["eGFR", ">90 mL/min/1.73m²", "N/A", "CKD Stage 3: 30–59; Stage 4: 15–29; Stage 5: <15"],
["LDL Cholesterol", "<130 mg/dL", "N/A", "Target in DM: <70 mg/dL (high CVD risk)\n<55 mg/dL (very high CVD risk)"],
["Blood Pressure", "<120/80 mmHg", "N/A", "Target in DM: <130/80 mmHg"],
["Serum Creatinine", "M: 0.7–1.3 mg/dL\nF: 0.6–1.1 mg/dL", "N/A", "↑ in DKD; calculate eGFR to stage CKD"],
["TSH (T1DM screen)", "0.4–4.0 mIU/L", "N/A", "Check at diagnosis; ↑ = hypothyroidism"],
["Vitamin B12\n(Metformin patients)", "200–900 pg/mL", "N/A", "Screen annually; replace if <300 pg/mL or symptomatic neuropathy"],
["Blood β-hydroxybutyrate", "<0.3 mmol/L", "N/A", ">3.0 = DKA; 0.6–1.5 = impending ketosis"],
["Arterial pH (DKA)", "7.35–7.45", "N/A", "<7.30 = DKA; <7.00 = severe DKA"],
["Fasting C-Peptide", "0.5–3.0 nmol/L", "N/A", "<0.2 nmol/L = T1DM (absolute insulin deficiency)"],
["HOMA-IR", "<1.9", "N/A", ">2.9 = significant insulin resistance"],
]
content.append(tbl(qr_data, [3.5*cm, 3.5*cm, 3.8*cm, 6.6*cm]))
content.append(Spacer(1, 6))
# ── SECTION 12: MONITORING SCHEDULE ─────────────────────────────────────────
content.append(h1("12. Recommended Monitoring Schedule (ADA 2024)"))
content.append(Spacer(1, 5))
sched_data = [
["Test", "Every Visit\n(3–4 months)", "Every 6 Months", "Annually", "At Diagnosis"],
["HbA1c", "✓ (if not at target)", "✓ (if at target)", "", "✓"],
["Blood Pressure", "✓", "", "", "✓"],
["Weight / BMI", "✓", "", "", "✓"],
["Fasting Glucose", "✓ (self-monitoring)", "", "", "✓"],
["Lipid Panel (Full)", "", "", "✓", "✓"],
["Urine UACR", "", "", "✓", "✓"],
["Serum Creatinine / eGFR", "", "", "✓", "✓"],
["Foot Examination\n(Neuropathy screening)", "", "", "✓", "✓"],
["Dilated Eye Exam", "", "", "✓ (T1DM >5yrs; T2DM from Dx)", "✓ (T2DM)"],
["TSH (T1DM)", "", "", "Every 1–2 yrs", "✓"],
["Vitamin B12\n(on Metformin)", "", "", "✓", "✓"],
["tTG-IgA (T1DM)", "", "", "If symptomatic", "✓"],
["Liver Function Tests", "", "", "✓", "✓"],
["Dental Examination", "", "", "✓", "✓"],
["Flu Vaccine", "✓ (annually)", "", "", ""],
]
content.append(tbl(sched_data, [4.0*cm, 3.5*cm, 3.0*cm, 4.3*cm, 2.6*cm]))
content.append(Spacer(1, 8))
# ── REFERENCES ───────────────────────────────────────────────────────────────
content.append(HRFlowable(width="100%", thickness=1, color=GRIDCLR, spaceBefore=4, spaceAfter=5))
content.append(Paragraph("<b>References</b>", h2_style))
refs = [
"1. American Diabetes Association. <i>Standards of Medical Care in Diabetes 2024.</i> Diabetes Care 2024;47(Suppl 1).",
"2. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. In: <i>Harrison's Principles of Internal Medicine, 22nd Ed.</i> McGraw Hill; 2025.",
"3. McPherson RA, Pincus MR. Diabetes mellitus. In: <i>Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd Ed.</i> Elsevier; 2017.",
"4. Sacks DB, et al. Chapter 33: Carbohydrates. In: <i>Tietz Textbook of Laboratory Medicine, 7th Ed.</i> Elsevier; 2023.",
"5. Katzung BG. Pancreatic Hormones and Antidiabetic Drugs. In: <i>Basic and Clinical Pharmacology, 16th Ed.</i> McGraw Hill; 2021.",
"6. Creasy RK, et al. Gestational Diabetes. In: <i>Maternal-Fetal Medicine: Principles and Practice, 8th Ed.</i> Elsevier; 2019.",
]
for r in refs:
content.append(Paragraph(r, note_style))
content.append(Spacer(1, 5))
content.append(Paragraph(
"Generated by Orris Medical Reference • July 2026 • For educational use only. Always correlate with clinical findings and current institutional guidelines.",
footer_style))
# Build
doc.build(content)
print(f"PDF created: {OUTPUT}")
!
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Laboratory investigations for diabetes in pdf format
Finding Sources
Finding Sources
Reading File
Reading File
Finding Sources
Reading File
Reading File
Reading File
Running Command
mkdir -p /home/daytona/workspace/diabetes-pdf && ls /home/daytona/workspace/diabetes-pdf/
Writing File
~/diabetes-pdf/gen.py
from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.units import inch, cm
from reportlab.platypus import (
SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle, HRFlowable
)
from reportlab.lib.enums import TA_CENTER, TA_JUSTIFY
OUT = "/home/daytona/workspace/diabetes-pdf/Diabetes_Laboratory_Investigations.pdf"
doc = SimpleDocTemplate(OUT, pagesize=A4,
rightMargin=1.8*cm, leftMargin=1.8*cm,
topMargin=2*cm, bottomMargin=2*cm,
title="Laboratory Investigations for Diabetes Mellitus")
styles = getSampleStyleSheet()
W = 17.4*cm
NAVY = colors.HexColor('#0d3b6e')
LTGRAY = colors.HexColor('#eef4fb')
WHITE = colors.white
GRID = colors.HexColor('#b0c8e8')
title_s = ParagraphStyle('T', parent=styles['Title'], fontSize=21,
textColor=NAVY, spaceAfter=4, alignment=TA_CENTER, fontName='Helvetica-Bold')
sub_s = ParagraphStyle('S', parent=styles['Normal'], fontSize=10,
textColor=colors.HexColor('#444'), spaceAfter=10, alignment=TA_CENTER)
body_s = ParagraphStyle('B', parent=styles['Normal'], fontSize=9,
textColor=colors.HexColor('#222'), spaceAfter=4, leading=13, alignment=TA_JUSTIFY)
note_s = ParagraphStyle('N', parent=styles['Normal'], fontSize=8,
textColor=colors.HexColor('#555'), spaceAfter=3, leading=11,
leftIndent=8, fontName='Helvetica-Oblique')
foot_s = ParagraphStyle('F', parent=styles['Normal'], fontSize=7.5,
textColor=colors.HexColor('#888'), alignment=TA_CENTER)
h2_s = ParagraphStyle('H2', parent=styles['Normal'], fontSize=10.5,
textColor=NAVY, spaceBefore=6, spaceAfter=3, fontName='Helvetica-Bold')
def sec(text):
inner = ParagraphStyle('hi', parent=styles['Normal'], fontSize=11.5,
textColor=WHITE, fontName='Helvetica-Bold', leading=16)
t = Table([[Paragraph(text, inner)]], colWidths=[W])
t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,-1), NAVY),
('TOPPADDING', (0,0), (-1,-1), 7),
('BOTTOMPADDING', (0,0), (-1,-1), 7),
('LEFTPADDING', (0,0), (-1,-1), 10),
]))
return t
def tbl(data, widths):
t = Table(data, colWidths=widths)
t.setStyle(TableStyle([
('BACKGROUND', (0,0), (-1,0), NAVY),
('TEXTCOLOR', (0,0), (-1,0), WHITE),
('FONTNAME', (0,0), (-1,0), 'Helvetica-Bold'),
('FONTSIZE', (0,0), (-1,0), 8.5),
('ALIGN', (0,0), (-1,0), 'CENTER'),
('VALIGN', (0,0), (-1,-1), 'MIDDLE'),
('FONTNAME', (0,1), (-1,-1), 'Helvetica'),
('FONTSIZE', (0,1), (-1,-1), 8),
('ROWBACKGROUNDS', (0,1), (-1,-1), [LTGRAY, WHITE]),
('GRID', (0,0), (-1,-1), 0.4, GRID),
('TOPPADDING', (0,0), (-1,-1), 4),
('BOTTOMPADDING', (0,0), (-1,-1), 4),
('LEFTPADDING', (0,0), (-1,-1), 5),
('RIGHTPADDING', (0,0), (-1,-1), 5),
('WORDWRAP', (0,0), (-1,-1), True),
]))
return t
c = []
# ── TITLE ────────────────────────────────────────────────────────────────────
c.append(Spacer(1, 0.35*inch))
c.append(Paragraph("Laboratory Investigations", title_s))
c.append(Paragraph("for Diabetes Mellitus", title_s))
c.append(Paragraph("Diagnostic Criteria • Monitoring Tests • Complication Markers • Reference Values", sub_s))
c.append(HRFlowable(width="100%", thickness=2, color=NAVY, spaceAfter=5))
c.append(Paragraph(
"Sources: Harrison's Principles of Internal Medicine 22E • Henry's Clinical Diagnosis & Management by Laboratory Methods 23E • "
"Tietz Textbook of Laboratory Medicine 7E • ADA Standards of Medical Care 2024 • Katzung's Basic & Clinical Pharmacology 16E",
note_s))
c.append(Spacer(1, 0.12*inch))
# ── 1. CLASSIFICATION ────────────────────────────────────────────────────────
c.append(sec("1. Classification of Diabetes Mellitus"))
c.append(Spacer(1,5))
cls = [
["Type", "Key Features", "Pathophysiology"],
["Type 1 DM\n(T1DM)", "Onset usually <30 yrs; lean; absolute insulin deficiency; prone to DKA; autoimmune markers +ve", "Autoimmune β-cell destruction; HLA-DR3/DR4 association; GAD65, IA-2, ZnT8, IAA autoantibodies"],
["Type 2 DM\n(T2DM)", ">90% of cases; onset usually >40 yrs (earlier with obesity); insulin resistance + relative deficiency; rarely DKA", "Progressive β-cell secretory failure on background of insulin resistance; strong genetic and lifestyle component"],
["Gestational DM\n(GDM)", "Diagnosed during pregnancy 24–28 weeks; resolves postpartum in most; ↑ risk of future T2DM", "Hormonal insulin resistance (hPL, progesterone, cortisol)"],
["LADA", "Adult onset; resembles T2DM initially; slow β-cell destruction; GAD65 antibodies +ve", "5–10% of adults clinically diagnosed as T2DM; ultimately requires insulin"],
["Other Types", "MODY (monogenic); drug-induced (steroids, antipsychotics); pancreatic disease; endocrinopathies", "Exocrine pancreatic disease; Cushing's; acromegaly; haemochromatosis; drugs"],
]
c.append(tbl(cls, [2.3*cm, 7.5*cm, 7.6*cm]))
c.append(Spacer(1,6))
# ── 2. DIAGNOSTIC CRITERIA ───────────────────────────────────────────────────
c.append(sec("2. Diagnostic Criteria (ADA 2024)"))
c.append(Spacer(1,5))
c.append(Paragraph(
"Any <b>ONE</b> of the four criteria below is sufficient for diagnosis. "
"In the absence of unequivocal hyperglycaemia, diagnosis requires <b>two abnormal results</b> "
"from the same sample or two separate samples.",
body_s))
diag = [
["Test", "Normal", "Prediabetes", "Diabetes (Diagnostic)", "Conditions / Notes"],
["Fasting Plasma Glucose\n(FPG)", "<100 mg/dL\n(<5.6 mmol/L)", "IFG: 100–125 mg/dL\n(5.6–6.9 mmol/L)", "≥126 mg/dL\n(≥7.0 mmol/L)", "Fast ≥8 hours (no caloric intake). High biological variation - repeat near threshold."],
["2-hr Plasma Glucose\n75 g OGTT", "<140 mg/dL\n(<7.8 mmol/L)", "IGT: 140–199 mg/dL\n(7.8–11.0 mmol/L)", "≥200 mg/dL\n(≥11.1 mmol/L)", "75 g anhydrous glucose in water. Morning after 3 days unrestricted diet + 10–16h fast."],
["HbA1c\n(Glycated Haemoglobin)", "<5.7%\n(<39 mmol/mol)", "5.7–6.4%\n(39–47 mmol/mol)", "≥6.5%\n(≥48 mmol/mol)", "NGSP-certified, DCCT-standardised lab method only. NOT valid with haemoglobinopathies, haemolysis, recent transfusion."],
["Random Plasma Glucose\n+ Classic Symptoms", "N/A", "N/A", "≥200 mg/dL\n(≥11.1 mmol/L)\n+ symptoms", "Symptoms = polyuria, polydipsia, unexplained weight loss. Sufficient alone if classic symptoms present."],
]
c.append(tbl(diag, [2.9*cm, 2.5*cm, 2.8*cm, 2.7*cm, 6.5*cm]))
c.append(Paragraph("<i>IFG = Impaired Fasting Glucose; IGT = Impaired Glucose Tolerance; OGTT = Oral Glucose Tolerance Test</i>", note_s))
c.append(Spacer(1,6))
# ── 3. GESTATIONAL DM ────────────────────────────────────────────────────────
c.append(sec("3. Gestational Diabetes (GDM) – Screening & Diagnostic Values"))
c.append(Spacer(1,5))
c.append(Paragraph("Screen all women at 24–28 weeks gestation. High-risk women: screen at first prenatal visit.", body_s))
gdm = [
["Approach", "Test", "Time Point", "GDM Threshold (any ONE met)"],
["One-Step IADPSG\n(75 g OGTT, fasting)", "Plasma glucose\n(any ONE value = GDM)", "Fasting\n1 hour\n2 hour", "≥92 mg/dL (5.1 mmol/L)\n≥180 mg/dL (10.0 mmol/L)\n≥153 mg/dL (8.5 mmol/L)"],
["Two-Step (NIH/ACOG)\nStep 1: 50 g GCT\n(non-fasting)", "Plasma glucose at 1h\n→ if positive, do Step 2", "1 hour", "≥130–140 mg/dL (7.2–7.8 mmol/L)\n[threshold varies by institution]"],
["Step 2: 100 g OGTT\n(fasting)\n≥2 values met = GDM", "Carpenter/Coustan\n\nNDDG", "Fasting/1h/2h/3h\n\nFasting/1h/2h/3h", "95 / 180 / 155 / 140 mg/dL\n\n105 / 190 / 165 / 145 mg/dL"],
]
c.append(tbl(gdm, [3.3*cm, 3.5*cm, 2.5*cm, 8.1*cm]))
c.append(Spacer(1,6))
# ── 4. GLYCAEMIC MONITORING ──────────────────────────────────────────────────
c.append(sec("4. Glycaemic Monitoring Tests"))
c.append(Spacer(1,5))
gly = [
["Test", "Reference / Target Values", "Frequency", "Notes & Limitations"],
["HbA1c\n(Glycated Hb)", "Non-diabetic: <5.7% (<39 mmol/mol)\nTarget most adults: <7.0% (<53)\nElderly/frail: <8.0%\nSelected patients: <6.5%", "Every 3 months if uncontrolled;\nevery 6 months if at target", "Reflects ~3-month average BG (RBC lifespan). UNRELIABLE in: haemolytic anaemia, sickle cell disease, thalassaemia, recent transfusion, uremia, iron deficiency."],
["Fasting Plasma\nGlucose (FPG)", "Normal: 70–99 mg/dL\n(3.9–5.5 mmol/L)\nTarget in treated DM: 80–130 mg/dL\n(4.4–7.2 mmol/L)", "Regular self-monitoring;\nroutine clinic labs", "Requires ≥8h fast. High day-to-day biological variation within individuals."],
["Postprandial\nGlucose (2h PPG)", "Normal: <140 mg/dL (<7.8 mmol/L)\nTarget in treated DM: <180 mg/dL\n(<10.0 mmol/L)", "2 hours after start of meal", "Better predictor of HbA1c than FPG alone. Important in gestational DM management."],
["Fructosamine\n(Glycated Serum Protein)", "Normal: 205–285 µmol/L\nPoorly controlled DM: >285 µmol/L", "Use when HbA1c unreliable; reflects ~2–3 week average BG", "Affected by serum albumin levels (requires albumin ≥3 g/dL for reliable result)."],
["1,5-Anhydroglucitol\n(1,5-AG)", "Normal: 10.7–32.0 µg/mL (M)\n6.8–29.3 µg/mL (F)\nLow = poorly controlled DM", "Reflects postprandial hyperglycaemia over preceding 1–2 weeks", "Decreases rapidly when BG >180 mg/dL. Falsely low with SGLT2 inhibitors."],
["Continuous Glucose\nMonitor (CGM)\nTime-in-Range", "Target: >70% in 70–180 mg/dL\nTime below 70 mg/dL: <4%\nTime below 54 mg/dL: <1%\nTime above 180 mg/dL: <25%", "Continuous real-time monitoring", "Cannot be used to diagnose diabetes (requires lab plasma glucose confirmation)."],
["Urine Glucose\n(Glucosuria)", "Absent (negative)", "Screening only; not for diagnosis or monitoring", "Appears only when BG exceeds renal threshold (~180 mg/dL). False negatives in well-controlled DM."],
]
c.append(tbl(gly, [2.8*cm, 4.0*cm, 3.2*cm, 7.4*cm]))
c.append(Spacer(1,6))
# ── 5. AUTOANTIBODIES ────────────────────────────────────────────────────────
c.append(sec("5. Autoantibody Tests – Type 1 DM Diagnosis & Typing"))
c.append(Spacer(1,5))
c.append(Paragraph(
"Islet autoantibodies present in <b>85–90%</b> of immune-mediated T1DM at initial diagnosis. "
"Multiple autoantibodies confer near 100% risk of T1DM progression.",
body_s))
ab = [
["Autoantibody", "Sensitivity in T1DM", "Key Clinical Use"],
["GAD65\n(Anti-glutamic acid decarboxylase)", "~80% at onset; persists longest", "First-line test. Also found in LADA (5–10% of apparent T2DM adults). Most widely used clinically."],
["IA-2A\n(Insulinoma-associated protein 2)", "~60–70%", "Predicts rapid progression. Combined with GADA improves predictive value significantly."],
["IAA\n(Insulin Autoantibodies)", "~50% at diagnosis\nHigher in young children (<5 yrs)", "DO NOT test after insulin therapy started (cannot distinguish from exogenous-insulin antibodies). Most specific predictor in young children."],
["ZnT8A\n(Zinc Transporter 8)", "~60–80% at onset", "Detected in ~26% of T1DM patients negative for other autoantibodies. FDA-approved assay (2014)."],
["ICA\n(Islet Cell Antibodies)", "~80% at onset (older method)", "Largely replaced by more specific assays above. Detected by indirect immunofluorescence."],
["C-Peptide\n(Fasting)", "T1DM: <0.2 nmol/L\nT2DM: 0.5–3.0 nmol/L (normal/high early)", "Best test for endogenous insulin secretion. Not affected by exogenous insulin. Stimulated (post-glucagon) C-peptide >0.6 nmol/L = adequate β-cell reserve."],
["Fasting Serum Insulin", "Normal: 2–25 µIU/mL\n(14–174 pmol/L)\nT1DM: low/undetectable", "Not routine for diagnosis. Used with glucose for HOMA-IR. High fasting insulin + high glucose = insulin resistance (T2DM pattern)."],
]
c.append(tbl(ab, [3.5*cm, 3.0*cm, 10.9*cm]))
c.append(Spacer(1,6))
# ── 6. INSULIN RESISTANCE ────────────────────────────────────────────────────
c.append(sec("6. Insulin Resistance & Beta-Cell Function Indices"))
c.append(Spacer(1,5))
ir = [
["Index", "Formula & Normal Value", "Interpretation"],
["HOMA-IR", "= (Fasting insulin µIU/mL × Fasting glucose mg/dL) / 405\nNormal: <1.9\nInsulin resistance: >2.9", "Widely used research tool. Simple estimate from fasting values. Requires accurate fasting insulin assay; not validated in all populations."],
["HOMA-β", "= (20 × Fasting insulin µIU/mL) / (Fasting glucose mmol/L − 3.5)\nNormal: ~100%", "Estimates residual β-cell secretory capacity. Progressively declines in T2DM natural history."],
["Fasting C-Peptide", "Normal: 0.5–3.0 nmol/L (1.5–9.0 ng/mL)\nT1DM: <0.2 nmol/L\nT2DM early: normal/↑", "Gold standard for measuring endogenous insulin secretion. Stimulated C-peptide >0.6 nmol/L = preserved β-cell function."],
["Proinsulin", "Normal fasting: <13.5 pmol/L\n(<20% of total immunoreactive insulin", "↑ in insulinoma; disproportionate proinsulin (>25% of total) = β-cell dysfunction in T2DM."],
]
c.append(tbl(ir, [2.5*cm, 5.5*cm, 9.4*cm]))
c.append(Spacer(1,6))
# ── 7. ACUTE COMPLICATIONS ───────────────────────────────────────────────────
c.append(sec("7. Laboratory Findings in Acute Diabetic Emergencies"))
c.append(Spacer(1,5))
acute = [
["Parameter", "DKA (Diabetic Ketoacidosis)", "HHS (Hyperosmolar Hyperglycaemic State)", "Hypoglycaemia"],
["Plasma Glucose", "250–600 mg/dL\n(13.9–33.3 mmol/L)", ">600 mg/dL\n(often 900–1200 mg/dL)", "<70 mg/dL (<3.9)\nSevere: <54 mg/dL (<3.0)"],
["Arterial pH", "<7.30\nSevere: <7.00", "Normal to slightly ↓\n(7.35–7.45)", "Normal (7.35–7.45)"],
["Serum Bicarbonate\n(HCO₃)", "<18 mEq/L\nSevere: <10 mEq/L", ">18 mEq/L\n(usually normal)", "Normal (22–29 mEq/L)"],
["Anion Gap\n[Na − (Cl + HCO₃)]", "↑↑ >12 mEq/L\n(often >20; high AG metabolic acidosis)\nNormal: 8–12 mEq/L", "Normal or mildly ↑\n(8–16 mEq/L)", "Normal"],
["Blood β-OH-Butyrate\n(β-hydroxybutyrate)", "Markedly ↑: >3.0 mmol/L\n(often 5–10 mmol/L)\nNormal: <0.3 mmol/L", "Absent or trace\n(<0.3 mmol/L)", "Normal or ↓\n(fasting hypoglycaemia)"],
["Urine Ketones\n(dipstick)", "Large / 3+ positive", "Absent to trace", "Normal"],
["Serum Osmolality", "290–320 mOsm/kg\n(Normal: 275–295)", ">320 mOsm/kg\n(often 350–380)", "Normal"],
["Serum Sodium (Na⁺)", "Variable – may be low/normal/high\nCorrected Na = Na + 1.6×[(Glu−100)/100]", "Normal to high\n(130–150 mEq/L)", "Normal"],
["Serum Potassium (K⁺)", "Initially normal/high (ICF shift)\nthen FALLS rapidly with insulin Rx\n– Monitor every 1–2h!", "May be normal to high", "Normal"],
["Serum Creatinine / eGFR", "May be ↑ (dehydration)\nNormal: Cr 0.6–1.2 mg/dL", "↑↑ (severe dehydration)\nBUN often >30 mg/dL", "Normal"],
["WBC Count", "Leukocytosis 10,000–25,000/µL\n(stress response; does not always = infection)", "Leukocytosis", "Normal"],
["Serum Phosphate", "Initially normal/high → falls rapidly with insulin treatment. Monitor during treatment.", "May be mildly ↓", "Normal"],
["Serum Lactate", "May be mildly ↑; exclude concurrent lactic acidosis\nNormal: 0.5–2.0 mmol/L", "Normal", "Low in severe insulin-induced hypoglycaemia"],
]
c.append(tbl(acute, [3.2*cm, 4.9*cm, 4.8*cm, 4.5*cm]))
c.append(Paragraph("<i>Key DKA criteria: Glucose >250 mg/dL + pH <7.30 + Bicarbonate <18 + Ketones positive. HHS: Glucose >600 + Osmolality >320 + No significant ketosis.</i>", note_s))
c.append(Spacer(1,6))
# ── 8. KETONE TESTING ────────────────────────────────────────────────────────
c.append(sec("8. Ketone Testing in Diabetes"))
c.append(Spacer(1,5))
ket = [
["Test", "Normal", "DKA Range", "Clinical Notes"],
["Blood β-hydroxybutyrate\n(BOHB) – PREFERRED", "<0.3 mmol/L", ">3.0 mmol/L\n(severe: >5 mmol/L)", "Most sensitive/specific for DKA. Falls with treatment (unlike acetoacetate). Use to monitor DKA recovery. Available on point-of-care meters."],
["Urine Ketones\n(Acetest / Nitroprusside dipstick)", "Negative", "Large / 3+", "Detects acetoacetate and acetone ONLY – NOT β-hydroxybutyrate. May remain positive even as DKA resolves. NOT suitable for monitoring treatment response."],
["Anion Gap\n(indirect marker)", "8–12 mEq/L", ">12 (often >20 in DKA)", "Falls as DKA resolves. Should normalise before stopping IV insulin infusion."],
["Urine pH / Dipstick", "pH 4.5–8.0 (typically ~6)", "pH <5 (acidic)\nKetones 3+", "Urine dipstick ketones confirm ketonuria. Always confirm with blood BOHB if available."],
]
c.append(tbl(ket, [3.2*cm, 2.5*cm, 2.8*cm, 8.9*cm]))
c.append(Spacer(1,6))
# ── 9. RENAL & COMPLICATIONS ─────────────────────────────────────────────────
c.append(sec("9. Monitoring for Chronic Complications"))
c.append(Spacer(1,5))
comp = [
["Complication", "Test", "Normal Value", "Abnormal Threshold", "Frequency"],
["Diabetic Kidney\nDisease (DKD)", "Urine Albumin-to-Creatinine\nRatio (UACR – spot urine)", "<30 mg/g\n(normoalbuminuria)", "30–300 mg/g = moderately ↑\n(microalbuminuria)\n>300 mg/g = severely ↑\n(macroalbuminuria)", "Annually: T1DM from 5 yrs post-diagnosis; T2DM from diagnosis"],
["DKD", "eGFR (Serum Creatinine\n+ CKD-EPI formula)", ">60 mL/min/\n1.73m²", "Stage 3: 30–59\nStage 4: 15–29\nStage 5 (ESRD): <15", "Annually; more frequent if eGFR <60"],
["DKD", "24-hr Urine Albumin\n(if UACR unreliable)", "<30 mg/24h", "30–300 = micro\n>300 = macro\n>3500 = nephrotic", "Selectively"],
["Dyslipidaemia\n(CVD risk)", "Fasting Lipid Panel\n(TC, LDL-C, HDL-C, TG,\nNon-HDL-C)", "TC <200 mg/dL\nLDL <100 mg/dL\nHDL >40(M)/>50(F) mg/dL\nTG <150 mg/dL\nNon-HDL <130 mg/dL", "LDL target in DM: <70 mg/dL\n(high CV risk);\n<55 mg/dL (very high risk)\nTG >500 = pancreatitis risk", "At diagnosis; then annually"],
["Liver (NAFLD/NASH)", "ALT, AST\nFIB-4 score", "ALT 7–56 U/L\nAST 10–40 U/L", "ALT/AST >3× ULN = significant hepatocellular injury\nFIB-4 >2.67 = advanced fibrosis", "At diagnosis; annually (esp. on statins/pioglitazone)"],
["Thyroid\n(autoimmunity T1DM)", "TSH, Free T4\nAnti-TPO antibodies", "TSH: 0.4–4.0 mIU/L\nFT4: 0.8–1.8 ng/dL", "↑ TSH = hypothyroidism\n(Hashimoto's)\nAnti-TPO +ve = autoimmune thyroid disease", "At T1DM diagnosis; every 1–2 yrs"],
["Coeliac Disease\n(associated T1DM)", "Anti-tTG IgA\nTotal serum IgA", "tTG-IgA: <4 U/mL\nIgA: 70–400 mg/dL", ">10× ULN = diagnostic\n(if IgA deficient: use IgG-based tests)", "At T1DM diagnosis; if symptomatic"],
["Cardiovascular\nRisk", "hs-CRP\nHomocysteine", "hs-CRP: <1.0 mg/L\nHomocysteine: 5–15 µmol/L", "hs-CRP >3.0 mg/L = high CV risk\nHomocysteine >15 = hyperhomocysteinaemia", "Baseline; periodically"],
["Neuropathy", "Nerve Conduction Studies\n(clinical + monofilament test)", "Normal NCS", "Reduced conduction velocity;\nLoss of 10-g monofilament sensation", "Annually from diagnosis"],
["Vitamin B12\n(Metformin use)", "Serum Vitamin B12", "200–900 pg/mL\n(148–664 pmol/L)", "Deficiency: <200 pg/mL\n(↑ risk with long-term metformin)", "Annually in metformin users"],
["Uric Acid", "Serum Uric Acid", "M: 3.5–7.2 mg/dL\nF: 2.6–6.0 mg/dL", "↑ in insulin resistance/MetS;\nassociated with DKD progression and gout", "At diagnosis; periodically"],
]
c.append(tbl(comp, [2.5*cm, 3.0*cm, 3.1*cm, 5.0*cm, 3.8*cm]))
c.append(Spacer(1,6))
# ── 10. ROUTINE PANEL ────────────────────────────────────────────────────────
c.append(sec("10. Routine Laboratory Panel for All Diabetic Patients"))
c.append(Spacer(1,5))
rout = [
["Investigation", "Normal Reference Range", "Finding in Diabetes / Significance"],
["Fasting Plasma Glucose", "70–99 mg/dL\n(3.9–5.5 mmol/L)", "↑ for diagnosis (≥126) and monitoring. Target in treated DM: 80–130 mg/dL."],
["HbA1c", "Non-diabetic: <5.7% (<39 mmol/mol)", "Primary long-term glycaemic marker. Diagnostic ≥6.5%. Treatment target <7% for most adults."],
["Urine UACR (spot)", "<30 mg/g creatinine", "Microalbuminuria 30–300; macroalbuminuria >300; signals onset of diabetic kidney disease."],
["Serum Creatinine\n+ eGFR", "Cr: M 0.7–1.3, F 0.6–1.1 mg/dL\neGFR: >60 mL/min/1.73m²", "Tracks DKD progression; eGFR guides dosing of metformin (hold if eGFR <30) and other renally-cleared drugs."],
["Serum Electrolytes\n(Na, K, Cl, HCO₃)", "Na 136–145; K 3.5–5.0;\nCl 98–106; HCO₃ 22–29 mEq/L", "K⁺ and HCO₃⁻ critical in DKA/HHS. K⁺ monitoring essential on ACEi/ARB + DKD. HCO₃⁻ monitors acidosis resolution."],
["BUN (Urea)", "8–20 mg/dL\n(2.9–7.1 mmol/L)", "↑ in DKD and in dehydration (DKA/HHS). BUN:Cr ratio >20 = pre-renal."],
["Lipid Panel\n(Full fasting)", "TC <200; LDL <100; HDL >40/50;\nTG <150 mg/dL", "Dyslipidaemia common in T2DM (↑TG, ↓HDL, small dense LDL). LDL target <70 mg/dL in high CV risk."],
["Liver Function Tests\n(ALT, AST, ALP, GGT)", "ALT 7–56; AST 10–40;\nALP 44–147; GGT 9–48 U/L", "NAFLD/NASH common in T2DM. Monitor on statins and thiazolidinediones. ALT ↑ in pioglitazone-related hepatotoxicity."],
["CBC (Full Blood Count)", "Hb M 13.5–17.5, F 12–15.5 g/dL\nWBC 4–11×10³/µL\nPlatelets 150–400×10³/µL", "Anaemia of CKD in DKD. Leukocytosis signals infection (especially foot infections, UTI). Macrocytosis: B12/folate deficiency."],
["Thyroid Function (TSH)", "TSH: 0.4–4.0 mIU/L", "Hypothyroidism worsens glycaemic control and dyslipidaemia. Mandatory at T1DM diagnosis; check in unexplained T2DM worsening."],
["Vitamin B12", "200–900 pg/mL\n(148–664 pmol/L)", "↓ with long-term metformin use (blocks B12 absorption). Causes neuropathy – check annually in long-term metformin users."],
["Serum Uric Acid", "M 3.5–7.2; F 2.6–6.0 mg/dL", "↑ in insulin resistance/metabolic syndrome. Associated with DKD progression. Risk of gout."],
["Blood Pressure\n(office/home)", "Normal: <120/80 mmHg\nTarget in DM: <130/80 mmHg", "Hypertension in >70% of T2DM. BP control reduces CV events, DKD progression, retinopathy, and stroke risk."],
["Urine Dipstick\n(Glucose, Ketones, Protein)", "All negative/trace", "Glucosuria at BG >180 mg/dL; ketonuria in DKA; proteinuria signals DKD (confirm with UACR)."],
]
c.append(tbl(rout, [3.5*cm, 3.8*cm, 10.1*cm]))
c.append(Spacer(1,6))
# ── 11. QUICK REFERENCE ──────────────────────────────────────────────────────
c.append(sec("11. Quick-Reference: Key Values at a Glance"))
c.append(Spacer(1,5))
qr = [
["Parameter", "Normal", "Prediabetes", "Diabetes / Treatment Target"],
["Fasting Plasma Glucose", "<100 mg/dL\n<5.6 mmol/L", "100–125 mg/dL\n5.6–6.9 mmol/L", "Diagnosis: ≥126 mg/dL\nTarget: 80–130 mg/dL (treated)"],
["2-hr OGTT Glucose", "<140 mg/dL\n<7.8 mmol/L", "140–199 mg/dL\n7.8–11.0 mmol/L", "Diagnosis: ≥200 mg/dL\nTarget: <180 mg/dL (PPG, treated)"],
["HbA1c", "<5.7%\n<39 mmol/mol", "5.7–6.4%\n39–47 mmol/mol", "Diagnosis: ≥6.5%\nTarget: <7.0% (most adults)"],
["Urine UACR", "<30 mg/g", "—", "30–300 = microalbuminuria\n>300 = macroalbuminuria"],
["eGFR", ">90 mL/min/1.73m²", "—", "Stage 3: 30–59; Stage 4: 15–29;\nStage 5 (ESRD): <15"],
["LDL Cholesterol", "<130 mg/dL", "—", "Target in DM: <70 mg/dL\nVery high CV risk: <55 mg/dL"],
["Blood Pressure", "<120/80 mmHg", "—", "Target in DM: <130/80 mmHg"],
["Blood β-OH-Butyrate", "<0.3 mmol/L", "—", "0.6–1.5 = impending ketosis\n>3.0 = DKA"],
["Arterial pH (DKA)", "7.35–7.45", "—", "<7.30 = DKA\n<7.00 = severe DKA"],
["Fasting C-Peptide", "0.5–3.0 nmol/L", "—", "<0.2 nmol/L = T1DM (absolute insulin deficiency)"],
["HOMA-IR", "<1.9", "—", ">2.9 = significant insulin resistance"],
["Vitamin B12\n(Metformin users)", "200–900 pg/mL", "—", "<200 = deficiency; <300 = borderline\n(replace if symptomatic neuropathy)"],
["TSH", "0.4–4.0 mIU/L", "—", "↑ = hypothyroidism; screen all T1DM\nat diagnosis and every 1–2 yrs"],
]
c.append(tbl(qr, [3.8*cm, 3.3*cm, 3.6*cm, 6.7*cm]))
c.append(Spacer(1,6))
# ── 12. MONITORING SCHEDULE ──────────────────────────────────────────────────
c.append(sec("12. Recommended Monitoring Schedule (ADA 2024)"))
c.append(Spacer(1,5))
sched = [
["Test / Investigation", "At\nDiagnosis", "Every Visit\n(3–4 months)", "Every\n6 Months", "Annually"],
["HbA1c", "✓", "✓ (if not at target)", "✓ (if at target)", "—"],
["Blood Pressure", "✓", "✓", "—", "—"],
["Weight / BMI / Waist", "✓", "✓", "—", "—"],
["Fasting Glucose (self-monitor)", "✓", "✓", "—", "—"],
["Lipid Panel (full)", "✓", "—", "—", "✓"],
["Urine UACR", "✓", "—", "—", "✓"],
["Serum Creatinine / eGFR", "✓", "—", "—", "✓"],
["Liver Function Tests", "✓", "—", "—", "✓"],
["Dilated Eye Exam", "✓ (T2DM)\nAt 5 yrs (T1DM)", "—", "—", "✓"],
["Foot Exam (neuropathy)", "✓", "—", "—", "✓"],
["TSH (T1DM)", "✓", "—", "—", "Every 1–2 yrs"],
["Vitamin B12 (metformin)", "✓", "—", "—", "✓"],
["tTG-IgA Coeliac (T1DM)", "✓", "—", "—", "If symptomatic"],
["Uric Acid", "✓", "—", "—", "✓"],
["Annual Flu Vaccine", "—", "—", "—", "✓"],
["Dental Examination", "✓", "—", "—", "✓"],
]
c.append(tbl(sched, [5.0*cm, 2.2*cm, 3.2*cm, 2.5*cm, 4.5*cm]))
c.append(Spacer(1,8))
# ── REFERENCES ───────────────────────────────────────────────────────────────
c.append(HRFlowable(width="100%", thickness=1, color=GRID, spaceBefore=4, spaceAfter=5))
c.append(Paragraph("<b>References</b>", h2_s))
refs = [
"1. American Diabetes Association. <i>Standards of Medical Care in Diabetes 2024.</i> Diabetes Care 2024;47(Suppl 1).",
"2. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 Diabetes. In: <i>Harrison's Principles of Internal Medicine, 22nd Ed.</i> McGraw Hill; 2025.",
"3. McPherson RA, Pincus MR. Diabetes Mellitus. In: <i>Henry's Clinical Diagnosis and Management by Laboratory Methods, 23rd Ed.</i> Elsevier.",
"4. Sacks DB, et al. Carbohydrates. In: <i>Tietz Textbook of Laboratory Medicine, 7th Ed.</i> Elsevier; 2023.",
"5. Katzung BG. Pancreatic Hormones and Antidiabetic Drugs. In: <i>Basic and Clinical Pharmacology, 16th Ed.</i> McGraw Hill; 2021.",
"6. Resnik R, et al. Gestational Diabetes. In: <i>Creasy & Resnik's Maternal-Fetal Medicine, 8th Ed.</i> Elsevier; 2019.",
]
for r in refs:
c.append(Paragraph(r, note_s))
c.append(Spacer(1,5))
c.append(Paragraph(
"Generated by Orris Medical Reference • July 2026 • For educational use only. Always correlate with clinical findings and institutional guidelines.",
foot_s))
doc.build(c)
print("Done:", OUT)
Running Command
cd /home/daytona/workspace/diabetes-pdf && python gen.py
Running Command
ls -lh /home/daytona/workspace/diabetes-pdf/Diabetes_Laboratory_Investigations.pdf
Your PDF is ready:
Diabetes Laboratory Investigations
PDF Document · PDF
The PDF contains 12 comprehensive sections:
-
Classification - T1DM, T2DM, GDM, LADA, and other types with pathophysiology
-
Diagnostic Criteria (ADA 2024) - All 4 routes to diagnosis with exact cutoffs:
- FPG ≥126 mg/dL / HbA1c ≥6.5% / 2-hr OGTT ≥200 mg/dL / Random ≥200 + symptoms
- Prediabetes ranges for each test
-
Gestational Diabetes - One-step IADPSG and Two-step NIH/ACOG thresholds (fasting/1h/2h/3h values)
-
Glycaemic Monitoring Tests - HbA1c targets, FPG targets, PPG targets, fructosamine, 1,5-AG, CGM time-in-range values
-
Autoantibody Tests - GAD65, IA-2A, IAA, ZnT8A, ICA sensitivities and clinical uses; C-peptide values for T1DM vs T2DM
-
Insulin Resistance Indices - HOMA-IR, HOMA-β, C-peptide, proinsulin with formulas and normal values
-
Acute Emergencies - DKA vs HHS vs Hypoglycaemia: glucose, pH, HCO₃, anion gap, ketones, osmolality, electrolytes
-
Ketone Testing - Blood β-hydroxybutyrate (preferred), urine dipstick limitations, anion gap monitoring
-
Chronic Complication Monitoring - DKD (UACR, eGFR), lipids, liver function, thyroid, coeliac, cardiovascular risk, neuropathy, B12
-
Routine Lab Panel - All 15 standard tests with normal ranges and significance in diabetes
-
Quick-Reference Summary Table - All key values in one place
-
Recommended Monitoring Schedule - ADA 2024 frequency table (at diagnosis / every visit / 6-monthly / annually)
Sources: Harrison's 22E, Henry's Lab Methods 23E, Tietz Lab Medicine 7E, ADA Standards 2024, Katzung's Pharmacology 16E.
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