const pptxgen = require("pptxgenjs");
const { execSync } = require("child_process");

// Fetch images as base64
const imageUrls = [
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_941c21066dfd3864f40b5622a42c85b1791757b3d5bc203e73b2853099bfe1a8.jpg",  // insulin signaling
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_813a248f26e63929707d7321e9dd648d0663b85caf1f97e30270cebb42bc33b6.jpg",  // obesity->T2DM->complications
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_102b96ba8f3f670845b3e31d4c8ac898fa119a78e5babe19cc600103962cd244.jpg",  // diabetic foot
  "https://cdn.orris.care/cdss_images/pmc_clinical_VQA_71d3003edcc2a813ec4021c6862a60f156a23fffe7656d6138554444b23f0a69.jpg",  // retinopathy
  "https://cdn.orris.care/cdss_images/HARRISON_1763035986492_e2de3a37-3e6e-4ec4-9178-bf8624edacba.png",  // DKA/HHS lab values table
];

console.log("Fetching images...");
let images = [];
try {
  const result = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`,
    { maxBuffer: 50 * 1024 * 1024 }
  ).toString();
  images = JSON.parse(result);
  console.log("Images fetched:", images.map(i => i.error ? "ERROR: " + i.error : "OK"));
} catch (e) {
  console.error("Image fetch error:", e.message);
  images = imageUrls.map(url => ({ url, base64: null, error: e.message }));
}

// ─── COLOUR PALETTE ────────────────────────────────────────────────────────
const C = {
  navy:    "0D1F4F",   // dominant dark
  blue:    "1565C0",   // primary accent
  teal:    "00838F",   // secondary accent
  amber:   "F57F17",   // highlight / warning
  red:     "C62828",   // danger / emergency
  white:   "FFFFFF",
  offwhite:"F5F7FA",
  light:   "E3F2FD",
  muted:   "90A4AE",
  text:    "212121",
  subtext: "455A64",
};

let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Orris Medical Education";
pres.title = "Diabetes Mellitus & Diabetic Emergencies";

// ─── HELPERS ────────────────────────────────────────────────────────────────
function addBg(slide, color) {
  slide.background = { color };
}

function addAccentBar(slide, color, h = 0.08) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h, fill: { color } });
}

function addBottomBar(slide, color = C.navy) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.45, w: "100%", h: 0.18, fill: { color } });
}

function sectionTitle(slide, label, bgColor = C.navy) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: bgColor } });
  slide.addShape(pres.ShapeType.rect, { x: 0.4, y: 2.3, w: 0.12, h: 1.2, fill: { color: C.amber } });
  slide.addText(label, {
    x: 0.7, y: 2.2, w: 8.6, h: 1.5,
    fontSize: 42, bold: true, color: C.white,
    fontFace: "Calibri", valign: "middle"
  });
}

function contentHeader(slide, title, sub = "") {
  addBg(slide, C.offwhite);
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: 0.75, fill: { color: C.navy } });
  slide.addText(title, {
    x: 0.3, y: 0.05, w: 9.4, h: 0.65,
    fontSize: 22, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });
  if (sub) {
    slide.addText(sub, {
      x: 0.3, y: 0.72, w: 9.4, h: 0.28,
      fontSize: 10, color: C.subtext, fontFace: "Calibri", italic: true
    });
  }
  addBottomBar(slide);
}

function bullets(slide, items, x, y, w, h, fontSize = 13, color = C.text) {
  const textItems = items.map((item, i) => {
    if (typeof item === "string") {
      return { text: item, options: { bullet: { type: "bullet" }, breakLine: i < items.length - 1, fontSize, color, fontFace: "Calibri", paraSpaceBefore: 4 } };
    }
    return { text: item.text, options: { bullet: item.bullet !== false ? { type: "bullet" } : false, bold: item.bold || false, breakLine: i < items.length - 1, fontSize: item.size || fontSize, color: item.color || color, fontFace: "Calibri", paraSpaceBefore: item.space || 4, indentLevel: item.indent || 0 } };
  });
  slide.addText(textItems, { x, y, w, h, valign: "top" });
}

function box(slide, x, y, w, h, bgColor, title, titleColor, bodyItems, bodyFontSize = 11) {
  slide.addShape(pres.ShapeType.rect, { x, y, w, h, fill: { color: bgColor }, line: { color: C.muted, pt: 0.5 }, shadow: { type: "outer", blur: 4, offset: 2, angle: 45, color: "888888", opacity: 0.3 } });
  if (title) {
    slide.addText(title, { x: x + 0.1, y: y + 0.06, w: w - 0.2, h: 0.3, fontSize: 12, bold: true, color: titleColor || C.white, fontFace: "Calibri" });
  }
  if (bodyItems && bodyItems.length) {
    const textItems = bodyItems.map((item, i) => ({
      text: typeof item === "string" ? item : item.text,
      options: {
        bullet: { type: "bullet" },
        breakLine: i < bodyItems.length - 1,
        fontSize: bodyFontSize,
        color: C.text,
        fontFace: "Calibri",
        paraSpaceBefore: 3,
        bold: typeof item === "object" && item.bold,
      }
    }));
    slide.addText(textItems, { x: x + 0.1, y: y + (title ? 0.38 : 0.1), w: w - 0.2, h: h - (title ? 0.45 : 0.2), valign: "top" });
  }
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 1 — TITLE
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } });
  // Gradient-like layered shapes
  s.addShape(pres.ShapeType.rect, { x: 6.5, y: 0, w: 3.5, h: "100%", fill: { color: C.blue }, transparency: 60 });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.8, w: "100%", h: 0.82, fill: { color: C.teal }, transparency: 40 });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: "100%", fill: { color: C.amber } });

  s.addText("DIABETES MELLITUS", {
    x: 0.5, y: 0.8, w: 9, h: 0.9,
    fontSize: 38, bold: true, color: C.white, fontFace: "Calibri", charSpacing: 3
  });
  s.addText("& DIABETIC EMERGENCIES", {
    x: 0.5, y: 1.65, w: 9, h: 0.7,
    fontSize: 28, bold: false, color: C.amber, fontFace: "Calibri", charSpacing: 2
  });
  s.addShape(pres.ShapeType.line, { x: 0.5, y: 2.48, w: 6, h: 0, line: { color: C.teal, pt: 2 } });
  s.addText("Physiology • Pathophysiology • Clinical Features\nNatural History • Investigations • Management", {
    x: 0.5, y: 2.65, w: 8.5, h: 0.8,
    fontSize: 14, color: C.muted, fontFace: "Calibri", lineSpacingMultiple: 1.4
  });
  s.addText("Goldman-Cecil Medicine | Harrison's Principles of Internal Medicine\nFamily Medicine | Rosen's Emergency Medicine", {
    x: 0.5, y: 4.9, w: 9, h: 0.55,
    fontSize: 10, color: C.white, fontFace: "Calibri", italic: true, transparency: 20
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 2 — TABLE OF CONTENTS
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Table of Contents");
  const sections = [
    { num: "01", label: "Normal Glucose Physiology & Insulin Secretion" },
    { num: "02", label: "Definition & Classification of Diabetes Mellitus" },
    { num: "03", label: "Pathophysiology — Type 1 & Type 2 DM" },
    { num: "04", label: "Clinical Features & Natural History" },
    { num: "05", label: "Investigations & Diagnostic Criteria" },
    { num: "06", label: "Management of Diabetes Mellitus" },
    { num: "07", label: "Chronic Complications (Micro & Macrovascular)" },
    { num: "08", label: "Diabetic Ketoacidosis (DKA)" },
    { num: "09", label: "Hyperosmolar Hyperglycaemic State (HHS)" },
    { num: "10", label: "Hypoglycaemia" },
  ];
  sections.forEach((sec, i) => {
    const col = i < 5 ? 0 : 1;
    const row = i < 5 ? i : i - 5;
    const x = col === 0 ? 0.3 : 5.2;
    const y = 0.95 + row * 0.85;
    s.addShape(pres.ShapeType.rect, { x, y, w: 4.7, h: 0.72, fill: { color: col === 0 ? C.navy : C.blue }, shadow: { type: "outer", blur: 3, offset: 2, angle: 45, color: "555555", opacity: 0.25 } });
    s.addText(sec.num, { x: x + 0.1, y, w: 0.55, h: 0.72, fontSize: 20, bold: true, color: C.amber, fontFace: "Calibri", valign: "middle", align: "center" });
    s.addShape(pres.ShapeType.line, { x: x + 0.65, y: y + 0.12, w: 0, h: 0.48, line: { color: C.teal, pt: 1.5 } });
    s.addText(sec.label, { x: x + 0.75, y, w: 3.85, h: 0.72, fontSize: 11.5, color: C.white, fontFace: "Calibri", valign: "middle" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — PHYSIOLOGY
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "01  Normal Glucose Physiology\n      & Insulin Secretion", C.navy);
  s.addText("Foundation: Understanding normal before the pathological", {
    x: 0.7, y: 3.8, w: 8, h: 0.4, fontSize: 14, color: C.teal, fontFace: "Calibri", italic: true
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 3 — GLUCOSE PHYSIOLOGY
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Normal Glucose Homeostasis", "Glucose-Insulin axis");
  
  // Left column
  box(s, 0.3, 0.9, 4.2, 2.1, C.navy, "Insulin Secretion (Pancreatic β-Cells)", C.amber, [
    "Glucose enters β-cells via GLUT-2 transporter",
    "Glycolysis → ATP ↑ → K⁺ ATP channels close",
    "Membrane depolarization → Ca²⁺ influx",
    "Insulin granule exocytosis",
    "First phase: rapid (0–10 min); Second phase: sustained",
  ], 11);
  
  box(s, 0.3, 3.1, 4.2, 2.1, C.teal, "Insulin Actions on Target Tissues", C.white, [
    "Muscle: GLUT-4 translocation → glucose uptake",
    "Liver: glycogenesis ↑, gluconeogenesis ↓",
    "Adipose: lipogenesis ↑, lipolysis ↓",
    "Protein synthesis ↑, K⁺ uptake ↑",
    "Counter-regulatory: glucagon, cortisol, GH, epinephrine",
  ], 11);
  
  // Right column - image
  if (images[0] && images[0].base64) {
    s.addImage({ data: images[0].base64, x: 4.75, y: 0.88, w: 4.9, h: 3.2 });
    s.addText("Insulin signalling pathway — GLUT-4 translocation (PMC)", {
      x: 4.75, y: 4.08, w: 4.9, h: 0.25, fontSize: 8, color: C.muted, italic: true, fontFace: "Calibri"
    });
  } else {
    box(s, 4.75, 0.88, 4.9, 3.4, C.light, "Insulin Signalling Pathway", C.navy, [
      "Insulin → binds receptor → IRS phosphorylation",
      "PI3K → AKT → PDK1 activation",
      "GLUT-4 vesicles exocytosed to membrane",
      "Glucose enters cell → metabolism or storage",
    ], 12);
  }
  
  // Normal values box
  s.addShape(pres.ShapeType.rect, { x: 4.75, y: 4.35, w: 4.9, h: 0.85, fill: { color: C.amber }, transparency: 15 });
  s.addText([
    { text: "Normal Fasting Glucose: ", options: { bold: true, fontSize: 11, color: C.navy } },
    { text: "3.9–5.5 mmol/L (70–99 mg/dL)  ", options: { fontSize: 11, color: C.text } },
    { text: "Normal 2-hr OGTT: ", options: { bold: true, fontSize: 11, color: C.navy } },
    { text: "<7.8 mmol/L (<140 mg/dL)", options: { fontSize: 11, color: C.text } },
  ], { x: 4.85, y: 4.42, w: 4.7, h: 0.7, valign: "middle", wrap: true });
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — CLASSIFICATION
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "02  Definition & Classification\n      of Diabetes Mellitus", C.blue);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 4 — DEFINITION & CLASSIFICATION
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Definition & Classification of Diabetes Mellitus");
  
  // Definition
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.85, w: 9.4, h: 0.65, fill: { color: C.light } });
  s.addText([
    { text: "Definition: ", options: { bold: true, fontSize: 13, color: C.navy } },
    { text: "Diabetes mellitus is a chronic metabolic disorder characterised by hyperglycaemia resulting from absolute or relative insulin deficiency, insulin resistance, or both — leading to long-term micro- and macrovascular complications.", options: { fontSize: 12, color: C.text } }
  ], { x: 0.45, y: 0.87, w: 9.1, h: 0.6, valign: "middle", wrap: true });

  const types = [
    { title: "Type 1 DM", color: C.red, items: ["Autoimmune β-cell destruction", "Absolute insulin deficiency", "Prone to DKA", "~5–10% of all DM", "Peak onset: childhood / adolescence"] },
    { title: "Type 2 DM", color: C.blue, items: ["Insulin resistance + relative deficiency", "Progressive β-cell failure", "~90–95% of all DM", "Associated with obesity, sedentary lifestyle", "Insidious onset"] },
    { title: "Gestational DM", color: C.teal, items: ["First detected in pregnancy", "Placental diabetogenic hormones", "~6% of pregnancies", "↑ risk of T2DM later in life", "Resolves post-delivery (usually)"] },
    { title: "Other Types", color: C.subtext, items: ["MODY (monogenic diabetes)", "Secondary: pancreatitis, drugs", "Cushing's, acromegaly", "Neonatal DM", "Post-transplant DM"] },
  ];
  types.forEach((t, i) => {
    const x = 0.3 + i * 2.37;
    s.addShape(pres.ShapeType.rect, { x, y: 1.6, w: 2.2, h: 0.4, fill: { color: t.color } });
    s.addText(t.title, { x, y: 1.6, w: 2.2, h: 0.4, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.rect, { x, y: 2.0, w: 2.2, h: 3.22, fill: { color: C.white }, line: { color: t.color, pt: 1.5 } });
    const textItems = t.items.map((item, idx) => ({
      text: item,
      options: { bullet: { type: "bullet" }, breakLine: idx < t.items.length - 1, fontSize: 10.5, color: C.text, fontFace: "Calibri", paraSpaceBefore: 6 }
    }));
    s.addText(textItems, { x: x + 0.1, y: 2.05, w: 2.0, h: 3.1, valign: "top" });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — PATHOPHYSIOLOGY
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "03  Pathophysiology\n      Type 1 & Type 2 DM", C.navy);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 5 — PATHOPHYSIOLOGY TYPE 1
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Pathophysiology — Type 1 Diabetes Mellitus");

  // Flow diagram boxes
  const steps = [
    { label: "Genetic\nSusceptibility", detail: "HLA-DR3, DR4\nHLA-DQ genes", color: C.navy },
    { label: "Environmental\nTrigger", detail: "Viral infection\nDietary factors", color: C.blue },
    { label: "Autoimmune\nActivation", detail: "CD4/CD8 T-cells\nIslet antibodies (ICA, anti-GAD, IA-2)", color: C.teal },
    { label: "β-Cell\nDestruction", detail: "Insulitis → progressive\nloss of β-cell mass", color: C.amber },
    { label: "Absolute Insulin\nDeficiency", detail: "→ DKA, hyperglycaemia\nketo-acidosis", color: C.red },
  ];
  
  const bw = 1.68, bh = 1.55, startX = 0.3, startY = 0.88;
  steps.forEach((st, i) => {
    const x = startX + i * 1.92;
    s.addShape(pres.ShapeType.rect, { x, y: startY, w: bw, h: bh, fill: { color: st.color } });
    s.addText(st.label, { x, y: startY + 0.1, w: bw, h: 0.55, fontSize: 11.5, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addShape(pres.ShapeType.line, { x: x + 0.15, y: startY + 0.66, w: bw - 0.3, h: 0, line: { color: C.white, pt: 0.8, transparency: 50 } });
    s.addText(st.detail, { x: x + 0.1, y: startY + 0.72, w: bw - 0.2, h: 0.75, fontSize: 9.5, color: C.white, fontFace: "Calibri", align: "center", valign: "top" });
    if (i < steps.length - 1) {
      s.addShape(pres.ShapeType.rect, { x: x + bw, y: startY + 0.6, w: 0.24, h: 0.35, fill: { color: C.amber } });
      s.addText("▶", { x: x + bw, y: startY + 0.6, w: 0.24, h: 0.35, fontSize: 14, color: C.white, align: "center", valign: "middle" });
    }
  });

  // Antibodies section
  box(s, 0.3, 2.55, 4.5, 1.2, C.light, "Islet Autoantibodies (Diagnostic Markers)", C.navy, [
    "ICA (Islet cell antibody) — 70–80% of T1DM",
    "Anti-GAD65 — most sensitive (80–95%)",
    "IA-2 / IA-2β — tyrosine phosphatase antibodies",
    "ZnT8 antibody — zinc transporter 8",
  ], 10.5);

  // Honeymoon phase
  box(s, 4.9, 2.55, 4.75, 1.2, "FFF9C4", "Honeymoon Phase", C.navy, [
    "Transient recovery of residual β-cell function",
    "Occurs weeks–months after diagnosis",
    "Insulin requirement ↓ temporarily",
    "Eventually lost as destruction continues",
  ], 10.5);

  // Bottom note
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.85, w: 9.35, h: 0.85, fill: { color: C.red }, transparency: 85 });
  s.addText("When >80% of β-cell mass is destroyed, overt DM manifests. Without exogenous insulin, patients are prone to life-threatening diabetic ketoacidosis (DKA).", {
    x: 0.5, y: 3.9, w: 9.15, h: 0.75, fontSize: 11.5, color: C.text, fontFace: "Calibri", italic: false, valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 6 — PATHOPHYSIOLOGY TYPE 2
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Pathophysiology — Type 2 Diabetes Mellitus", "The 'Ominous Octet' (DeFronzo)");

  // Left column - pathophysiology
  box(s, 0.3, 0.85, 4.7, 1.55, C.navy, "Core Defects", C.amber, [
    "Insulin resistance in muscle, liver & adipose tissue",
    "Progressive β-cell dysfunction (↓ insulin secretion)",
    "↑ Hepatic glucose production (gluconeogenesis)",
    "↑ Lipolysis → free fatty acids → lipotoxicity",
    "Incretin defect: ↓ GLP-1 response",
  ], 11);

  box(s, 0.3, 2.5, 4.7, 1.25, C.teal, "Ominous Octet (DeFronzo)", C.white, [
    "↑ Hepatic glucose output   ↓ Muscle glucose uptake",
    "↓ Incretin effect   ↑ Glucagon secretion (α-cells)",
    "↑ Renal glucose reabsorption   ↓ Brain insulin signalling",
    "↑ Lipolysis   ↓ β-cell insulin secretion",
  ], 11);

  box(s, 0.3, 3.85, 4.7, 0.85, "FFF9C4", "Risk Factors", C.navy, [
    "Obesity (BMI ≥35 → 90× ↑ risk)  |  Physical inactivity  |  Family history  |  Age >45 years",
    "Ethnicity (South Asian, African, Hispanic)  |  Hypertension  |  Dyslipidaemia  |  PCOS",
  ], 10.5);

  // Right — image or visual
  if (images[1] && images[1].base64) {
    s.addImage({ data: images[1].base64, x: 5.2, y: 0.85, w: 4.45, h: 3.2 });
    s.addText("Obesity → Inflammation → T2DM → Vascular Complications (PMC)", {
      x: 5.2, y: 4.05, w: 4.45, h: 0.25, fontSize: 8, color: C.muted, italic: true, fontFace: "Calibri"
    });
  } else {
    box(s, 5.2, 0.85, 4.45, 3.4, C.light, "Pathophysiological Cascade", C.navy, [
      "Caloric excess & sedentary lifestyle",
      "→ Central obesity & visceral fat",
      "→ Adipokine imbalance (↓ adiponectin, ↑ TNF-α, IL-6)",
      "→ Hepatic & peripheral insulin resistance",
      "→ Compensatory hyperinsulinaemia",
      "→ β-cell exhaustion & failure",
      "→ Overt T2DM with hyperglycaemia",
    ], 12);
  }
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "04  Clinical Features\n      & Natural History", C.teal);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 7 — CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Clinical Features of Diabetes Mellitus");

  // Classic triad
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.85, w: 9.4, h: 0.4, fill: { color: C.amber }, transparency: 20 });
  s.addText("Classic Triad (when glucose >180–200 mg/dL / 10–11.1 mmol/L — exceeding renal threshold)", {
    x: 0.4, y: 0.88, w: 9.2, h: 0.35, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", valign: "middle"
  });

  const triad = [
    { sym: "POLYURIA", detail: "Glycosuria → osmotic diuresis\nUrine output >3 L/day", color: C.blue },
    { sym: "POLYDIPSIA", detail: "Secondary to hypovolaemia\nThirst & fluid intake ↑↑", color: C.teal },
    { sym: "WEIGHT LOSS", detail: "Catabolism, glycosuria\nMuscle wasting (T1DM)", color: C.red },
  ];
  triad.forEach((t, i) => {
    const x = 0.3 + i * 3.15;
    s.addShape(pres.ShapeType.rect, { x, y: 1.35, w: 2.9, h: 1.15, fill: { color: t.color } });
    s.addText(t.sym, { x, y: 1.35, w: 2.9, h: 0.42, fontSize: 13, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(t.detail, { x, y: 1.77, w: 2.9, h: 0.7, fontSize: 10, color: C.white, fontFace: "Calibri", align: "center" });
  });

  // Other symptoms
  box(s, 0.3, 2.6, 4.5, 2.1, C.navy, "Type 1 DM Presentation", C.amber, [
    "Acute onset (days to weeks)",
    "Marked weight loss, ketosis, DKA",
    "Predominantly children/young adults",
    "Polyphagia (hunger despite eating)",
    "Blurred vision, fatigue",
    "Nausea/vomiting if DKA",
  ], 11);

  box(s, 5.0, 2.6, 4.65, 2.1, C.blue, "Type 2 DM Presentation", C.white, [
    "Insidious onset (months to years)",
    "Often asymptomatic at diagnosis",
    "Frequently found on screening",
    "Recurrent infections (UTI, candidiasis)",
    "Visual blurring, neuropathic symptoms",
    "May present with complications first",
  ], 11);

  // Bottom bar: prediabetes note
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.75, w: 9.35, h: 0.55, fill: { color: C.light } });
  s.addText([
    { text: "Prediabetes: ", options: { bold: true, fontSize: 11.5, color: C.navy } },
    { text: "Impaired fasting glucose (IFG): 5.6–6.9 mmol/L (100–125 mg/dL)  |  Impaired glucose tolerance (IGT): 2-hr OGTT 7.8–11.0 mmol/L  |  HbA1c 39–47 mmol/mol (5.7–6.4%)", options: { fontSize: 10.5, color: C.text } }
  ], { x: 0.45, y: 4.78, w: 9.15, h: 0.5, valign: "middle", wrap: true });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 8 — NATURAL HISTORY
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Natural History of Diabetes Mellitus");

  // Timeline for T2DM
  s.addText("Type 2 DM Natural History — Progressive β-cell Failure", {
    x: 0.3, y: 0.88, w: 9.4, h: 0.35, fontSize: 13, bold: true, color: C.navy, fontFace: "Calibri"
  });

  const timeline = [
    { phase: "Normal\nGlucose", year: "Years\n−10 to −5", color: C.teal },
    { phase: "Insulin\nResistance", year: "~5 yrs\nbefore Dx", color: C.blue },
    { phase: "Pre-\ndiabetes", year: "~2–5 yrs\nbefore Dx", color: C.amber },
    { phase: "Overt\nDiabetes", year: "Diagnosis", color: C.red },
    { phase: "Progressive\nComplications", year: "Years\nafter Dx", color: "8B0000" },
  ];
  timeline.forEach((t, i) => {
    const x = 0.3 + i * 1.92;
    s.addShape(pres.ShapeType.rect, { x, y: 1.3, w: 1.7, h: 0.8, fill: { color: t.color } });
    s.addText(t.phase, { x, y: 1.3, w: 1.7, h: 0.8, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
    s.addText(t.year, { x, y: 2.1, w: 1.7, h: 0.5, fontSize: 9, color: C.subtext, fontFace: "Calibri", align: "center" });
    if (i < timeline.length - 1) {
      s.addText("→", { x: x + 1.7, y: 1.45, w: 0.22, h: 0.5, fontSize: 18, bold: true, color: C.amber, align: "center" });
    }
  });

  // T1DM vs T2DM comparison
  box(s, 0.3, 2.7, 4.5, 1.95, C.navy, "Type 1 DM — Natural History", C.amber, [
    "Abrupt destruction of β-cells (months)",
    "Insulin-dependent from diagnosis",
    "Honeymoon phase: transient remission",
    "Complications begin ~5 yrs post-diagnosis",
    "Life expectancy ↓ ~10–15 yrs if uncontrolled",
  ], 11);

  box(s, 5.0, 2.7, 4.65, 1.95, C.blue, "Type 2 DM — Prognosis", C.white, [
    "Life expectancy ↓ ~6 yrs at age 50 years",
    "40–50% have complications at diagnosis",
    "CVD is leading cause of death (2–2.5× ↑ risk)",
    "Progression can be halted with lifestyle & treatment",
    "Remission possible with weight loss/bariatric surgery",
  ], 11);

  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.72, w: 9.35, h: 0.55, fill: { color: "FFF9C4" } });
  s.addText("Every 18 mg/dL (1.0 mmol/L) increase in fasting glucose → estimated 17% increase in cardiovascular events or death (Goldman-Cecil Medicine)", {
    x: 0.45, y: 4.75, w: 9.15, h: 0.5, fontSize: 11, color: C.text, fontFace: "Calibri", italic: true, valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — INVESTIGATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "05  Investigations &\n      Diagnostic Criteria", C.blue);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 9 — DIAGNOSTIC CRITERIA
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Diagnostic Criteria for Diabetes Mellitus", "ADA / WHO criteria");

  // Diagnostic criteria table header
  const headers = ["Test", "Normal", "Prediabetes", "Diabetes"];
  const hColors = [C.navy, C.teal, C.amber, C.red];
  const colW = [2.8, 2.1, 2.3, 2.4];
  const colX = [0.3, 3.1, 5.2, 7.5];
  headers.forEach((h, i) => {
    s.addShape(pres.ShapeType.rect, { x: colX[i], y: 0.85, w: colW[i], h: 0.42, fill: { color: hColors[i] } });
    s.addText(h, { x: colX[i], y: 0.85, w: colW[i], h: 0.42, fontSize: 12, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  });

  const rows = [
    ["Fasting Plasma Glucose", "<5.6 mmol/L\n(<100 mg/dL)", "5.6–6.9 mmol/L\n(100–125 mg/dL)", "≥7.0 mmol/L\n(≥126 mg/dL)"],
    ["2-hr OGTT (75g)", "<7.8 mmol/L\n(<140 mg/dL)", "7.8–11.0 mmol/L\n(140–199 mg/dL)", "≥11.1 mmol/L\n(≥200 mg/dL)"],
    ["HbA1c", "<39 mmol/mol\n(<5.7%)", "39–47 mmol/mol\n(5.7–6.4%)", "≥48 mmol/mol\n(≥6.5%)"],
    ["Random Plasma Glucose", "N/A", "N/A", "≥11.1 mmol/L + symptoms"],
  ];
  const rowBg = [C.white, "F5F5F5", C.white, "F5F5F5"];
  rows.forEach((row, ri) => {
    const y = 1.27 + ri * 0.72;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: colX[ci], y, w: colW[ci], h: 0.7, fill: { color: rowBg[ri] }, line: { color: C.muted, pt: 0.5 } });
      s.addText(cell, { x: colX[ci] + 0.08, y: y + 0.03, w: colW[ci] - 0.16, h: 0.64, fontSize: ci === 0 ? 10.5 : 10, bold: ci === 0, color: C.text, fontFace: "Calibri", valign: "middle", align: ci === 0 ? "left" : "center" });
    });
  });

  // Note boxes
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 4.2, w: 4.5, h: 0.55, fill: { color: C.light } });
  s.addText("⚠ Without symptoms: 2 abnormal tests on separate occasions required for diagnosis", {
    x: 0.4, y: 4.23, w: 4.3, h: 0.5, fontSize: 10, color: C.navy, fontFace: "Calibri", valign: "middle"
  });
  s.addShape(pres.ShapeType.rect, { x: 5.0, y: 4.2, w: 4.65, h: 0.55, fill: { color: "FFF9C4" } });
  s.addText("✓ With classic symptoms + random glucose ≥11.1 mmol/L: diagnosis confirmed without repeat testing", {
    x: 5.1, y: 4.23, w: 4.45, h: 0.5, fontSize: 10, color: C.text, fontFace: "Calibri", valign: "middle"
  });

  box(s, 0.3, 4.82, 9.35, 0.43, C.navy, null, null, null);
  s.addText("Additional investigations: Islet autoantibodies (T1DM), C-peptide levels, fasting lipids, renal function, urine ACR, retinal screening, ECG, foot examination", {
    x: 0.4, y: 4.84, w: 9.2, h: 0.38, fontSize: 10, color: C.white, fontFace: "Calibri", valign: "middle"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — MANAGEMENT
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "06  Management of\n      Diabetes Mellitus", C.navy);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 10 — MANAGEMENT OVERVIEW
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Management of Diabetes Mellitus — Overview");

  // Glycaemic targets
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.85, w: 9.4, h: 0.38, fill: { color: C.teal } });
  s.addText("Glycaemic Targets: HbA1c <53 mmol/mol (<7.0%) for most adults  |  Fasting: 4.4–7.2 mmol/L  |  Post-prandial: <10 mmol/L", {
    x: 0.4, y: 0.87, w: 9.2, h: 0.34, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });

  const pillars = [
    { title: "1 Lifestyle\nModification", items: ["Medical Nutrition Therapy: calorie deficit, low glycaemic index, <10% saturated fat", "Physical activity: ≥150 min/wk moderate aerobic exercise", "Weight loss: 5–10% reduces HbA1c by 0.5–2.0%", "Smoking cessation, alcohol moderation"], color: C.teal },
    { title: "2 Pharmacological\nTherapy", items: ["T2DM: Metformin first-line (if tolerated)", "Add SGLT2i or GLP-1 RA if CVD/CKD/HF", "Stepwise intensification to combination therapy", "T1DM: Insulin (basal-bolus regimen) from diagnosis"], color: C.blue },
    { title: "3 Monitoring &\nScreening", items: ["HbA1c every 3 months until stable, then 6-monthly", "Self-monitoring of blood glucose (SMBG)", "Annual: retinal exam, urine ACR, renal function", "Annual foot examination, lipids, BP"], color: C.navy },
  ];
  pillars.forEach((p, i) => {
    const x = 0.3 + i * 3.18;
    box(s, x, 1.3, 2.95, 3.35, p.color, p.title, C.amber, p.items, 10.5);
  });

  // Oral agents table
  s.addText("Key Pharmacological Agents", {
    x: 0.3, y: 4.72, w: 4.0, h: 0.32, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri"
  });
  const drugs = ["Metformin — ↓ hepatic glucose output, weight neutral", "SGLT2 inhibitors — ↓ renal reabsorption, cardioprotective", "GLP-1 receptor agonists — ↑ insulin, ↓ glucagon, weight loss", "DPP-4 inhibitors — ↑ incretin, weight neutral, safe in CKD", "Sulfonylureas — ↑ insulin secretion, risk hypoglycaemia", "Thiazolidinediones — ↓ insulin resistance, risk HF, fractures"];
  const textItems = drugs.map((d, i) => ({
    text: d,
    options: { bullet: { type: "bullet" }, breakLine: i < drugs.length - 1, fontSize: 10, color: C.text, fontFace: "Calibri", paraSpaceBefore: 2 }
  }));
  s.addText(textItems, { x: 0.3, y: 5.05, w: 9.4, h: 0.6, valign: "top" });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 11 — INSULIN THERAPY
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Insulin Therapy");

  const insulinTypes = [
    { type: "Rapid-Acting Analogue", examples: "Lispro, Aspart, Glulisine", onset: "5–15 min", peak: "30–90 min", duration: "3–5 hr", use: "Mealtime bolus" },
    { type: "Short-Acting (Regular)", examples: "Actrapid, Humulin R", onset: "30–60 min", peak: "2–4 hr", duration: "6–8 hr", use: "Mealtime, IV infusions" },
    { type: "Intermediate (NPH)", examples: "Insulatard, Humulin N", onset: "1–3 hr", peak: "5–8 hr", duration: "12–18 hr", use: "Basal (twice daily)" },
    { type: "Long-Acting Analogue", examples: "Glargine, Detemir, Degludec", onset: "1–4 hr", peak: "None/flat", duration: "20–42 hr", use: "Once-daily basal" },
    { type: "Pre-mixed", examples: "30/70, 50/50 mixtures", onset: "Varies", peak: "Biphasic", duration: "10–16 hr", use: "Twice-daily convenience" },
  ];

  const cols = ["Insulin Type", "Examples", "Onset", "Peak", "Duration", "Use"];
  const cw = [2.2, 2.0, 0.85, 1.0, 0.9, 1.75];
  const cx = [0.3, 2.5, 4.5, 5.35, 6.35, 7.25];
  cols.forEach((c, i) => {
    s.addShape(pres.ShapeType.rect, { x: cx[i], y: 0.85, w: cw[i], h: 0.38, fill: { color: C.navy } });
    s.addText(c, { x: cx[i], y: 0.85, w: cw[i], h: 0.38, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  });
  const rBg = [C.white, "F0F4FF", C.white, "F0F4FF", C.white];
  insulinTypes.forEach((row, ri) => {
    const y = 1.23 + ri * 0.62;
    const rowData = [row.type, row.examples, row.onset, row.peak, row.duration, row.use];
    rowData.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: cx[ci], y, w: cw[ci], h: 0.6, fill: { color: rBg[ri] }, line: { color: C.muted, pt: 0.4 } });
      s.addText(cell, { x: cx[ci] + 0.05, y: y + 0.03, w: cw[ci] - 0.1, h: 0.54, fontSize: ci === 0 ? 10.5 : 10, bold: ci === 0, color: C.text, fontFace: "Calibri", valign: "middle", align: ci === 0 ? "left" : "center" });
    });
  });

  box(s, 0.3, 4.4, 4.5, 0.85, C.light, "Basal-Bolus Regimen (T1DM)", C.navy, [
    "Basal insulin: once/twice daily long-acting (40–50% TDD)",
    "Bolus insulin: rapid-acting before each meal (carb counting)",
    "Target: HbA1c <53 mmol/mol (<7%) without hypoglycaemia",
  ], 10.5);

  box(s, 5.0, 4.4, 4.65, 0.85, "FFF0F0", "Insulin Storage & Safety", C.red, [
    "Unopened: refrigerate 2–8°C  |  In use: room temp up to 28 days",
    "Hypoglycaemia = main adverse effect → always carry glucose",
    "Weight gain, lipodystrophy at injection sites",
  ], 10.5);
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "07  Chronic Complications", C.teal);
  s.addText("Microvascular & Macrovascular", {
    x: 0.7, y: 3.6, w: 8, h: 0.5, fontSize: 22, color: C.amber, fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 12 — COMPLICATIONS
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Chronic Complications of Diabetes Mellitus");

  // Micro
  box(s, 0.3, 0.85, 4.5, 3.5, C.navy, "Microvascular Complications", C.amber, [
    "RETINOPATHY — most common cause of blindness",
    "  Non-proliferative: microaneurysms, hard exudates",
    "  Proliferative: neovascularisation, vitreous haemorrhage",
    "  Screen: annual fundoscopy",
    "NEPHROPATHY — leading cause of ESKD",
    "  Microalbuminuria → proteinuria → CKD",
    "  ACEi/ARB: first-line nephroprotection",
    "  Screen: annual urine ACR + eGFR",
    "NEUROPATHY — affects up to 50% of diabetics",
    "  Peripheral: stocking-glove sensory loss, burning",
    "  Autonomic: gastroparesis, orthostatic hypotension",
    "  Painful neuropathy: amitriptyline, gabapentin",
  ], 10.5);

  // Macro
  box(s, 5.0, 0.85, 4.65, 2.1, C.red, "Macrovascular Complications", C.white, [
    "Coronary artery disease: 2–2.5× ↑ risk MI",
    "Stroke / cerebrovascular disease",
    "Peripheral vascular disease → diabetic foot",
    "Heart failure: independent risk factor",
    "Aggressive risk factor control essential",
  ], 11);

  // Diabetic foot image
  if (images[2] && images[2].base64) {
    s.addImage({ data: images[2].base64, x: 5.0, y: 2.98, w: 4.65, h: 2.3 });
    s.addText("Diabetic Foot Syndrome — neuropathy + ischaemia (PMC)", {
      x: 5.0, y: 5.28, w: 4.65, h: 0.2, fontSize: 8, color: C.muted, italic: true, fontFace: "Calibri"
    });
  } else {
    box(s, 5.0, 2.98, 4.65, 2.2, "FFF0F0", "Diabetic Foot", C.red, [
      "Combination of neuropathy + peripheral vascular disease",
      "Impaired pain sensation → unnoticed injuries",
      "Impaired healing → chronic ulcers → infection",
      "Leading cause of non-traumatic amputations",
      "Screen: annual foot examination + monofilament test",
    ], 11);
  }
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — DKA
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "08  Diabetic Ketoacidosis\n      (DKA)", C.red);
  s.addText("Acute metabolic emergency — mortality ~4%", {
    x: 0.7, y: 3.7, w: 8, h: 0.4, fontSize: 16, color: C.amber, fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 13 — DKA PATHOPHYSIOLOGY & CLINICAL
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Diabetic Ketoacidosis — Pathophysiology & Clinical Features");

  // Diagnostic triad
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.85, w: 9.4, h: 0.38, fill: { color: C.red } });
  s.addText("Diagnostic Triad (DKA):   D — Hyperglycaemia ≥13.9 mmol/L (or known DM)   |   K — Ketonuria ≥2+ or ketonaemia ≥3 mmol/L   |   A — pH <7.3 or HCO₃⁻ <15 mmol/L", {
    x: 0.4, y: 0.87, w: 9.1, h: 0.33, fontSize: 10.5, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });

  // Pathophysiology cascade
  box(s, 0.3, 1.3, 4.55, 2.55, C.navy, "Pathophysiology", C.amber, [
    "↓ Insulin + ↑ counter-regulatory hormones",
    "→ ↑ Lipolysis → free fatty acids to liver",
    "→ ↑ Ketogenesis: β-hydroxybutyrate, acetoacetate",
    "→ Metabolic acidosis (anion gap ↑)",
    "→ ↑ Hepatic glucose output + ↓ utilisation",
    "→ Hyperglycaemia → osmotic diuresis",
    "→ Dehydration + electrolyte loss (K⁺, Na⁺, PO₄)",
    "Total body K⁺ depleted despite serum K⁺ normal/↑",
  ], 11);

  // Precipitants
  box(s, 0.3, 3.92, 4.55, 1.35, C.teal, "Common Precipitants", C.white, [
    "New-onset T1DM  |  Missed insulin / poor adherence",
    "Infection (most common — UTI, pneumonia, sepsis)",
    "Acute coronary syndrome  |  Surgery / trauma",
    "SGLT-2 inhibitors (euglycaemic DKA)",
  ], 11);

  // Clinical features
  box(s, 5.05, 1.3, 4.6, 2.1, C.blue, "Clinical Features", C.white, [
    "Polyuria, polydipsia, vomiting, abdominal pain",
    "Dehydration: dry mucosae, sunken eyes, ↓ skin turgor",
    "Kussmaul breathing: deep, rapid (compensatory)",
    "Smell of acetone (fruity breath)",
    "Tachycardia, hypotension (if severe dehydration)",
    "Altered consciousness → coma (severe)",
  ], 11);

  // Severity
  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 3.47, w: 4.6, h: 0.3, fill: { color: C.subtext } });
  s.addText("Severity Classification", { x: 5.05, y: 3.47, w: 4.6, h: 0.3, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  const sevCols = ["Severity", "pH", "HCO₃⁻", "Mentation"];
  const sevW = [1.0, 1.0, 1.1, 1.5];
  const sevX = [5.05, 6.05, 7.05, 8.15];
  sevCols.forEach((c, i) => {
    s.addShape(pres.ShapeType.rect, { x: sevX[i], y: 3.77, w: sevW[i], h: 0.32, fill: { color: C.navy } });
    s.addText(c, { x: sevX[i], y: 3.77, w: sevW[i], h: 0.32, fontSize: 9, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  });
  const sevRows = [
    ["Mild", "7.25–7.30", "15–18", "Alert"],
    ["Moderate", "7.00–7.24", "10–14", "Alert/drowsy"],
    ["Severe", "<7.00", "<10", "Stupor/coma"],
  ];
  const sevRBg = [C.white, "F5F5F5", "FFEBEE"];
  sevRows.forEach((row, ri) => {
    const y = 4.09 + ri * 0.43;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: sevX[ci], y, w: sevW[ci], h: 0.41, fill: { color: sevRBg[ri] }, line: { color: C.muted, pt: 0.4 } });
      s.addText(cell, { x: sevX[ci] + 0.04, y, w: sevW[ci] - 0.08, h: 0.41, fontSize: 9.5, bold: ri === 2, color: ri === 2 ? C.red : C.text, fontFace: "Calibri", valign: "middle", align: "center" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 14 — DKA MANAGEMENT
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "DKA Management — The 5 Rs");

  const Rs = [
    { r: "1 RESUSCITATE", items: ["IV access × 2, O₂, cardiac monitor, urinary catheter", "Assessment: GCS, capillary glucose, ketones, VBG", "NBM if vomiting/↓ GCS"], color: C.red },
    { r: "2 REHYDRATE", items: ["0.9% NaCl: 1L over 1st hour", "Then 1L/hr × 2, then 1L/2hr × 2, then guided by UO", "Switch to 0.45% NaCl if Na⁺ >150 mmol/L"], color: C.blue },
    { r: "3 REPLACE K⁺", items: ["Check K⁺ before insulin", "K⁺ >5.5: withhold KCl  |  K⁺ 3.5–5.5: add 40 mmol/L bag", "K⁺ <3.5: replace first, delay insulin"], color: C.teal },
    { r: "4 REDUCE KETONES", items: ["Fixed-rate IV insulin infusion: 0.1 units/kg/hr", "Target: ketones ↓ 0.5 mmol/L/hr, glucose ↓ 3 mmol/L/hr", "Add 10% dextrose if glucose <14 mmol/L"], color: C.amber },
    { r: "5 REVERSE CAUSE", items: ["Identify & treat precipitant", "If infection: appropriate antibiotics", "Thromboprophylaxis (dehydration ↑ DVT risk)"], color: C.navy },
  ];

  Rs.forEach((r, i) => {
    const col = i < 3 ? 0 : 1;
    const row = i < 3 ? i : i - 3;
    const x = col === 0 ? 0.3 : 5.05;
    const y = 0.85 + row * 1.52;
    box(s, x, y, 4.55, 1.42, r.color, r.r, C.white, r.items, 11);
  });

  // Monitoring box
  box(s, 5.05, 3.95, 4.55, 1.32, "FFF9C4", "Monitoring Targets", C.navy, [
    "Hourly: capillary glucose + ketones",
    "1-2 hourly: VBG (pH, bicarbonate, K⁺)",
    "Resolution: ketones <0.3 mmol/L, pH >7.3, HCO₃⁻ >15",
    "Transition to SC insulin: when eating + drinking",
  ], 11);
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — HHS
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "09  Hyperosmolar Hyperglycaemic\n      State (HHS)", "8B0000");
  s.addText("Mortality up to 20% — predominantly elderly T2DM patients", {
    x: 0.7, y: 3.9, w: 8.5, h: 0.4, fontSize: 14, color: C.amber, fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 15 — HHS
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Hyperosmolar Hyperglycaemic State (HHS)");

  // Definition
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.85, w: 9.4, h: 0.5, fill: { color: "8B0000" } });
  s.addText("Diagnostic Criteria:  Glucose ≥33.3 mmol/L (600 mg/dL)  |  Osmolality ≥320 mOsm/kg  |  pH ≥7.3  |  HCO₃⁻ ≥18 mmol/L  |  Minimal ketonaemia", {
    x: 0.4, y: 0.87, w: 9.1, h: 0.45, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", valign: "middle"
  });

  box(s, 0.3, 1.45, 4.5, 1.75, C.navy, "Pathophysiology", C.amber, [
    "Relative insulin deficiency (not absolute — prevents DKA)",
    "Profound hyperglycaemia → osmotic diuresis",
    "Severe dehydration (fluid deficit 8–15 L)",
    "Impaired ability to drink (elderly, cognitively impaired)",
    "Effective serum osmolality: 2×Na + glucose >320 mOsm/kg",
  ], 11);

  box(s, 0.3, 3.28, 4.5, 1.98, C.blue, "Clinical Features", C.white, [
    "Insidious onset over days to weeks",
    "Extreme dehydration, weakness",
    "Neurological: confusion, focal deficits, seizures",
    "Absent Kussmaul breathing (no acidosis)",
    "No acetone breath",
    "Coma in severe cases",
  ], 11);

  box(s, 5.05, 1.45, 4.6, 1.75, C.teal, "Management Principles", C.white, [
    "Slow rehydration: 0.9% NaCl — target 50% correction in 12 hrs",
    "Insulin: low-dose IV infusion AFTER fluid resuscitation",
    "K⁺ replacement: as per DKA protocol",
    "Glucose lowering: target 5 mmol/L reduction/hr",
    "Anticoagulation: LMWH (very high thrombotic risk)",
  ], 11);

  // DKA vs HHS comparison
  s.addShape(pres.ShapeType.rect, { x: 5.05, y: 3.28, w: 4.6, h: 0.32, fill: { color: C.subtext } });
  s.addText("DKA vs HHS — Key Differences", { x: 5.05, y: 3.28, w: 4.6, h: 0.32, fontSize: 11, bold: true, color: C.white, fontFace: "Calibri", align: "center", valign: "middle" });
  const compareRows = [
    ["Feature", "DKA", "HHS"],
    ["Typical patient", "T1DM, young", "T2DM, elderly"],
    ["Glucose", "13.9–33.3 mmol/L", ">33.3 mmol/L"],
    ["pH", "<7.30", "≥7.30"],
    ["Ketones", "+++", "Absent/trace"],
    ["Osmolality", "300–320", ">320 mOsm/kg"],
    ["Mortality", "~4%", "~20%"],
  ];
  const cmpW = [1.6, 1.5, 1.5];
  const cmpX = [5.05, 6.65, 8.15];
  compareRows.forEach((row, ri) => {
    const y = 3.6 + ri * 0.38;
    const bg = ri === 0 ? C.navy : ri % 2 === 0 ? "F5F5F5" : C.white;
    row.forEach((cell, ci) => {
      s.addShape(pres.ShapeType.rect, { x: cmpX[ci], y, w: cmpW[ci], h: 0.36, fill: { color: bg }, line: { color: C.muted, pt: 0.4 } });
      s.addText(cell, { x: cmpX[ci] + 0.05, y, w: cmpW[ci] - 0.1, h: 0.36, fontSize: ri === 0 ? 10 : 9.5, bold: ri === 0 || ci === 0, color: ri === 0 ? C.white : C.text, fontFace: "Calibri", valign: "middle", align: "center" });
    });
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SECTION DIVIDER — HYPOGLYCAEMIA
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  sectionTitle(s, "10  Hypoglycaemia", C.amber);
  s.addText("Most common acute complication — can be life-threatening", {
    x: 0.7, y: 3.9, w: 8, h: 0.4, fontSize: 15, color: C.white, fontFace: "Calibri"
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 16 — HYPOGLYCAEMIA
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  contentHeader(s, "Hypoglycaemia — Definition, Features & Management");

  // Definition
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 0.85, w: 9.4, h: 0.4, fill: { color: C.amber } });
  s.addText("Definition:  Glucose <3.9 mmol/L (<70 mg/dL)  |  Severe if requires assistance  |  Level 3 (severe): <3.0 mmol/L with cognitive impairment", {
    x: 0.4, y: 0.87, w: 9.1, h: 0.36, fontSize: 11, bold: true, color: C.navy, fontFace: "Calibri", valign: "middle"
  });

  box(s, 0.3, 1.32, 3.05, 2.25, C.navy, "Causes", C.amber, [
    "Excess insulin dose",
    "Skipped / delayed meal",
    "Increased physical activity",
    "Alcohol (inhibits gluconeogenesis)",
    "Renal failure (↓ insulin clearance)",
    "Sulfonylurea / meglitinide use",
    "Insulinoma (rare)",
  ], 11);

  box(s, 3.5, 1.32, 3.05, 2.25, C.blue, "Clinical Features (Whipple's Triad)", C.white, [
    "Autonomic (early): sweating, palpitations, tremor, anxiety",
    "Neuroglycopaenic: confusion, slurred speech, focal deficit",
    "Severe: seizures, loss of consciousness, coma",
    "Symptoms resolve with glucose normalisation",
    "Hypoglycaemia unawareness: ↓ counter-regulatory response",
  ], 11);

  box(s, 6.65, 1.32, 3.0, 2.25, C.teal, "Whipple's Triad", C.white, [
    "1. Symptoms consistent with hypoglycaemia",
    "2. Low plasma glucose (<3.9 mmol/L)",
    "3. Symptom relief with glucose correction",
  ], 11.5);

  // Management — Rule of 15
  s.addShape(pres.ShapeType.rect, { x: 0.3, y: 3.65, w: 9.4, h: 0.32, fill: { color: C.amber } });
  s.addText("MANAGEMENT — RULE OF 15", { x: 0.4, y: 3.65, w: 9.1, h: 0.32, fontSize: 12, bold: true, color: C.navy, fontFace: "Calibri", align: "center", valign: "middle" });

  box(s, 0.3, 3.97, 4.5, 1.25, "FFF9C4", "Conscious Patient", C.navy, [
    "15–20g fast-acting carbohydrate (4 glucose tabs, 150 ml juice)",
    "Recheck glucose after 15 minutes",
    "If still <4 mmol/L: repeat 15g carbohydrate",
    "Once >4 mmol/L: long-acting carbohydrate meal",
  ], 11);

  box(s, 5.0, 3.97, 4.65, 1.25, "FFEBEE", "Unconscious / Unable to Swallow", C.red, [
    "IV Dextrose 50%: 50 mL (25g) via large vein IV",
    "Or Glucagon 1 mg IM/SC (if no IV access)",
    "Recovery: follow with long-acting carbohydrate",
    "Investigate cause, adjust medications",
  ], 11);
}

// ══════════════════════════════════════════════════════════════════════════════
// SLIDE 17 — SUMMARY
// ══════════════════════════════════════════════════════════════════════════════
{
  let s = pres.addSlide();
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: "100%", h: "100%", fill: { color: C.navy } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.2, h: "100%", fill: { color: C.amber } });
  s.addShape(pres.ShapeType.rect, { x: 0, y: 4.9, w: "100%", h: 0.73, fill: { color: C.teal }, transparency: 30 });

  s.addText("Key Take-Home Messages", {
    x: 0.5, y: 0.18, w: 9.2, h: 0.55, fontSize: 24, bold: true, color: C.amber, fontFace: "Calibri", charSpacing: 1
  });
  s.addShape(pres.ShapeType.line, { x: 0.5, y: 0.75, w: 5, h: 0, line: { color: C.teal, pt: 2 } });

  const points = [
    "DM is a metabolic disorder of hyperglycaemia — T1 (autoimmune) & T2 (insulin resistance) are distinct entities",
    "Diagnosis requires: FPG ≥7.0 mmol/L, 2-hr OGTT ≥11.1 mmol/L, HbA1c ≥48 mmol/mol (≥6.5%), or random glucose ≥11.1 + symptoms",
    "T2DM management: lifestyle first, then metformin; SGLT2i or GLP-1 RA if CVD/CKD/HF co-exist",
    "DKA = Hyperglycaemia + Ketonaemia + Acidosis → treat with fluids, insulin, K⁺ replacement & find cause",
    "HHS = Extreme hyperglycaemia + hyperosmolality without significant ketosis → slow rehydration + careful insulin",
    "Hypoglycaemia (<3.9 mmol/L) → Rule of 15 (conscious) or IV dextrose/IM glucagon (unconscious)",
    "Complications prevention: HbA1c control + BP + lipids + annual screening for eyes, kidneys, feet & nerves",
  ];
  const textItems = points.map((p, i) => ({
    text: `${i + 1}.  ${p}`,
    options: { bullet: false, breakLine: i < points.length - 1, fontSize: 11.5, color: C.white, fontFace: "Calibri", paraSpaceBefore: 7 }
  }));
  s.addText(textItems, { x: 0.5, y: 0.82, w: 9.2, h: 4.0, valign: "top" });

  s.addText("Sources: Goldman-Cecil Medicine 2024 · Harrison's Principles of Internal Medicine 22e · Rosen's Emergency Medicine · Family Medicine 9e", {
    x: 0.4, y: 4.94, w: 9.2, h: 0.45, fontSize: 9, color: C.white, fontFace: "Calibri", italic: true, transparency: 20
  });
}

// ══════════════════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/diabetes-pptx/Diabetes_Mellitus_and_Emergencies.pptx" })
  .then(() => console.log("✅ PPTX created successfully!"))
  .catch(err => { console.error("❌ Error:", err); process.exit(1); });