Explain T2 DM DIAGNOSIS AND SUGGEST DIAGNOSIS AND TREATMENT STEP BY STEP

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I now have comprehensive content. Let me compile the complete, authoritative answer:

Type 2 Diabetes Mellitus (T2DM): Diagnosis & Treatment — Step by Step

PART 1 — PATHOPHYSIOLOGY IN BRIEF

T2DM is characterized by two core defects:

Insulin resistance — peripheral tissues (muscle, liver, adipose) fail to respond normally to insulin
Progressive β-cell dysfunction — the pancreas cannot compensate with sufficient insulin secretion

Unlike T1DM, autoimmune destruction is absent. The disease progresses silently for years, making screening critical.

PART 2 — WHO IS AT RISK? (Screen These Patients First)

Risk Factor	Detail
Age ≥ 35–45 years	Screen all asymptomatic adults
Overweight/Obesity	BMI > 25 (>23 in Asian populations)
Family history	First-degree relative with T2DM
Physical inactivity	Sedentary lifestyle
Prediabetes	Prior IFG, IGT, or HbA1c 5.7–6.4%
Hypertension	BP ≥ 140/90 mmHg
Dyslipidemia	HDL < 35, TG > 250 mg/dL
History of GDM	Gestational diabetes
PCOS	Polycystic ovary syndrome
Ethnicity	African American, Hispanic, Asian, Native American

The ADA recommends screening overweight/obese adults with any one risk factor above, and universal screening at age 35+ regardless of risk factors. — Henry's Clinical Diagnosis and Management by Laboratory Methods

PART 3 — DIAGNOSTIC CRITERIA (ADA Standard)

Any one of the following confirms diabetes (confirmed on repeat testing in asymptomatic individuals):

Test	Diagnostic Threshold
HbA1c	≥ 6.5% (≥ 48 mmol/mol)
Fasting Plasma Glucose (FPG)	≥ 126 mg/dL (≥ 7.0 mmol/L) — fasting = no caloric intake for ≥8 hrs
2-hour Plasma Glucose (OGTT)	≥ 200 mg/dL (≥ 11.1 mmol/L) using 75g oral glucose load
Random Plasma Glucose	≥ 200 mg/dL + classic symptoms (polyuria, polydipsia, unexplained weight loss)

"In a patient without classic symptoms, a single abnormal test result is not sufficient for diagnosis. A confirmatory test is required." — Tietz Textbook of Laboratory Medicine, 7th Ed

Prediabetes (High Risk — Not Yet Diabetes)

Category	Value
Impaired Fasting Glucose (IFG)	FPG 100–125 mg/dL (5.6–6.9 mmol/L)
Impaired Glucose Tolerance (IGT)	2-hr OGTT 140–199 mg/dL (7.8–11.0 mmol/L)
Intermediate HbA1c	5.7–6.4% (39–46 mmol/mol)

Prediabetes carries a 5-year cumulative diabetes incidence of 12–25% and also increases cardiovascular risk. — Tietz Textbook of Laboratory Medicine, 7th Ed

PART 4 — INITIAL WORKUP AT DIAGNOSIS

After confirming diabetes, perform the following baseline evaluations:

Glycemic:

HbA1c (establishes baseline control)
Fasting glucose

Renal & Cardiovascular:

Urine albumin-to-creatinine ratio (microalbuminuria)
Serum creatinine + eGFR
Lipid panel (LDL, HDL, TG, total cholesterol)
Blood pressure

Organ Screening:

Dilated retinal exam (diabetic retinopathy)
Neurologic exam / monofilament test (peripheral neuropathy)
ECG if cardiovascular risk is high
Thyroid function (TSH) — commonly coexists

PART 5 — TREATMENT: STEP-BY-STEP ALGORITHM

Treatment algorithm for T2DM — Goodman & Gilman's Pharmacological Basis of Therapeutics

STEP 1 — Lifestyle Modification (All Patients, Always)

Start at diagnosis and reinforce at every visit.

Medical Nutrition Therapy: Reduce refined carbohydrates, saturated fat; increase fiber; caloric deficit if obese
Physical Activity: Minimum 150 min/week of moderate aerobic exercise (e.g., brisk walking)
Weight Loss: Even 5–10% body weight reduction significantly improves insulin sensitivity
Smoking cessation, alcohol moderation
Diabetes education — self-monitoring of blood glucose (SMBG), foot care, hypoglycemia recognition

STEP 2 — First-Line Pharmacotherapy: Metformin

Start metformin at the time of diagnosis, alongside lifestyle changes.

Mechanism: Decreases hepatic gluconeogenesis; increases insulin sensitivity via AMPK activation
Dose: Start 500 mg once or twice daily with meals; titrate to 1000 mg twice daily
Target: HbA1c ≤ 7% (individualized — may be stricter [6.5%] for young/newly diagnosed, or looser [8%] for elderly/frail)
Advantages: Weight neutral to modest weight loss, no hypoglycemia, cardiovascular benefit (UKPDS), low cost
Contraindications: eGFR < 30 mL/min/1.73m², active liver disease, alcohol excess, contrast dye procedures

"Metformin is generally accepted as the first-line treatment of type 2 diabetes and is the most commonly used oral agent." — Goodman & Gilman's, 14th Ed

Reassess HbA1c in 2–3 months.

STEP 3 — Second Agent (If HbA1c Target Not Met)

If HbA1c remains above goal on metformin monotherapy, add a second agent based on comorbidities:

Priority Condition	Preferred Add-On
ASCVD (established CV disease)	GLP-1 receptor agonist (liraglutide, semaglutide) OR SGLT-2 inhibitor (empagliflozin, dapagliflozin)
Heart Failure	SGLT-2 inhibitor (empagliflozin, dapagliflozin)
Diabetic Nephropathy (CKD)	SGLT-2 inhibitor first; GLP-1 RA as alternative
Obesity / Weight loss desired	GLP-1 receptor agonist (semaglutide, liraglutide)
Hypoglycemia risk	DPP-4 inhibitor (sitagliptin, saxagliptin) — weight neutral, no hypoglycemia
Cost is major concern	Sulfonylurea (glimepiride, glipizide) — effective, cheap; risk of hypoglycemia + weight gain

STEP 4 — Triple Therapy or Insulin

If dual therapy is insufficient:

Add a third oral/injectable agent, OR
Initiate basal insulin (long-acting: glargine, detemir, degludec) — typically at bedtime, combined with oral agents
- Start: 10 units/day (or 0.1–0.2 units/kg/day); titrate by 2 units every 3 days until fasting glucose 80–130 mg/dL
As β-cell function declines, transition to basal-bolus insulin (basal + prandial doses at meals)

"Progressive insulin deficiency in type 2 diabetes often makes it increasingly difficult to achieve the glycemic goal solely with oral agents; thus, insulin is necessary in a substantial proportion." — Goodman & Gilman's

GLYCEMIC TARGETS SUMMARY

Measure	General Target	Notes
HbA1c	< 7%	< 6.5% in young/newly dx; < 8% in elderly/frail
Fasting glucose	80–130 mg/dL
2-hr post-prandial	< 180 mg/dL
Blood pressure	< 130/80 mmHg
LDL cholesterol	< 100 mg/dL (< 70 if ASCVD)	Statin therapy for most patients

PART 6 — MONITORING & FOLLOW-UP

Test	Frequency
HbA1c	Every 3 months until at goal, then every 6 months
Fasting glucose / SMBG	As indicated by medication regimen
Urine albumin (microalbuminuria)	Annually
eGFR / serum creatinine	Annually
Lipid panel	Annually
Retinal exam	Annually (or every 1–2 years if stable)
Foot exam (monofilament)	Annually or at every visit
Blood pressure	Every visit
Dental exam	Annually

PART 7 — COMPLICATION PREVENTION

Complication	Prevention Strategy
Retinopathy	Tight glycemic + BP control; annual retinal screening
Nephropathy	SGLT-2 inhibitors; ACE inhibitors/ARBs for microalbuminuria
Neuropathy	Glycemic control; foot care; gabapentin/duloxetine for pain
Cardiovascular disease	Statin, antihypertensive, aspirin (if high CV risk), GLP-1 RA or SGLT-2i
Foot ulcers	Regular inspection, appropriate footwear, monofilament testing

QUICK SUMMARY FLOWCHART

Screening (risk factors or age ≥35)
        ↓
Diagnostic Testing (FPG, HbA1c, OGTT)
        ↓
Confirm T2DM Diagnosis
        ↓
Baseline Workup (HbA1c, lipids, eGFR, urine albumin, retinal exam, neuro exam)
        ↓
STEP 1: Lifestyle + Metformin → Reassess HbA1c in 3 months
        ↓ (if not at goal)
STEP 2: Metformin + Second Agent (chosen by comorbidities)
        ↓ (if not at goal)
STEP 3: Triple Therapy or Add Basal Insulin
        ↓ (progressive disease)
STEP 4: Basal-Bolus Insulin ± Oral Agents

Sources: Tietz Textbook of Laboratory Medicine, 7th Ed | Goodman & Gilman's Pharmacological Basis of Therapeutics, 14th Ed | Goldman-Cecil Medicine | Henry's Clinical Diagnosis and Management | ADA Standards of Medical Care in Diabetes

Generate a diabetes monitoring checklist template

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mkdir -p /home/daytona/workspace/diabetes-checklist && ls /home/daytona/workspac…

Writing File

~/diabetes-checklist/generate.js

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const fs = require('fs');

// ─── Colour palette ───────────────────────────────────────────────
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  // --- Patient Information ---
  sectionTitle("Patient Information"),
  spacer(40, 60),
  patientInfoTable(),
  spacer(160, 60),

  // ══════════════════════════════════════
  // SECTION A — CLINICAL VISIT CHECKLIST
  // ══════════════════════════════════════
  colorBar("SECTION A — CLINICAL VISIT CHECKLIST  (Clinician Use)"),
  spacer(60, 40),

  // A1 Glycemic
  sectionTitle("A1 · Glycemic Monitoring"),
  makeTable([
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    checkRow("HbA1c measurement",  "", "< 7%  (individualise)",  false),
    checkRow("Fasting plasma glucose",  "", "80–130 mg/dL",  true),
    checkRow("2-hour post-prandial glucose",  "", "< 180 mg/dL",  false),
    checkRow("Self-monitoring blood glucose (SMBG) review",  "", "Per regimen",  true),
    checkRow("Continuous glucose monitor (CGM) data review (if applicable)",  "", "TIR > 70%",  false),
    checkRow("Hypoglycaemia episodes documented & assessed",  "", "Frequency / severity",  true),
  ]),
  note("Reassess HbA1c every 3 months until target reached; then every 6 months."),
  spacer(120, 60),

  // A2 Cardiovascular
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    checkRow("Fasting lipid panel (LDL, HDL, TG, TC)",  "", "LDL < 100 (<70 ASCVD)",  true),
    checkRow("Statin therapy reviewed / initiated",  "", "Moderate–high intensity",  false),
    checkRow("Body weight & BMI recorded",  "", "Target 5–10% ↓ if obese",  true),
    checkRow("Waist circumference",  "", "M < 94 cm  |  F < 80 cm",  false),
    checkRow("Cardiovascular risk score calculated (e.g. ASCVD 10-yr)",  "", "Document & act",  true),
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  // A3 Renal
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    checkRow("Urine albumin-to-creatinine ratio (UACR)",  "", "< 30 mg/g (normal)",  true),
    checkRow("Electrolytes (Na, K, HCO₃)",  "", "Within normal limits",  false),
    checkRow("SGLT-2 inhibitor initiated / reviewed (if CKD / HF)",  "", "eGFR threshold",  true),
    checkRow("ACE inhibitor / ARB for microalbuminuria",  "", "UACR ≥ 30 mg/g",  false),
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  note("Screen for diabetic kidney disease from diagnosis of T2DM (annually thereafter)."),
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  // A4 Retinal & Ocular
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    checkRow("Visual acuity recorded",  "", "Baseline & annually",  true),
    checkRow("Referral to ophthalmology (if retinopathy detected)",  "", "Prompt referral",  false),
    checkRow("Glaucoma / cataract screening discussed",  "", "Higher risk in DM",  true),
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  spacer(120, 60),

  // A5 Neuropathy
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    checkRow("Vibration sense (128 Hz tuning fork)",  "", "Annually",  true),
    checkRow("Ankle reflexes assessed",  "", "Document findings",  false),
    checkRow("Peripheral pulses (dorsalis pedis, tibialis posterior)",  "", "ABI if indicated",  true),
    checkRow("Foot inspection — ulcers, calluses, deformity",  "", "Every visit",  false),
    checkRow("Footwear assessed — appropriate, well-fitting",  "", "Patient education",  true),
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    checkRow("Metformin dose reviewed / optimised",  "", "Max 2g/day (tolerated)",  true),
    checkRow("Second-line agent reviewed (SGLT-2i / GLP-1 RA / SU / DPP-4i)",  "", "Per comorbidities",  false),
    checkRow("Insulin type, dose, injection technique reviewed (if on insulin)",  "", "Rotating sites",  true),
    checkRow("Hypoglycaemia risk assessed with current regimen",  "", "Minimise SU/insulin risk",  false),
    checkRow("Aspirin / antiplatelet therapy reviewed (if ASCVD)",  "", "75–100 mg/day",  true),
    checkRow("Adherence barriers identified & addressed",  "", "Cost, side-effects, beliefs",  false),
    checkRow("Drug interactions checked",  "", "Particularly with new Rx",  true),
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    checkRow("Physical activity review",  "", "≥ 150 min/week moderate",  true),
    checkRow("Smoking status documented",  "", "Cessation support offered",  false),
    checkRow("Alcohol intake assessed",  "", "Moderate or abstain",  true),
    checkRow("Depression / diabetes distress screening (PHQ-2 or PHQ-9)",  "", "Annually",  false),
    checkRow("Diabetes education / self-management support",  "", "Ongoing",  true),
    checkRow("Immunisations reviewed (flu, pneumococcal, COVID-19)",  "", "As per schedule",  false),
    checkRow("Sick day rules / emergency contacts discussed",  "", "Patient aware",  true),
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      ]}),
      ...["HbA1c (%)","FPG (mg/dL)","LDL (mg/dL)","eGFR (mL/min)","UACR (mg/g)","BP (mmHg)","Weight (kg)","BMI","TG (mg/dL)"].map((t,i) =>
        new TableRow({ children: [
          new TableCell({ children:[new Paragraph({children:[new TextRun({text:t,size:pt(9),font:"Calibri"})]})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:2200,type:WidthType.DXA}}),
          new TableCell({ children:[new Paragraph({text:""})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:2000,type:WidthType.DXA}}),
          new TableCell({ children:[new Paragraph({children:[new TextRun({text:["<7%","80–130","<100","≥60","<30","<130/80","","<25","<150"][i],size:pt(9),italics:true,color:GREY_TEXT,font:"Calibri"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:1800,type:WidthType.DXA}}),
          new TableCell({ children:[new Paragraph({children:[new TextRun({text:"☐ Yes  ☐ No",size:pt(9),font:"Segoe UI Symbol"})]})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:1200,type:WidthType.DXA}}),
          new TableCell({ children:[new Paragraph({text:""})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:2300,type:WidthType.DXA}}),
        ]})
      ),
    ],
    width: { size: 9500, type: WidthType.DXA },
    borders: { top:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, bottom:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, left:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, right:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, insideH:{style:BorderStyle.SINGLE,size:2,color:"D0DFF0"}, insideV:{style:BorderStyle.SINGLE,size:2,color:"D0DFF0"} },
  }),
  spacer(200, 60),

  // ══════════════════════════════════════
  // SECTION B — PATIENT SELF-MONITORING LOG
  // ══════════════════════════════════════
  new Paragraph({ children:[new PageBreak()] }),
  ...titleBlock(),
  spacer(80, 80),

  colorBar("SECTION B — PATIENT SELF-MONITORING LOG  (Patient Use — Daily / Weekly)"),
  spacer(60, 40),

  // B1 daily log
  sectionTitle("B1 · Daily Glucose, BP & Weight Log (2-Week Tracker)"),
  note("Record fasting glucose every morning before eating. Record blood pressure and weight at the same time each day."),
  spacer(40, 60),
  makeLogTable(),
  spacer(120, 60),

  // B2 Medication tracker
  sectionTitle("B2 · Daily Medication Adherence Tracker"),
  new Table({
    rows: [
      new TableRow({ tableHeader: true, children: [
        new TableCell({ children:[new Paragraph({children:[new TextRun({text:"Medication",bold:true,size:pt(9),color:BLUE_DARK,font:"Calibri"})]})], shading:{type:ShadingType.SOLID,color:BLUE_PALE}, width:{size:2500,type:WidthType.DXA}}),
        new TableCell({ children:[new Paragraph({children:[new TextRun({text:"Dose",bold:true,size:pt(9),color:BLUE_DARK,font:"Calibri"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:BLUE_PALE}, width:{size:1200,type:WidthType.DXA}}),
        ...["Mon","Tue","Wed","Thu","Fri","Sat","Sun"].map(d =>
          new TableCell({ children:[new Paragraph({children:[new TextRun({text:d,bold:true,size:pt(9),color:BLUE_DARK,font:"Calibri"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:BLUE_PALE}, width:{size:700,type:WidthType.DXA}})
        ),
      ]}),
      ...Array.from({length:5},(_,i)=>
        new TableRow({ children: [
          new TableCell({ children:[new Paragraph({text:""})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:2500,type:WidthType.DXA}}),
          new TableCell({ children:[new Paragraph({text:""})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:1200,type:WidthType.DXA}}),
          ...Array.from({length:7},()=>
            new TableCell({ children:[new Paragraph({children:[new TextRun({text:"☐",size:pt(11),font:"Segoe UI Symbol"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:700,type:WidthType.DXA}})
          ),
        ]})
      ),
    ],
    width: { size: 8500, type: WidthType.DXA },
    borders: { top:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, bottom:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, left:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, right:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, insideH:{style:BorderStyle.SINGLE,size:2,color:"D0DFF0"}, insideV:{style:BorderStyle.SINGLE,size:2,color:"D0DFF0"} },
  }),
  spacer(120, 60),

  // B3 Symptoms
  sectionTitle("B3 · Symptom Diary — Report to Doctor If Present"),
  makeTable([
    tableHeader("✓","Symptom to Watch For","When to Act"),
    checkRow("Unusual thirst or frequent urination",  "", "Persistent → call clinic",  false),
    checkRow("Blurred vision",  "", "Any new change → urgent",  true),
    checkRow("Numbness, tingling or pain in feet / hands",  "", "Report at next visit",  false),
    checkRow("Chest pain, shortness of breath",  "", "Emergency — call 999/112",  true),
    checkRow("Dizziness, sweating, shakiness (hypoglycaemia signs)",  "", "Treat immediately (15g glucose)",  false),
    checkRow("Slow-healing cuts or sores on feet",  "", "Report within 24–48 hrs",  true),
    checkRow("Persistent nausea, vomiting (DKA risk)",  "", "Emergency — seek care",  false),
    checkRow("Swelling in legs / ankles",  "", "Report at next visit",  true),
    checkRow("Skin infections, recurring UTIs",  "", "Contact clinic",  false),
  ]),
  spacer(120, 60),

  // B4 Lifestyle goals
  sectionTitle("B4 · Weekly Lifestyle Self-Assessment"),
  makeTable([
    tableHeader("✓","Lifestyle Goal","My This-Week Score"),
    checkRow("Ate a balanced, low-GI diet (limit refined carbs & sugars)",  "", "0–7 days: ___",  false),
    checkRow("Completed ≥ 150 min moderate exercise this week",  "", "Total mins: ___",  true),
    checkRow("Avoided smoking",  "", "☐ Yes  ☐ No",  false),
    checkRow("Limited alcohol (≤1 unit/day women; ≤2 units/day men)",  "", "☐ Yes  ☐ No",  true),
    checkRow("Maintained regular sleep schedule (7–9 hrs)",  "", "Avg hrs/night: ___",  false),
    checkRow("Performed daily foot inspection",  "", "0–7 days: ___",  true),
    checkRow("Wore appropriate, well-fitting footwear all day",  "", "☐ Yes  ☐ No",  false),
    checkRow("Attended all scheduled clinic appointments",  "", "☐ Yes  ☐ No",  true),
  ]),
  spacer(120, 60),

  // B5 Emergency targets card
  sectionTitle("B5 · Quick Reference — My Target Numbers"),
  new Table({
    rows: [
      new TableRow({ tableHeader: true, children: [
        new TableCell({ children:[new Paragraph({children:[new TextRun({text:"Measurement",bold:true,size:pt(9),color:WHITE,font:"Calibri"})]})], shading:{type:ShadingType.SOLID,color:BLUE_DARK}, width:{size:2800,type:WidthType.DXA}}),
        new TableCell({ children:[new Paragraph({children:[new TextRun({text:"My Personal Target",bold:true,size:pt(9),color:WHITE,font:"Calibri"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:BLUE_DARK}, width:{size:2400,type:WidthType.DXA}}),
        new TableCell({ children:[new Paragraph({children:[new TextRun({text:"General Guideline",bold:true,size:pt(9),color:WHITE,font:"Calibri"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:BLUE_DARK}, width:{size:2300,type:WidthType.DXA}}),
      ]}),
      ...[
        ["HbA1c","__________","< 7%"],
        ["Fasting Blood Glucose","__________","80–130 mg/dL"],
        ["2-hr Post-Meal Glucose","__________","< 180 mg/dL"],
        ["Blood Pressure","__________","< 130/80 mmHg"],
        ["LDL Cholesterol","__________","< 100 mg/dL"],
        ["Weight / BMI","__________","Discuss with doctor"],
      ].map(([label, mine, guide], i) =>
        new TableRow({ children: [
          new TableCell({ children:[new Paragraph({children:[new TextRun({text:label,size:pt(10),bold:true,color:"222222",font:"Calibri"})]})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:2800,type:WidthType.DXA}}),
          new TableCell({ children:[new Paragraph({children:[new TextRun({text:mine,size:pt(10),color:BLUE_MID,font:"Calibri"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:2400,type:WidthType.DXA}}),
          new TableCell({ children:[new Paragraph({children:[new TextRun({text:guide,size:pt(9),italics:true,color:GREY_TEXT,font:"Calibri"})],alignment:AlignmentType.CENTER})], shading:{type:ShadingType.SOLID,color:i%2===0?WHITE:BLUE_LIGHT}, width:{size:2300,type:WidthType.DXA}}),
        ]})
      ),
    ],
    width: { size: 7500, type: WidthType.DXA },
    borders: { top:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, bottom:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, left:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, right:{style:BorderStyle.SINGLE,size:4,color:"B0C4DE"}, insideH:{style:BorderStyle.SINGLE,size:2,color:"D0DFF0"}, insideV:{style:BorderStyle.SINGLE,size:2,color:"D0DFF0"} },
  }),

  spacer(200, 80),

  // Footer note
  new Paragraph({
    children: [new TextRun({ text: "This template is based on ADA Standards of Medical Care in Diabetes. It is a monitoring tool only and does not replace professional medical advice. Always consult your healthcare provider for treatment decisions.", size: pt(8), color: GREY_TEXT, italics: true, font: "Calibri" })],
    alignment: AlignmentType.CENTER,
    border: { top: { style: BorderStyle.SINGLE, size: 4, color: BLUE_LIGHT } },
    spacing: { before: 120 },
  }),
];

// ─── Assemble document ────────────────────────────────────────────
const doc = new Document({
  styles: {
    default: {
      document: {
        run: { font: "Calibri", size: pt(10), color: "222222" },
      },
    },
  },
  sections: [{
    properties: {
      page: {
        margin: { top: 720, bottom: 720, left: 900, right: 900 },
      },
    },
    headers: {
      default: new Header({
        children: [new Paragraph({
          children: [
            new TextRun({ text: "DIABETES MONITORING CHECKLIST  |  Type 2 DM", bold: true, size: pt(9), color: BLUE_MID, font: "Calibri" }),
            new TextRun({ text: "    Page ", size: pt(9), color: GREY_TEXT, font: "Calibri" }),
            new TextRun({ children: [PageNumber.CURRENT], size: pt(9), color: GREY_TEXT, font: "Calibri" }),
          ],
          border: { bottom: { style: BorderStyle.SINGLE, size: 4, color: BLUE_LIGHT } },
          alignment: AlignmentType.RIGHT,
        })],
      }),
    },
    children,
  }],
});

Packer.toBuffer(doc).then(buf => {
  fs.writeFileSync("/home/daytona/workspace/diabetes-checklist/Diabetes_Monitoring_Checklist.docx", buf);
  console.log("✅ Written successfully.");
}).catch(err => {
  console.error("❌ Error:", err.message);
  process.exit(1);
});

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