Diabetes Drug Combinations - Complete Simple Guide ✅

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm, mm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.colors import HexColor
from reportlab.pdfgen import canvas
from reportlab.platypus import BaseDocTemplate, PageTemplate, Frame

# ── Color palette ──────────────────────────────────────────────
C_BLUE      = HexColor("#1a5276")   # dark navy blue – headers
C_LBLUE     = HexColor("#d6eaf8")   # light blue – row fill
C_GREEN     = HexColor("#1e8449")   # dark green – section accent
C_LGREEN    = HexColor("#d5f5e3")   # light green
C_ORANGE    = HexColor("#e67e22")   # orange – warnings
C_LORANGE   = HexColor("#fdebd0")   # light orange
C_RED       = HexColor("#c0392b")   # red – avoid
C_LRED      = HexColor("#fadbd8")   # light red
C_PURPLE    = HexColor("#7d3c98")   # purple – elderly
C_LPURPLE   = HexColor("#e8daef")   # light purple
C_TEAL      = HexColor("#148f77")   # teal – affordable
C_LTEAL     = HexColor("#d0ece7")   # light teal
C_GOLD      = HexColor("#b7950b")   # gold – premium
C_LGOLD     = HexColor("#fef9e7")   # light gold
C_GREY      = HexColor("#f2f3f4")   # very light grey rows
C_DARK      = HexColor("#2c3e50")   # near-black text
C_MID       = HexColor("#566573")   # medium grey text

W, H = A4  # 595 x 842 pts

# ── Document ────────────────────────────────────────────────────
OUTPUT = "/home/daytona/workspace/diabetes-pdf/Diabetes_Drug_Guide.pdf"
doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    leftMargin=1.5*cm, rightMargin=1.5*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="Diabetes Drug Guide – Patient Handout",
    author="Dr. Guide"
)

# ── Styles ──────────────────────────────────────────────────────
styles = getSampleStyleSheet()

def style(name, **kw):
    s = ParagraphStyle(name, **kw)
    return s

S_TITLE = style("TITLE",
    fontSize=22, leading=28, textColor=C_BLUE,
    fontName="Helvetica-Bold", alignment=TA_CENTER, spaceAfter=4)

S_SUBTITLE = style("SUBTITLE",
    fontSize=11, leading=14, textColor=C_MID,
    fontName="Helvetica", alignment=TA_CENTER, spaceAfter=12)

S_SECTION = style("SECTION",
    fontSize=13, leading=16, textColor=colors.white,
    fontName="Helvetica-Bold", alignment=TA_LEFT,
    spaceAfter=4, spaceBefore=10,
    backColor=C_BLUE, borderPadding=(4, 6, 4, 6))

S_SUBSEC = style("SUBSEC",
    fontSize=11, leading=14, textColor=C_BLUE,
    fontName="Helvetica-Bold", spaceBefore=8, spaceAfter=2)

S_BODY = style("BODY",
    fontSize=9, leading=13, textColor=C_DARK,
    fontName="Helvetica", spaceAfter=2)

S_SMALL = style("SMALL",
    fontSize=8, leading=11, textColor=C_MID,
    fontName="Helvetica", spaceAfter=2)

S_NOTE = style("NOTE",
    fontSize=8.5, leading=12, textColor=C_DARK,
    fontName="Helvetica-Oblique", spaceAfter=3)

S_WARN = style("WARN",
    fontSize=9, leading=12, textColor=C_RED,
    fontName="Helvetica-Bold", spaceAfter=2)

S_TH = style("TH",
    fontSize=9, leading=11, textColor=colors.white,
    fontName="Helvetica-Bold", alignment=TA_CENTER)

S_TD = style("TD",
    fontSize=8.5, leading=11, textColor=C_DARK,
    fontName="Helvetica", alignment=TA_LEFT)

S_TDC = style("TDC",
    fontSize=8.5, leading=11, textColor=C_DARK,
    fontName="Helvetica", alignment=TA_CENTER)

S_TDB = style("TDB",
    fontSize=8.5, leading=11, textColor=C_DARK,
    fontName="Helvetica-Bold", alignment=TA_LEFT)

# ── Helper: section header ──────────────────────────────────────
def sec_header(text, bg=C_BLUE):
    tbl = Table([[Paragraph(f"  {text}", style("SH",
        fontSize=12, leading=15, textColor=colors.white,
        fontName="Helvetica-Bold"))]],
        colWidths=[W - 3*cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("ROWBACKGROUNDS", (0,0), (-1,-1), [bg]),
        ("TOPPADDING", (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING", (0,0), (-1,-1), 8),
    ]))
    return tbl

def sub_header(text, bg=C_LBLUE, tc=C_BLUE):
    tbl = Table([[Paragraph(f"  {text}", style("SSH",
        fontSize=10, leading=13, textColor=tc,
        fontName="Helvetica-Bold"))]],
        colWidths=[W - 3*cm])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING", (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING", (0,0), (-1,-1), 6),
    ]))
    return tbl

def spacer(h=0.3):
    return Spacer(1, h*cm)

def hr(color=C_LBLUE, thickness=1):
    return HRFlowable(width="100%", thickness=thickness, color=color, spaceAfter=3, spaceBefore=3)

def para(text, st=S_BODY):
    return Paragraph(text, st)

def note(text):
    return Paragraph(f"<i>{text}</i>", S_SMALL)

def warn(text):
    return Paragraph(f"⚠ {text}", S_WARN)

# ── Generic table builder ───────────────────────────────────────
def drug_table(headers, rows, col_widths, header_bg=C_BLUE, alt1=C_GREY, alt2=colors.white):
    data = [[Paragraph(h, S_TH) for h in headers]]
    for i, row in enumerate(rows):
        styled = []
        for j, cell in enumerate(row):
            if j == 0:
                styled.append(Paragraph(str(cell), S_TDB))
            else:
                styled.append(Paragraph(str(cell), S_TD))
        data.append(styled)

    tbl = Table(data, colWidths=col_widths, repeatRows=1)
    style_cmds = [
        ("BACKGROUND",    (0,0), (-1,0),  header_bg),
        ("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"),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 5),
        ("RIGHTPADDING",  (0,0), (-1,-1), 5),
        ("GRID",          (0,0), (-1,-1), 0.4, HexColor("#bdc3c7")),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [alt1, alt2]),
    ]
    tbl.setStyle(TableStyle(style_cmds))
    return tbl

# ════════════════════════════════════════════════════════════════
# BUILD CONTENT
# ════════════════════════════════════════════════════════════════
story = []

# ── COVER / TITLE ───────────────────────────────────────────────
story.append(spacer(0.5))
story.append(para(
    '<font color="#1a5276"><b>🩺 Diabetes Drug Guide</b></font>',
    style("CT", fontSize=26, leading=32, fontName="Helvetica-Bold",
          alignment=TA_CENTER, textColor=C_BLUE)))
story.append(para(
    "Complete Prescription Reference with Brand Names &amp; Doses",
    style("CST", fontSize=13, leading=16, fontName="Helvetica",
          alignment=TA_CENTER, textColor=C_MID)))
story.append(spacer(0.2))
story.append(HRFlowable(width="100%", thickness=2, color=C_BLUE, spaceAfter=4))
story.append(para(
    "For Indian patients · Prices approximate (2025-2026) · Always consult your doctor before changing medicines",
    style("CDS", fontSize=9, leading=12, fontName="Helvetica-Oblique",
          alignment=TA_CENTER, textColor=C_MID)))
story.append(spacer(0.4))

# ── BOX: Blood Sugar Targets ────────────────────────────────────
tgt_data = [
    [Paragraph("<b>Measurement</b>", S_TH),
     Paragraph("<b>Normal Person</b>", S_TH),
     Paragraph("<b>Diabetic Target</b>", S_TH),
     Paragraph("<b>Elderly Target</b>", S_TH)],
    [Paragraph("Fasting (morning)", S_TD),
     Paragraph("70–100 mg/dL", S_TDC),
     Paragraph("<b>80–130 mg/dL</b>", S_TDC),
     Paragraph("90–150 mg/dL", S_TDC)],
    [Paragraph("Post-meal (2 hrs after eating)", S_TD),
     Paragraph("< 140 mg/dL", S_TDC),
     Paragraph("<b>< 180 mg/dL</b>", S_TDC),
     Paragraph("< 200 mg/dL", S_TDC)],
    [Paragraph("HbA1c (3-month average)", S_TD),
     Paragraph("< 5.7%", S_TDC),
     Paragraph("<b>< 7.0%</b>", S_TDC),
     Paragraph("< 8.0%", S_TDC)],
]
tgt_tbl = Table(tgt_data, colWidths=[6.5*cm, 3.5*cm, 3.5*cm, 3.5*cm])
tgt_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  C_BLUE),
    ("TEXTCOLOR",     (0,0), (-1,0),  colors.white),
    ("FONTNAME",      (0,0), (-1,0),  "Helvetica-Bold"),
    ("ALIGN",         (1,0), (-1,-1), "CENTER"),
    ("VALIGN",        (0,0), (-1,-1), "MIDDLE"),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("GRID",          (0,0), (-1,-1), 0.4, HexColor("#bdc3c7")),
    ("ROWBACKGROUNDS",(0,1), (-1,-1), [C_LGOLD, colors.white]),
]))
story.append(sec_header("BLOOD SUGAR TARGETS"))
story.append(spacer(0.1))
story.append(tgt_tbl)
story.append(spacer(0.4))

# ════════════════════════════════════════════════════════════════
# SECTION 1 – WHICH DRUG WHEN
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 1: WHICH DRUG TO USE — BASED ON SUGAR PATTERN"))
story.append(spacer(0.15))

# 1a – Only fasting high
story.append(sub_header("SITUATION A: Only Fasting Sugar High, Post-meal is Normal", bg=C_LBLUE, tc=C_BLUE))
story.append(spacer(0.1))
story.append(para("<b>What it means:</b> Liver releases too much glucose overnight. "
                  "Body does not make enough baseline insulin.", S_BODY))
story.append(spacer(0.1))
sit_a = [
    ["Drug", "Dose", "Brand Names (India)", "Price/tab", "When to Take"],
    ["Metformin\n(Start here always)", "500–1000 mg\ntwice daily", "Glycomet 500/1000\nGlucophage 500\nFormit 500", "₹3–6", "With dinner\n(or morning+night)"],
    ["Metformin +\nGlimepiride\n(if Metformin not enough)", "Met 500 mg +\nGlim 1–2 mg\ntwice daily", "Glycomet GP 500/1\nGlycomet GP 500/2\nGluconorm G 1\nAmaryl M 1/2", "₹9–19", "With breakfast\n(main meal)"],
    ["Metformin +\nGliclazide\n(safer alternative)", "Met 500 mg +\nGliclazide 40–80 mg", "Reclide M 80\nGlizid M 80\nDiamicron MR (single)", "₹10–12", "With breakfast"],
]
story.append(drug_table(
    sit_a[0], sit_a[1:],
    [4*cm, 3.2*cm, 5*cm, 2*cm, 2.8*cm],
    header_bg=C_BLUE, alt1=C_LBLUE, alt2=colors.white
))
story.append(spacer(0.3))

# 1b – Only PP high
story.append(sub_header("SITUATION B: Post-meal Sugar High, Fasting is Normal", bg=C_LGREEN, tc=C_GREEN))
story.append(spacer(0.1))
story.append(para("<b>What it means:</b> Body does not release insulin fast enough after eating. "
                  "Carbohydrates absorb too quickly.", S_BODY))
story.append(spacer(0.1))
sit_b = [
    ["Drug", "Dose", "Brand Names (India)", "Price/tab", "When to Take"],
    ["Voglibose\n(slows carb absorption)", "0.2 mg or 0.3 mg\nthree times daily", "Volix 0.3\nVolibo 0.3\nVoglibose generic", "₹3–6", "At FIRST BITE\nof each meal"],
    ["Metformin +\nVoglibose", "Met 500 +\nVogli 0.2 mg", "Volibo M 500/0.2\nPrandial M\nVoglistar M", "₹8–10", "At first bite\nof meal"],
    ["Repaglinide\n(short acting)", "0.5–2 mg before\neach meal", "Eurepa 0.5/1/2\nRegan 0.5/1", "₹5–10", "15 min before meal\nSkip if skipping meal"],
    ["Metformin +\nRepaglinide", "Met 500 +\nRepa 1 mg", "Eurepa MF 500/1\nRegan M", "₹9–12", "Before meals"],
    ["DPP4 Inhibitor\n(Sitagliptin)\nBoosts meal-time insulin", "Sitagliptin 50–100 mg\nonce daily", "Januvia 100\nZita 100", "₹25–30", "Any time with food"],
]
story.append(drug_table(
    sit_b[0], sit_b[1:],
    [4*cm, 3*cm, 5*cm, 2*cm, 3*cm],
    header_bg=C_GREEN, alt1=C_LGREEN, alt2=colors.white
))
story.append(spacer(0.3))

# 1c – Both high
story.append(sub_header("SITUATION C: Both Fasting AND Post-meal are High (Most Common)", bg=C_LORANGE, tc=C_ORANGE))
story.append(spacer(0.1))
story.append(para("<b>Start with Metformin + one second drug.</b> Choose second drug based on patient type "
                  "(see sections below). If HbA1c &gt; 9%, consider triple therapy or insulin early.", S_BODY))
story.append(spacer(0.1))
sit_c = [
    ["Combination", "Dose", "Brand Names (India)", "Price/tab", "Best For"],
    ["Metformin +\nGlimepiride\n(GOLD STANDARD)", "Met 500/1000 +\nGlim 1–2 mg BD", "Glycomet GP 500/1\nGlycomet GP 500/2\nGluconorm G 2\nAmaryl M 2", "₹9–19", "Most patients\nBudget-friendly\nStrong HbA1c drop"],
    ["Metformin +\nSitagliptin", "Met 500 +\nSita 50 mg BD\nor 1000 + 50 BD", "Janumet 500/50\nIstamet 500/50\nSitara M 500/50", "₹10–25", "Safe heart profile\nLow hypo risk"],
    ["Metformin +\nVildagliptin", "Met 500 +\nVilda 50 mg BD", "Galvus Met 500/50\nJalra M 500/50\nZomelis Met 500/50", "₹11–22", "Elderly\nWeight neutral"],
    ["Metformin +\nTeneligliptin\n(cheapest DPP4)", "Met 500 +\nTene 20 mg OD", "Tenlimac M 500/20\nDynaglipt M\nZita Met Plus", "₹10–15", "Budget + elderly\nCKD safe"],
    ["Metformin +\nDapagliflozin", "Met 500/1000 +\nDapa 10 mg OD", "Udapa M 500/10\nOxra Met 500/10\nXigduo XR (costly)", "₹12–70", "Overweight\nHeart/kidney risk"],
    ["Metformin +\nEmpagliflozin", "Met 500/1000 +\nEmpa 12.5–25 mg OD", "Empaone M 500/12.5\nGibtulio Met\nJardiance Met", "₹25–42", "Heart disease\nHeart failure"],
    ["Metformin +\nPioglitazone", "Met 500 +\nPio 15–30 mg OD", "Pioz MF 500/15\nPioglar M 500/15\nGlizone M 500/15", "₹7–9", "Fatty liver\nInsulin resistance"],
    ["Triple: Met +\nGlim + Voglibose", "Met 500 + Glim 2 +\nVogli 0.2 mg", "Glycomet Trio 2\nGluconorm V G 2\nVoglimac GM 2", "₹12–20", "Both fasting &amp;\nPP spike high"],
    ["Triple: Met +\nGlim + Pioglitazone", "Met 500 + Glim 2 +\nPio 15 mg", "Tribet 2\nAccuglim MP 2\nTripride 2", "₹14–16", "HbA1c &gt; 9%\nHigh insulin resistance"],
]
story.append(drug_table(
    sit_c[0], sit_c[1:],
    [4*cm, 3.2*cm, 4.5*cm, 2*cm, 3.3*cm],
    header_bg=C_ORANGE, alt1=C_LORANGE, alt2=colors.white
))
story.append(spacer(0.5))

# ════════════════════════════════════════════════════════════════
# SECTION 2 – HEART DISEASE
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 2: PATIENT WITH HEART DISEASE / HEART FAILURE", C_RED))
story.append(spacer(0.15))
story.append(para(
    "<b>Most important group!</b> SGLT2 inhibitors (Empagliflozin, Dapagliflozin) are now FIRST CHOICE "
    "in diabetics with heart disease — proven to reduce heart death and hospitalization "
    "(EMPA-REG, DECLARE-TIMI trials). Avoid Pioglitazone and Glibenclamide.", S_BODY))
story.append(spacer(0.1))

heart_data = [
    ["Drug", "Dose", "Brand Names", "Price/tab", "Why Use / Notes"],
    ["Metformin\n(always keep unless CKD)", "500–1000 mg BD", "Glycomet 500/1000\nGlucophage 500", "₹3–6", "Safe in heart disease\nReduce insulin resistance"],
    ["Empagliflozin\n✅ FIRST CHOICE in\nheart failure", "10 or 25 mg OD\n(morning)", "Jardiance 10/25\nEmpaone 10/25\nGibtulio 10/25", "₹25–42", "Proven: reduces CV death\nReduces HF hospitalizations\nLowers BP + weight"],
    ["Dapagliflozin\n✅ Also excellent", "10 mg OD\n(morning)", "Forxiga 10\nUdapa 10\nOxra 10", "₹12–25", "Proven in heart failure\nRenal protection too\nCheaper than Empa"],
    ["Sitagliptin\n(cardiovascular SAFE)", "50–100 mg OD/BD", "Januvia 100\nZita 100\nIstamet (with Met)", "₹10–25", "Neutral – no harm\nno CV benefit either\nGood add-on"],
    ["Metformin +\nEmpagliflozin", "Met 500 +\nEmpa 12.5 mg BD", "Empaone M 500/12.5\nGibtulio Met\nJardiance Met", "₹25–42", "BEST COMBINATION\nfor heart patients"],
    ["Metformin +\nDapagliflozin\n(budget option)", "Met 500 +\nDapa 10 mg OD", "Udapa M 500/10\nOxra Met 500/10", "₹12–14", "Affordable cardiac\nprotection combo"],
]
story.append(drug_table(
    heart_data[0], heart_data[1:],
    [3.8*cm, 2.8*cm, 4.5*cm, 2*cm, 4*cm],
    header_bg=C_RED, alt1=C_LRED, alt2=colors.white
))
story.append(spacer(0.15))

avoid_heart = [
    [Paragraph("<b>⚠ AVOID IN HEART DISEASE</b>", style("AH",
        fontSize=10, fontName="Helvetica-Bold", textColor=C_RED))],
    [Paragraph(
        "• <b>Pioglitazone</b> – causes fluid retention, worsens heart failure<br/>"
        "• <b>Glibenclamide (Daonil)</b> – increases cardiac risk, severe hypoglycemia<br/>"
        "• <b>High-dose Glimepiride</b> (keep ≤ 2 mg if needed)<br/>"
        "• <b>Rosiglitazone</b> – avoid completely in cardiac patients",
        style("AL", fontSize=9, fontName="Helvetica", textColor=C_DARK, leading=14))],
]
avoid_tbl = Table(avoid_heart, colWidths=[W - 3*cm])
avoid_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0),  C_LRED),
    ("BACKGROUND",    (0,1), (-1,-1), HexColor("#fff5f5")),
    ("BOX",           (0,0), (-1,-1), 1, C_RED),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(avoid_tbl)
story.append(spacer(0.5))

# ════════════════════════════════════════════════════════════════
# SECTION 3 – ELDERLY
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 3: ELDERLY PATIENTS (Age 65+)", C_PURPLE))
story.append(spacer(0.15))
story.append(para(
    "<b>Key concern:</b> Low sugar (hypoglycemia) is VERY DANGEROUS in elderly – can cause falls, "
    "fractures, confusion, and stroke. Relax HbA1c target to &lt;8%. "
    "Prefer drugs with NO hypoglycemia risk.", S_BODY))
story.append(spacer(0.1))

elderly_data = [
    ["Drug", "Dose", "Brand Names", "Price/tab", "Why Preferred"],
    ["Teneligliptin\n(BEST for elderly, budget)", "20 mg OD\n(morning)", "Tendia 20\nZita 20\nTena 20\nPandia 20", "₹8–12", "No hypoglycemia\nCheapest DPP4\nNo kidney dose change"],
    ["Metformin +\nTeneligliptin\n(BEST combo for elderly)", "Met 500 +\nTene 20 mg BD", "Tenlimac M 500/20\nDynaglipt M 500/20\nZita Met Plus 500/20", "₹10–15", "Safe, affordable\nNo hypo risk\nWeight neutral"],
    ["Linagliptin\n(BEST for elderly with CKD)", "5 mg OD", "Ondero 5\nLinares 5\nLintra 5\nTradjenta 5", "₹14–28", "No dose change even\nin dialysis!\nSafest kidney drug"],
    ["Metformin +\nLinagliptin", "Met 500 +\nLina 2.5 mg BD", "Ondero Met 500/2.5\nLinares M 500/2.5\nLintra M 500/2.5", "₹14–28", "Safest elderly combo\nif kidney function low"],
    ["Vildagliptin\n(good elderly option)", "50 mg BD", "Galvus 50\nJalra 50\nZomelis 50", "₹15–25", "No hypoglycemia\nWeight neutral\nTwice daily dosing"],
    ["Low-dose Glimepiride\n(if must use SU)", "0.5–1 mg only\nwith breakfast", "Amaryl 1 mg\nGlucored 1 mg\n(half tablet)", "₹4–6", "Use MINIMUM dose only\nMonitor carefully\nDO NOT use 4 mg+ in elderly"],
    ["Remogliflozin\n(if SGLT2 needed)", "100–200 mg BD", "Remo 100\nRemozen 100\nRemo V (+ Vilda)", "₹10–14", "Cheapest Indian SGLT2\nUse cautiously\nWatch for dehydration/UTI"],
]
story.append(drug_table(
    elderly_data[0], elderly_data[1:],
    [3.8*cm, 2.8*cm, 4.5*cm, 2*cm, 4*cm],
    header_bg=C_PURPLE, alt1=C_LPURPLE, alt2=colors.white
))
story.append(spacer(0.15))

avoid_eld = Table([[Paragraph(
    "<b>⚠ AVOID IN ELDERLY:</b>  Glibenclamide (Daonil) •  Metformin if eGFR &lt;30 •  "
    "Pioglitazone (edema, falls) •  High-dose Glimepiride (4–8 mg)",
    style("AE", fontSize=9, fontName="Helvetica", textColor=C_DARK, leading=13))]],
    colWidths=[W - 3*cm])
avoid_eld.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), C_LPURPLE),
    ("BOX",           (0,0), (-1,-1), 1, C_PURPLE),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(avoid_eld)
story.append(spacer(0.5))

# ════════════════════════════════════════════════════════════════
# SECTION 4 – CANNOT AFFORD
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 4: BUDGET-CONSCIOUS PATIENTS (Cannot Afford Costly Drugs)", C_TEAL))
story.append(spacer(0.15))
story.append(para(
    "<b>Goal:</b> Maximum sugar control at minimum cost. "
    "Jan Aushadhi (PMBJP) stores have generic Metformin, Glimepiride, "
    "Glipizide, Voglibose at 1/10th of MRP. Direct patient there.", S_BODY))
story.append(spacer(0.1))

budget_data = [
    ["Combination", "Dose", "Brand / Generic", "Cost/month*", "Good For"],
    ["Metformin alone\n(cheapest start)", "500 mg twice daily", "Glycomet 500\nGlucophage 500\nGeneric Metformin", "~₹60–120", "Newly diagnosed\nOverweight\nOnly mild elevation"],
    ["Metformin +\nGlimepiride\n(BEST BUDGET COMBO)", "Met 500 + Glim 1–2 mg\ntwice daily", "Glycomet GP 500/1\n(₹9/tab)\nGluconorm G 1\nAmaryl M 1", "~₹180–360", "Most Type 2 patients\nStrong HbA1c drop\nWidely available"],
    ["Metformin +\nGlipizide\n(very cheap alternative)", "Met 500 + Glipiz 5 mg\nbefore meals", "Glynase MF 500/5\n(₹5/tab)\nGeneric combo", "~₹100–200", "Rural / Govt hospital\nVery affordable"],
    ["Metformin +\nVoglibose\n(PP spike add-on)", "Met 500 + Vogli 0.2 mg\nwith meals", "Volibo M 500/0.2\nPrandial M\n(₹8–10/tab)", "~₹240–300", "Add when PP still high\non Metformin alone"],
    ["Triple cheap combo\n(HbA1c very high)", "Met 500 + Glim 2 +\nVogli 0.2 mg", "Glycomet Trio 2\nVoglimac GM 2\n(₹12–20/tab)", "~₹360–600", "Uncontrolled DM\nboth fasting + PP high"],
    ["Glimepiride alone\n(Metformin not tolerated)", "1–2 mg once daily\nwith breakfast", "Amaryl 1/2\nGlucored 1/2\nGeneric Glimepiride", "~₹120–200", "Metformin intolerance\nGastric issues"],
    ["Teneligliptin\n(cheapest DPP4, elderly)", "20 mg once daily", "Tendia 20\nZita 20\nTena 20\n(₹8–12/tab)", "~₹240–360", "Elderly on budget\nNo hypo risk\nCKD safe"],
    ["Remogliflozin\n(cheapest SGLT2)", "100–200 mg BD", "Remo 100\nRemozen 100\n(₹10–14/tab)", "~₹300–420", "Needs weight loss\nBP reduction\nCan't afford Dapa/Empa"],
]
story.append(drug_table(
    budget_data[0], budget_data[1:],
    [3.8*cm, 3*cm, 4.2*cm, 2.5*cm, 3.5*cm],
    header_bg=C_TEAL, alt1=C_LTEAL, alt2=colors.white
))
story.append(spacer(0.15))
jan_box = Table([[Paragraph(
    "<b>💊 Jan Aushadhi (PMBJP) Tip:</b>  All generic Metformin, Glimepiride, Glipizide, "
    "Voglibose, Pioglitazone available at Jan Aushadhi stores at 60–90% cheaper than MRP. "
    "Always ask patient to go to nearest Jan Aushadhi Kendra.",
    style("JB", fontSize=9, fontName="Helvetica", textColor=C_DARK, leading=13))]],
    colWidths=[W - 3*cm])
jan_box.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), C_LTEAL),
    ("BOX",           (0,0), (-1,-1), 1.5, C_TEAL),
    ("TOPPADDING",    (0,0), (-1,-1), 7),
    ("BOTTOMPADDING", (0,0), (-1,-1), 7),
    ("LEFTPADDING",   (0,0), (-1,-1), 10),
]))
story.append(jan_box)
story.append(spacer(0.5))

# ════════════════════════════════════════════════════════════════
# SECTION 5 – CAN AFFORD (PREMIUM)
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 5: PATIENTS WHO CAN AFFORD ALL DRUGS (Best Evidence-Based)", C_GOLD))
story.append(spacer(0.15))
story.append(para(
    "<b>Goal:</b> Best possible sugar control + organ protection + weight management + "
    "cardiovascular benefit. Use modern drugs with proven trial data.", S_BODY))
story.append(spacer(0.1))

premium_data = [
    ["Situation", "Best Combination", "Brand Names", "Daily Cost"],
    ["Overweight, no\ncomplications", "Metformin + Dapagliflozin\nor Empagliflozin", "Udapa M 500/10\nEmpaone M 500/12.5\nForxiga 10 + Glycomet", "₹30–60"],
    ["Heart disease /\nPost heart attack", "Metformin + Empagliflozin\n(+/- Sitagliptin if HbA1c high)", "Empaone M + Janumet\nJardiance Met + Januvia\nGibtulio Met", "₹60–100"],
    ["Heart failure\n(even non-diabetic)", "Empagliflozin or\nDapagliflozin alone", "Jardiance 10\nForxiga 10\nEmpaone 10", "₹42–80"],
    ["Kidney disease (CKD)\nwith Diabetes", "Metformin + Linagliptin\n+ Dapagliflozin (if eGFR ok)", "Ondero Met + Forxiga\nLinares M + Udapa", "₹40–70"],
    ["Fatty Liver (NASH)\n+ Diabetes", "Metformin + Pioglitazone\n+/- SGLT2 inhibitor", "Pioz MF 15 + Empaone\nGlizone M + Udapa M", "₹25–50"],
    ["Obese + Diabetes\n(best weight loss)", "Metformin + Semaglutide\n(injection, once weekly)\nor Liraglutide (daily)", "Ozempic 0.5/1 mg\n(Semaglutide)\nVictoza 1.2/1.8 mg", "₹150–300"],
    ["HbA1c &gt; 9% not\ncontrolled on 2 drugs", "Triple: Met + Glimepiride\n+ Sitagliptin/SGLT2i", "Tribet 2 + Januvia\nor Met GP + Udapa", "₹50–80"],
    ["Metformin\nnot tolerated (gastric)", "Sitagliptin + Dapagliflozin\n(Met-free combination)", "Sitara D 100/10\nSita Dapa 100/10\nIstamet D", "₹35–55"],
]
story.append(drug_table(
    premium_data[0], premium_data[1:],
    [4*cm, 5*cm, 4.5*cm, 3.5*cm],
    header_bg=C_GOLD, alt1=C_LGOLD, alt2=colors.white
))
story.append(spacer(0.3))

# GLP1 note
glp1 = Table([[Paragraph(
    "<b>💉 GLP-1 Agonists (Semaglutide / Liraglutide):</b> Best drugs for obese Type 2 diabetics "
    "who can afford injections. Semaglutide (Ozempic) given once a week. "
    "Average weight loss 5–12 kg. Proven to reduce CV events. "
    "Ozempic oral tablet (Rybelsus 7/14 mg) also available – take on empty stomach 30 min before food.",
    style("GP", fontSize=9, fontName="Helvetica", textColor=C_DARK, leading=13))]],
    colWidths=[W - 3*cm])
glp1.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), C_LGOLD),
    ("BOX",           (0,0), (-1,-1), 1.5, C_GOLD),
    ("TOPPADDING",    (0,0), (-1,-1), 7),
    ("BOTTOMPADDING", (0,0), (-1,-1), 7),
    ("LEFTPADDING",   (0,0), (-1,-1), 10),
]))
story.append(glp1)
story.append(spacer(0.5))

# ════════════════════════════════════════════════════════════════
# SECTION 6 – QUICK REFERENCE / DECISION TABLE
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 6: QUICK DECISION REFERENCE (At-a-Glance)", C_BLUE))
story.append(spacer(0.15))

qr_data = [
    ["Patient Type", "First Choice", "Alternative", "AVOID"],
    ["New diagnosis\nHbA1c 7–8%", "Metformin 500 BD\n(Glycomet 500)", "Metformin + Teneligliptin\n(Tenlimac M)", "Glibenclamide"],
    ["Only fasting high", "Metformin + Glimepiride 1 mg\n(Glycomet GP 500/1)", "Metformin + Gliclazide\n(Reclide M)", "Glibenclamide"],
    ["Only PP high", "Metformin + Voglibose\n(Volibo M / Prandial M)", "Metformin + Repaglinide\n(Eurepa MF)", "Nothing specific"],
    ["Both high, budget", "Metformin + Glimepiride 2 mg\n(Glycomet GP 500/2)", "Triple: Glycomet Trio 2", "Glibenclamide"],
    ["Heart disease /\nHeart failure", "Metformin + Empagliflozin\n(Empaone M / Jardiance Met)", "Metformin + Dapagliflozin\n(Udapa M)", "Pioglitazone\nGlibenclamide"],
    ["Elderly (65+)", "Metformin + Teneligliptin\n(Tenlimac M / Dynaglipt M)", "Metformin + Vildagliptin\n(Galvus Met / Jalra M)", "Glibenclamide\nHigh-dose Glimepiride"],
    ["Elderly + CKD", "Linagliptin 5 mg alone\n(Ondero 5 / Linares 5)", "Teneligliptin 20 mg\n(Tendia 20)", "Metformin (eGFR&lt;30)\nGlibenclamide"],
    ["Fatty Liver (NASH)", "Metformin + Pioglitazone\n(Pioz MF / Glizone M)", "Metformin + SGLT2i\n(Udapa M)", "None specific"],
    ["Overweight", "Metformin + Dapagliflozin\n(Udapa M / Oxra Met)", "Metformin + Semaglutide\n(Ozempic, if afford)", "Pioglitazone\n(weight gain)"],
    ["CKD moderate\n(eGFR 30–60)", "Metformin (low dose) +\nLinagliptin (Ondero Met)", "Teneligliptin (Tendia)\n+ Insulin if needed", "Metformin high dose\nGlibenclamide"],
    ["Irregular meals\n(skips often)", "Metformin + Repaglinide\n(Eurepa MF)", "Metformin + DPP4\n(Galvus Met)", "Long-acting SU (hypo risk)"],
    ["HbA1c &gt; 9%\n(very poor control)", "Triple oral OR\nStart Insulin + Metformin", "Met + Glim 2 + Pioglitazone\n(Tribet 2)", "Delay treatment"],
    ["Cannot take Metformin\n(severe gastric)", "Sitagliptin + Dapagliflozin\n(Sitara D / Istamet D)", "Glimepiride + Voglibose\n(Volix 2 / Voglistar G 2)", "Metformin"],
]
story.append(drug_table(
    qr_data[0], qr_data[1:],
    [3.5*cm, 5*cm, 4.5*cm, 4*cm],
    header_bg=C_BLUE, alt1=C_LBLUE, alt2=colors.white
))
story.append(spacer(0.5))

# ════════════════════════════════════════════════════════════════
# SECTION 7 – DRUGS TO NEVER COMBINE / IMPORTANT RULES
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 7: IMPORTANT RULES EVERY DOCTOR MUST KNOW", C_RED))
story.append(spacer(0.15))

rules_data = [
    ["Rule", "Reason"],
    ["Never combine TWO sulfonylureas\n(e.g. Glimepiride + Glipizide + Gliclazide)", "Same class – no extra benefit, doubled hypoglycemia risk"],
    ["Never combine TWO SGLT2 inhibitors\n(e.g. Dapagliflozin + Empagliflozin)", "No added benefit, increases DKA and UTI risk"],
    ["Never combine TWO DPP4 inhibitors\n(e.g. Sitagliptin + Vildagliptin)", "No extra effect, wasted cost"],
    ["Metformin: STOP if eGFR < 30\nor before contrast CT scan", "Risk of lactic acidosis. Resume 48 hrs after contrast."],
    ["SGLT2 inhibitors: STOP before surgery\nor prolonged fasting (> 24 hrs)", "Risk of euglycemic DKA (sugar normal but acid in blood)"],
    ["Pioglitazone: NEVER in heart failure,\nbladder cancer history", "Worsens fluid retention; possible bladder cancer link"],
    ["Glibenclamide (Daonil): AVOID in\nelderly, CKD, heart disease", "Very long-acting, severe unpredictable hypoglycemia"],
    ["Repaglinide / Nateglinide: SKIP DOSE\nif patient is skipping meal", "These work only when food is taken – otherwise hypo"],
    ["Always take SGLT2 inhibitors\nin MORNING not at night", "Causes increased urination – disturbs sleep if taken late"],
    ["Voglibose: must take at FIRST BITE\nof food, not before or after", "Works by slowing carb digestion at the time of eating"],
]
story.append(drug_table(
    rules_data[0], rules_data[1:],
    [8.5*cm, 8.5*cm],
    header_bg=C_RED, alt1=C_LRED, alt2=colors.white
))
story.append(spacer(0.5))

# ════════════════════════════════════════════════════════════════
# SECTION 8 – PATIENT INSTRUCTIONS (SIMPLE)
# ════════════════════════════════════════════════════════════════
story.append(sec_header("SECTION 8: SIMPLE PATIENT INSTRUCTIONS", C_GREEN))
story.append(spacer(0.15))

inst_data = [
    ["Drug Group", "Take It When?", "Common Brand", "Side Effects to Watch"],
    ["Metformin", "With food (to reduce nausea)\nMorning + Night", "Glycomet 500\nGlucophage 500", "Nausea, loose motions\n(settles in 2 weeks)"],
    ["Glimepiride\nGliclazide\nGlipizide\n(Sulfonylureas)", "With FIRST MEAL of the day\n(breakfast)\nDO NOT skip meal", "Amaryl 1/2\nGlizid 80\nGlynase 5", "Low sugar (dizziness, sweating)\nWeight gain"],
    ["Sitagliptin\nVildagliptin\nTeneligliptin\nLinagliptin\n(DPP4 inhibitors)", "Any time, with or without food\n(Vilda – twice daily)", "Januvia 100\nGalvus 50\nTendia 20\nOndero 5", "Generally very safe\nRare: joint pain, runny nose"],
    ["Dapagliflozin\nEmpagliflozin\nRemogliflozin\n(SGLT2 inhibitors)", "MORNING only with food\nDrink plenty of water (3–4 L/day)", "Forxiga 10\nJardiance 10\nRemo 100", "Frequent urination\nUTI/fungal infection\nDo not take if fasting/surgery"],
    ["Pioglitazone", "Once daily with food", "Pioz 15/30\nActos 15", "Swelling in legs\nWeight gain\nBladder discomfort (long term)"],
    ["Voglibose", "At VERY FIRST BITE of food", "Volix 0.3\nVolibo 0.3", "Gas, bloating, loose stools\n(common but harmless)"],
    ["Repaglinide", "15 min BEFORE each meal\nSkip if skipping meal", "Eurepa 0.5/1/2\nRegan 0.5/1", "Low sugar if meal skipped"],
    ["Insulin (Basal)\nGlargine / Degludec", "Fixed time every night\n(Glargine: bedtime)\n(Degludec: any fixed time)", "Lantus / Toujeo\nTresiba / Basalin", "Injection site pain\nLow sugar if dose too high\nKeep sugar biscuits ready"],
]
story.append(drug_table(
    inst_data[0], inst_data[1:],
    [3.5*cm, 3.5*cm, 3.5*cm, 6.5*cm],
    header_bg=C_GREEN, alt1=C_LGREEN, alt2=colors.white
))
story.append(spacer(0.4))

# ── FOOTER NOTE ────────────────────────────────────────────────
footer = Table([[Paragraph(
    "<b>Disclaimer:</b>  This guide is for doctor reference and patient education only. "
    "Drug doses must be individualized. Always check for contraindications and drug interactions. "
    "Prices are approximate 2025-2026 Indian market rates and vary by state and pharmacy. "
    "Consult a qualified physician before starting, stopping, or changing any medication.",
    style("FT", fontSize=8, fontName="Helvetica-Oblique", textColor=C_MID, leading=11,
          alignment=TA_JUSTIFY))]],
    colWidths=[W - 3*cm])
footer.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,-1), C_GREY),
    ("BOX",           (0,0), (-1,-1), 0.5, C_MID),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 8),
]))
story.append(footer)

# ── BUILD ────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF saved: {OUTPUT}")