"diabetes mellitus" AND management

ls /home/daytona/workspace/ 2>/dev/null && echo "exists" || mkdir -p /home/dayto…

mkdir -p /home/daytona/workspace/diabetes-pdf && python3 -c "from reportlab.lib …

~/diabetes-pdf/generate_pdf.py

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_LEFT, TA_CENTER, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether
)
from reportlab.lib.colors import HexColor
import os

# ── Colour palette ──────────────────────────────────────────────────────────
NAVY       = HexColor("#1B3A6B")
STEEL_BLUE = HexColor("#2E6DA4")
LIGHT_BLUE = HexColor("#D6E8F7")
TEAL       = HexColor("#1B7A78")
LIGHT_TEAL = HexColor("#D4EFEE")
AMBER      = HexColor("#E07B00")
AMBER_LIGHT= HexColor("#FFF3D6")
RED        = HexColor("#C0392B")
RED_LIGHT  = HexColor("#FDECEA")
GREEN      = HexColor("#1E7E34")
GREEN_LIGHT= HexColor("#E4F5E9")
GREY_DARK  = HexColor("#3D3D3D")
GREY_MID   = HexColor("#6B6B6B")
GREY_LIGHT = HexColor("#F4F6F8")
WHITE      = colors.white

OUTPUT = "/home/daytona/workspace/diabetes-pdf/Diabetes_Quick_Reference.pdf"

# ── Document ─────────────────────────────────────────────────────────────────
doc = SimpleDocTemplate(
    OUTPUT, pagesize=A4,
    leftMargin=1.5*cm, rightMargin=1.5*cm,
    topMargin=1.8*cm, bottomMargin=1.8*cm,
    title="Diabetes Mellitus – Quick Reference Guide",
    author="Orris Medical"
)

W = A4[0] - 3*cm   # usable width

styles = getSampleStyleSheet()

# Custom paragraph styles
def PS(name, **kw):
    return ParagraphStyle(name, **kw)

title_style = PS("DocTitle",
    fontName="Helvetica-Bold", fontSize=22, textColor=WHITE,
    alignment=TA_CENTER, leading=26, spaceAfter=2)

subtitle_style = PS("DocSubtitle",
    fontName="Helvetica", fontSize=11, textColor=HexColor("#C8DDEF"),
    alignment=TA_CENTER, leading=14, spaceAfter=4)

section_header = PS("SectionHeader",
    fontName="Helvetica-Bold", fontSize=11, textColor=WHITE,
    leading=14, spaceAfter=2, spaceBefore=2,
    leftIndent=4, rightIndent=4)

body = PS("Body",
    fontName="Helvetica", fontSize=8.5, textColor=GREY_DARK,
    leading=12, spaceAfter=3, spaceBefore=2)

body_small = PS("BodySmall",
    fontName="Helvetica", fontSize=7.8, textColor=GREY_DARK,
    leading=11, spaceAfter=2)

bold_body = PS("BoldBody",
    fontName="Helvetica-Bold", fontSize=8.5, textColor=GREY_DARK,
    leading=12, spaceAfter=2)

bullet_style = PS("Bullet",
    fontName="Helvetica", fontSize=8.5, textColor=GREY_DARK,
    leading=12, leftIndent=10, firstLineIndent=-7,
    spaceAfter=2)

caption_style = PS("Caption",
    fontName="Helvetica-Oblique", fontSize=7.5, textColor=GREY_MID,
    alignment=TA_CENTER, leading=10)

note_style = PS("Note",
    fontName="Helvetica-Oblique", fontSize=7.5, textColor=GREY_MID,
    leading=10, spaceAfter=2)

# ── Helper functions ─────────────────────────────────────────────────────────

def section_box(title, bg=STEEL_BLUE):
    """Coloured section header bar."""
    t = Table([[Paragraph(title, section_header)]], colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 5),
        ("BOTTOMPADDING", (0,0), (-1,-1), 5),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return t

def note_box(text, bg=AMBER_LIGHT, border=AMBER):
    """Callout box."""
    t = Table([[Paragraph(text, body_small)]], colWidths=[W])
    t.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), bg),
        ("BOX",           (0,0), (-1,-1), 1, border),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
    ]))
    return t

def header_table(col_data, col_widths, header_bg=NAVY):
    """Table with a bold coloured header row."""
    header_style = PS("TH", fontName="Helvetica-Bold", fontSize=8,
                      textColor=WHITE, leading=10, alignment=TA_LEFT)
    cell_style   = PS("TD", fontName="Helvetica", fontSize=8,
                      textColor=GREY_DARK, leading=11, alignment=TA_LEFT)
    rows = []
    for i, row in enumerate(col_data):
        if i == 0:
            rows.append([Paragraph(str(c), header_style) for c in row])
        else:
            rows.append([Paragraph(str(c), cell_style) for c in row])

    t = Table(rows, colWidths=col_widths, repeatRows=1)
    ts = TableStyle([
        ("BACKGROUND",    (0,0), (-1,0), header_bg),
        ("ROWBACKGROUNDS",(0,1), (-1,-1), [WHITE, GREY_LIGHT]),
        ("GRID",          (0,0), (-1,-1), 0.4, HexColor("#BFCCD6")),
        ("TOPPADDING",    (0,0), (-1,-1), 4),
        ("BOTTOMPADDING", (0,0), (-1,-1), 4),
        ("LEFTPADDING",   (0,0), (-1,-1), 6),
        ("RIGHTPADDING",  (0,0), (-1,-1), 6),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ])
    t.setStyle(ts)
    return t

def bullet(txt):
    return Paragraph(f"<bullet>\u2022</bullet> {txt}", bullet_style)

# ── Title Banner ──────────────────────────────────────────────────────────────

def make_title_banner():
    banner = Table(
        [[Paragraph("DIABETES MELLITUS", title_style)],
         [Paragraph("Quick Reference Guide — Diagnosis · Monitoring · Management", subtitle_style)],
         [Paragraph("Based on ADA Standards of Care | Harrison's 22e | Goodman &amp; Gilman's | Guyton &amp; Hall", caption_style)]],
        colWidths=[W]
    )
    banner.setStyle(TableStyle([
        ("BACKGROUND",    (0,0), (-1,-1), NAVY),
        ("TOPPADDING",    (0,0), (-1,-1), 12),
        ("BOTTOMPADDING", (0,0), (-1,-1), 10),
        ("LEFTPADDING",   (0,0), (-1,-1), 12),
        ("RIGHTPADDING",  (0,0), (-1,-1), 12),
        ("ROUNDEDCORNERS", [6]),
    ]))
    return banner

# ─────────────────────────────────────────────────────────────────────────────
# BUILD CONTENT
# ─────────────────────────────────────────────────────────────────────────────
story = []

# ── TITLE ────────────────────────────────────────────────────────────────────
story.append(make_title_banner())
story.append(Spacer(1, 8))

# ═══════════════════════════════════════════════════════════════════════
# 1. CLASSIFICATION
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("1.  CLASSIFICATION OF DIABETES MELLITUS", NAVY))
story.append(Spacer(1, 4))

class_data = [
    ["Type", "Mechanism / Aetiology", "Key Features"],
    ["Type 1 DM\n(T1DM)",
     "Autoimmune beta-cell destruction → absolute insulin deficiency",
     "5–10% of DM; abrupt onset; islet autoantibodies (GAD65, IA-2, IAA); ~30% present with DKA; peak incidence childhood/adolescence"],
    ["Type 2 DM\n(T2DM)",
     "Progressive beta-cell secretory failure on background of insulin resistance",
     "~90% of DM; insidious onset; linked to obesity, sedentary lifestyle, aging; many have complications at diagnosis"],
    ["Gestational DM\n(GDM)",
     "Diabetes first recognised in pregnancy (not clearly pre-existing overt DM)",
     "Screen all pregnant women 24–28 weeks; increased maternal/fetal risks; resolves post-partum (but ↑ future T2DM risk)"],
    ["Other Specific\nTypes",
     "Monogenic (MODY, neonatal DM); exocrine pancreas disease (cystic fibrosis, pancreatitis); drug-induced (glucocorticoids, anti-retroviral therapy, post-transplant)",
     "Consider in young, lean patients with family history or unusual clinical features; genetic testing may confirm"],
]
story.append(header_table(class_data, [2.5*cm, 6.5*cm, 8.5*cm]))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 2. DIAGNOSIS
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("2.  DIAGNOSTIC CRITERIA  (ADA)", STEEL_BLUE))
story.append(Spacer(1, 4))

# Diagnosis table – 2 column side by side
diag_data = [
    ["DIABETES (any ONE criterion, confirmed on 2 separate occasions unless classic symptoms present)",
     "PREDIABETES (any ONE criterion)"],
    ["• Fasting Plasma Glucose (FPG)  ≥ 126 mg/dL  (7.0 mmol/L)\n"
     "  [fasting = no caloric intake ≥ 8 h]\n\n"
     "• 2-hr Plasma Glucose (75 g OGTT)  ≥ 200 mg/dL  (11.1 mmol/L)\n\n"
     "• HbA1c  ≥ 6.5%  (48 mmol/mol)\n\n"
     "• Random Plasma Glucose  ≥ 200 mg/dL  WITH classic hyperglycaemic symptoms\n"
     "  (polyuria, polydipsia, unexplained weight loss)",
     "• Impaired Fasting Glucose (IFG):\n  FPG 100–125 mg/dL  (5.6–6.9 mmol/L)\n\n"
     "• Impaired Glucose Tolerance (IGT):\n  2-hr OGTT 140–199 mg/dL  (7.8–11.0 mmol/L)\n\n"
     "• HbA1c  5.7–6.4%  (39–47 mmol/mol)\n\n"
     "  → Lifestyle intervention reduces progression\n"
     "    to T2DM by ~58% (DPP trial)\n"
     "  → Metformin may be offered (high-risk patients)"],
]

diag_ps = PS("DiagCell", fontName="Helvetica", fontSize=8, textColor=GREY_DARK, leading=12)
diag_hdr = PS("DiagHdr", fontName="Helvetica-Bold", fontSize=8, textColor=WHITE, leading=11, alignment=TA_CENTER)

diag_rows = [
    [Paragraph(diag_data[0][0], diag_hdr), Paragraph(diag_data[0][1], diag_hdr)],
    [Paragraph(diag_data[1][0], diag_ps),  Paragraph(diag_data[1][1], diag_ps)],
]
diag_t = Table(diag_rows, colWidths=[W/2 - 2, W/2 - 2])
diag_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), STEEL_BLUE),
    ("BACKGROUND",    (0,1), (0,1), LIGHT_BLUE),
    ("BACKGROUND",    (1,1), (1,1), AMBER_LIGHT),
    ("BOX",           (0,0), (-1,-1), 0.5, STEEL_BLUE),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, HexColor("#BFCCD6")),
    ("TOPPADDING",    (0,0), (-1,-1), 6),
    ("BOTTOMPADDING", (0,0), (-1,-1), 6),
    ("LEFTPADDING",   (0,0), (-1,-1), 7),
    ("RIGHTPADDING",  (0,0), (-1,-1), 7),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(diag_t)
story.append(Spacer(1, 4))
story.append(note_box(
    "⚠  Renal glucose threshold ~200 mg/dL — glycosuria indicates established hyperglycaemia. "
    "HbA1c is unreliable in haemolytic anaemia, haemoglobinopathies, recent blood transfusion, and pregnancy (use FPG/OGTT instead).",
    bg=AMBER_LIGHT, border=AMBER))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 3. MONITORING
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("3.  MONITORING", TEAL))
story.append(Spacer(1, 4))

mon_data = [
    ["Parameter", "Target / Frequency", "Notes"],
    ["HbA1c",
     "< 7.0% (most adults)\n< 6.5% pre-conception\n> 8.0% in elderly/frail (relaxed)\nCheck every 3 months until at goal, then every 6 months",
     "Reflects avg glycaemia over ~3 months; 1% reduction in HbA1c ≈ 14 mg/dL reduction in mean glucose"],
    ["Fasting Blood Glucose",
     "80–130 mg/dL (4.4–7.2 mmol/L)\nSelf-monitor: frequency per clinical need",
     "Key for basal insulin titration; morning fasting level reflects overnight hepatic glucose output"],
    ["Post-prandial Glucose",
     "< 180 mg/dL  (10.0 mmol/L)\n1–2 h after meal start",
     "Target for post-meal bolus insulin dosing and GLP-1 RA assessment"],
    ["Continuous Glucose\nMonitoring (CGM)",
     "Time-In-Range (TIR) > 70%\n(70–180 mg/dL)\nTime Below Range < 4%\n(< 70 mg/dL)",
     "Preferred for T1DM; increasingly used in T2DM on insulin; reduces HbA1c and hypoglycaemia"],
    ["Urine Albumin/\nCreatinine Ratio (UACR)",
     "Normal: < 30 mg/g\nMicro: 30–300 mg/g\nMacro: > 300 mg/g\nAnnually from diagnosis (T2DM); after 5 yrs (T1DM)",
     "Earliest marker of diabetic nephropathy; ACEi/ARB indicated if UACR ≥ 30 mg/g"],
    ["eGFR",
     "At diagnosis then annually;\nReduce SGLT-2i if eGFR < 45 mL/min;\nAvoid metformin if eGFR < 30 mL/min",
     "Stage CKD and adjust drug therapy accordingly"],
    ["Blood Pressure",
     "Target: < 130/80 mmHg\nEvery visit",
     "BP control as important as glycaemia for CV/renal outcomes; ACEi/ARB first-line if DM + HTN"],
    ["Lipids",
     "LDL-C < 100 mg/dL (high risk)\nLDL-C < 70 mg/dL (ASCVD present)\nAnnually",
     "Statin therapy for all DM patients > 40 yrs or with CV risk factors (CARDS trial)"],
    ["Dilated Retinal Exam",
     "At diagnosis (T2DM)\n5 years after diagnosis (T1DM)\nThen annually if normal; more frequently if retinopathy present",
     "Diabetic retinopathy is leading cause of blindness in working-age adults"],
    ["Comprehensive Foot Exam",
     "Annually\n(visual inspection each visit for high-risk feet)",
     "Assess: pedal pulses, 10-g monofilament, 128-Hz tuning fork (great toe), ankle reflexes, nail care, deformities"],
    ["Dental Exam",
     "Every 6 months",
     "Periodontal disease more frequent in DM; bidirectional relationship with glycaemic control"],
    ["Weight / BMI",
     "Every visit",
     "5–10% weight loss improves insulin sensitivity significantly; weight loss drugs/surgery if BMI ≥ 30 kg/m²"],
]
story.append(header_table(mon_data, [3.5*cm, 5.5*cm, 8.5*cm], TEAL))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 4. MANAGEMENT — LIFESTYLE
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("4a.  MANAGEMENT — LIFESTYLE MODIFICATIONS", STEEL_BLUE))
story.append(Spacer(1, 4))

life_data = [
    ["Domain", "Recommendation"],
    ["Medical Nutrition\nTherapy (MNT)",
     "No single 'DM diet'; individualised with registered dietitian. Reduce refined carbohydrates, added sugars, saturated fats. "
     "Mediterranean, DASH, or low-carb patterns all acceptable. Consistent carbohydrate intake helps insulin timing. "
     "Caloric restriction (500–750 kcal/day deficit) for overweight/obese patients."],
    ["Physical Activity",
     "≥ 150 min/week moderate aerobic exercise (e.g. brisk walking) OR ≥ 75 min/week vigorous activity. "
     "Resistance training ≥ 2 days/week. Break prolonged sitting every 30 minutes. "
     "Exercise improves insulin sensitivity, lowers HbA1c by ~0.6–0.7%, and reduces CV risk."],
    ["Weight Management",
     "5–10% weight loss significantly improves glycaemia, BP, and lipids. "
     "> 15% weight loss may induce T2DM remission (DiRECT trial). "
     "GLP-1 RAs (semaglutide) and SGLT-2 inhibitors provide additional weight reduction. "
     "Bariatric surgery for BMI ≥ 35 kg/m² with inadequate glycaemic control."],
    ["Smoking Cessation",
     "Smoking doubles CV risk in DM. Cessation is one of the highest-yield interventions. "
     "Offer pharmacotherapy + behavioural support."],
    ["Alcohol",
     "Moderate intake only (≤ 1 drink/day women, ≤ 2 drinks/day men). "
     "Alcohol can cause delayed hypoglycaemia (inhibits gluconeogenesis) — consume with food; avoid on empty stomach."],
    ["Sleep",
     "Poor sleep impairs insulin sensitivity and glucose regulation. "
     "Screen for obstructive sleep apnoea (OSA) — prevalence > 50% in T2DM. "
     "CPAP treatment may improve glycaemic control."],
]
story.append(header_table(life_data, [3.5*cm, 14*cm], STEEL_BLUE))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 5. PHARMACOTHERAPY — T2DM
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("4b.  PHARMACOTHERAPY — TYPE 2 DM", NAVY))
story.append(Spacer(1, 4))

# Treatment algorithm as styled table
alg_header_ps = PS("AlgHdr", fontName="Helvetica-Bold", fontSize=8.5, textColor=WHITE, leading=12, alignment=TA_CENTER)
alg_cell_ps   = PS("AlgCell", fontName="Helvetica", fontSize=8, textColor=GREY_DARK, leading=11)
alg_note_ps   = PS("AlgNote", fontName="Helvetica-Oblique", fontSize=7.5, textColor=GREY_MID, leading=10, alignment=TA_CENTER)

alg_data = [
    ["STEP 1", "STEP 2", "STEP 3"],
    ["Lifestyle + Metformin\n(start at diagnosis)\n\nReassess HbA1c in 2–3 months",
     "Add 2nd agent if HbA1c target not met:\n• Sulfonylurea\n• TZD (pioglitazone)\n• DPP-4 inhibitor\n• GLP-1 RA ★\n• SGLT-2 inhibitor ★\n• Basal insulin",
     "Metformin + 2 other agents\nOR\nMetformin + insulin\n\nReassess HbA1c every 3 months"],
    ["",
     "★ For ASCVD: add GLP-1 RA or SGLT-2i early\n★ For HF/nephropathy: SGLT-2 inhibitor preferred",
     ""],
]

alg_rows = [
    [Paragraph(c, alg_header_ps) for c in alg_data[0]],
    [Paragraph(c, alg_cell_ps)   for c in alg_data[1]],
    [Paragraph(c, alg_note_ps)   for c in alg_data[2]],
]

alg_t = Table(alg_rows, colWidths=[W/3 - 1, W/3 + 2, W/3 - 1])
alg_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), NAVY),
    ("BACKGROUND",    (0,1), (0,1), LIGHT_BLUE),
    ("BACKGROUND",    (1,1), (1,1), LIGHT_TEAL),
    ("BACKGROUND",    (2,1), (2,1), LIGHT_BLUE),
    ("BACKGROUND",    (0,2), (-1,2), GREY_LIGHT),
    ("BOX",           (0,0), (-1,-1), 0.6, NAVY),
    ("INNERGRID",     (0,0), (-1,-1), 0.4, HexColor("#BFCCD6")),
    ("TOPPADDING",    (0,0), (-1,-1), 7),
    ("BOTTOMPADDING", (0,0), (-1,-1), 7),
    ("LEFTPADDING",   (0,0), (-1,-1), 7),
    ("RIGHTPADDING",  (0,0), (-1,-1), 7),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ("ALIGN",         (0,0), (-1,0), "CENTER"),
]))
story.append(alg_t)
story.append(Spacer(1, 5))

# Drug class table
drug_data = [
    ["Drug Class", "Key Agents", "Mechanism", "HbA1c ↓", "Advantages", "Cautions / Side Effects"],
    ["Biguanides\n(First-line)", "Metformin", "↓ Hepatic gluconeogenesis;\n↑ insulin sensitivity", "1–2%",
     "Weight neutral; cheap;\ncardioprotective; reduces\nprogression from prediabetes",
     "GI upset (start low, titrate);\nhold for contrast/surgery;\navoid if eGFR < 30; B12 deficiency"],
    ["Sulfonylureas", "Glimepiride\nGlipizide\nGliclazide", "Stimulates beta-cell\ninsulin secretion\n(closes K-ATP channels)", "1–2%",
     "Effective; oral; cheap",
     "Hypoglycaemia; weight gain;\navoiding in elderly and\nrenal impairment"],
    ["TZDs\n(PPAR-γ agonists)", "Pioglitazone", "↑ Insulin sensitivity\nin muscle, fat, liver", "0.5–1.4%",
     "↓ TG, ↑ HDL; cardioprotective\nin some data (PROactive)",
     "Weight gain; fluid retention;\ncontraindicated in HF;\n↑ fracture risk; bladder cancer risk"],
    ["DPP-4 Inhibitors\n(Gliptins)", "Sitagliptin\nSaxagliptin\nAlogliptin", "Inhibits DPP-4 →\n↑ active GLP-1 and GIP\n→ glucose-dependent\ninsulin secretion", "0.5–0.8%",
     "Weight neutral;\nlow hypoglycaemia risk;\nrenal-dose adjustment available",
     "Nasopharyngitis; do NOT\ncombine with GLP-1 RA;\nHF signal with saxagliptin"],
    ["GLP-1 Receptor\nAgonists", "Semaglutide\nLiraglutide\nDulaglutide\nExenatide", "Mimics GLP-1: ↑ glucose-\ndependent insulin secretion;\n↓ glucagon; slows gastric\nemptying; central satiety", "0.8–2.0%",
     "↓ Weight (2–15 kg);\nCVOT benefit (LEADER,\nSUSTAIN-6);\nnephroprotective;\nnow available orally", 
     "GI: nausea, vomiting, diarrhoea\n(common, often transient);\ninjection (most); avoid in\npersonal/family hx MTC;\n↑ HR (liraglutide)"],
    ["SGLT-2 Inhibitors\n(Gliflozins)", "Empagliflozin\nDapagliflozin\nCanagliflozin", "Blocks SGLT-2 in PCT →\n↓ renal glucose reabsorption\n→ glucosuria (~70 g/day)", "0.6–1.2%",
     "↓ Weight; ↓ BP;\nCVOT benefit (EMPA-REG);\n↓ HF hospitalisation;\nrenoprotective (CREDENCE)",
     "Genital mycotic infections;\nDKA (rare, even in T2DM);\ndo NOT use if eGFR < 45;\nFourier's gangrene (rare)"],
    ["Insulin\n(all types)", "See insulin table\nbelow", "Replaces/supplements\ndeficient endogenous insulin", "1.5–3.5%\n(no ceiling)",
     "Most effective at lowering\nglucose; no contraindication\nbased on renal/hepatic\nfunction; essential in T1DM",
     "Hypoglycaemia; weight gain;\ninjection; requires monitoring;\ncost issues"],
]
story.append(Spacer(1, 4))
story.append(header_table(drug_data, [2.8*cm, 2.5*cm, 3.8*cm, 1.4*cm, 3.8*cm, 3.2*cm], NAVY))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 6. INSULIN
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("4c.  INSULIN PREPARATIONS", TEAL))
story.append(Spacer(1, 4))

ins_data = [
    ["Type", "Examples", "Onset", "Peak", "Duration", "Clinical Use"],
    ["Rapid-acting\n(injected)", "Aspart, Lispro,\nGlulisine", "< 15 min", "0.5–1.5 h", "3–5 h", "Mealtime bolus; given just before meals"],
    ["Rapid-acting\n(inhaled)", "Afrezza\n(inhaled human)", "< 15 min", "1–2 h", "~3 h", "Pre-meal; not for smokers, lung disease"],
    ["Short-acting", "Regular\n(Humulin R, Actrapid)", "0.5–1 h", "2–3 h", "4–8 h", "IV drip (DKA); pre-meal if 30 min before"],
    ["Intermediate-acting", "NPH\n(Humulin N, Insulatard)", "2–4 h", "4–10 h", "10–16 h", "Twice-daily basal; less preferred (variable)"],
    ["Long-acting\nBasal", "Glargine U100\nDetemir", "2–4 h", "Minimal\npeak", "20–24 h", "Once-daily basal; T2DM basal therapy"],
    ["Ultra-long-acting\nBasal", "Degludec\nGlargine U300", "1–9 h", "Flat / no\npeak", "42 h (Degludec)\n> 24 h (U300)", "Once-daily; flexible timing; ↓ nocturnal hypo risk"],
    ["Pre-mixed", "70/30 NPH/Reg\nBiAspart 70/30", "Varies", "Dual", "Varies", "Twice-daily convenience; less flexible"],
]
story.append(header_table(ins_data, [2.5*cm, 3.5*cm, 1.8*cm, 2.2*cm, 2.5*cm, 5*cm], TEAL))
story.append(Spacer(1, 4))
story.append(note_box(
    "Basal-Bolus Regimen: Long-acting insulin once daily (basal) + rapid-acting with each meal (bolus) — best mimics physiological insulin secretion. "
    "Automated Insulin Delivery (AID / closed-loop systems): pump + CGM + algorithm — significantly improves TIR and reduces hypoglycaemia in T1DM.",
    bg=LIGHT_TEAL, border=TEAL))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 7. ACUTE COMPLICATIONS
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("5.  ACUTE COMPLICATIONS", RED))
story.append(Spacer(1, 4))

acute_data = [
    ["Complication", "Typical Patient", "Key Features", "Management Principles"],
    ["Diabetic Ketoacidosis\n(DKA)",
     "T1DM (also T2DM\nunder physiological stress\nor SGLT-2i use)",
     "Glucose > 250 mg/dL; pH < 7.3; bicarb < 18; ketones +++ "
     "in blood/urine; Kussmaul breathing; fruity breath; "
     "dehydration; altered consciousness in severe cases",
     "IV fluids (0.9% NaCl); insulin infusion (0.1 U/kg/h); "
     "K⁺ replacement (hold insulin if K⁺ < 3.5); "
     "bicarbonate only if pH < 6.9; identify & treat precipitant"],
    ["Hyperosmolar Hyperglycaemic\nState (HHS)",
     "Elderly T2DM;\noften dehydrated,\ninfected",
     "Glucose > 600 mg/dL; plasma osmolality > 320 mOsm/kg; "
     "minimal ketosis; pH normal; profound dehydration; "
     "neurological signs (seizures, coma) common",
     "Gradual fluid replacement (avoid too-rapid correction); "
     "low-dose insulin; anticoagulation (DVT risk); "
     "treat precipitant; correct Na⁺ carefully"],
    ["Hypoglycaemia",
     "T1DM/T2DM on\ninsulin or sulfonylurea",
     "< 70 mg/dL (mild-moderate); < 54 mg/dL (clinically significant); "
     "symptoms: tremor, sweating, palpitations, confusion, seizure; "
     "autonomic unawareness with recurrent episodes",
     "Conscious: 15 g fast-acting carbohydrate (rule of 15); "
     "unconscious: IM glucagon 1 mg or IV dextrose 50%; "
     "review insulin/medication dose; consider CGM"],
]
story.append(header_table(acute_data, [3.5*cm, 3.5*cm, 5.5*cm, 5*cm], RED))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 8. CHRONIC COMPLICATIONS
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("6.  CHRONIC COMPLICATIONS", NAVY))
story.append(Spacer(1, 4))

# Micro / Macro two-column
micro_hdr = PS("MicroHdr", fontName="Helvetica-Bold", fontSize=8.5, textColor=WHITE, leading=12, alignment=TA_CENTER)
micro_cell = PS("MicroCell", fontName="Helvetica", fontSize=8, textColor=GREY_DARK, leading=11)

comp_rows = [
    [Paragraph("MICROVASCULAR COMPLICATIONS", micro_hdr), Paragraph("MACROVASCULAR COMPLICATIONS", micro_hdr)],
    [
        Paragraph(
            "<b>Diabetic Retinopathy</b><br/>"
            "• Leading cause of blindness in working-age adults<br/>"
            "• Background → pre-proliferative → proliferative (neovascularisation)<br/>"
            "• Also: diabetic macular oedema (DMO)<br/>"
            "• Prevention: tight glycaemia + BP control<br/>"
            "• Treatment: laser photocoagulation, intravitreal anti-VEGF<br/><br/>"
            "<b>Diabetic Nephropathy (DKD)</b><br/>"
            "• Leading cause of ESRD in developed countries<br/>"
            "• Progression: microalbuminuria → macroalbuminuria → ↓ GFR → ESRD<br/>"
            "• Prevention: HbA1c control, BP control (ACEi/ARB), SGLT-2i<br/>"
            "• Screen UACR + eGFR annually<br/><br/>"
            "<b>Diabetic Neuropathy</b><br/>"
            "• Distal symmetric polyneuropathy (most common): numbness, tingling, burning feet; "
            "loss of protective sensation (LOPS)<br/>"
            "• Autonomic neuropathy: gastroparesis, erectile dysfunction, postural hypotension, "
            "neurogenic bladder, abnormal cardiac reflexes<br/>"
            "• Treatment: glycaemic control; duloxetine/pregabalin for pain; foot care",
            micro_cell),
        Paragraph(
            "<b>Cardiovascular Disease (CVD)</b><br/>"
            "• DM doubles CV risk; T2DM patients have equivalent MI risk to non-diabetics with prior MI<br/>"
            "• Atherosclerosis: CAD, stroke, peripheral arterial disease (PAD)<br/>"
            "• Management: statins, ACEi/ARB, antiplatelet (if indicated), GLP-1 RA / SGLT-2i<br/><br/>"
            "<b>Diabetic Foot</b><br/>"
            "• Triad: neuropathy + ischaemia + infection<br/>"
            "• Annual foot exam: monofilament, tuning fork, pedal pulses, ankle reflexes<br/>"
            "• Deformities: hammer toes, Charcot foot, callus formation<br/>"
            "• Ulceration may lead to osteomyelitis and amputation<br/>"
            "• Multidisciplinary foot team essential<br/><br/>"
            "<b>Other</b><br/>"
            "• Periodontal disease (bidirectional relationship with glycaemia)<br/>"
            "• Dermatological: diabetic dermopathy ('shin spots'), necrobiosis lipoidica, "
            "acanthosis nigricans<br/>"
            "• Sexual dysfunction; urinary tract infections; non-alcoholic fatty liver disease (NAFLD)<br/>"
            "• Cognitive impairment / dementia (↑ risk)",
            micro_cell)
    ]
]

comp_t = Table(comp_rows, colWidths=[W/2 - 2, W/2 - 2])
comp_t.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), NAVY),
    ("BACKGROUND",    (0,1), (0,1), LIGHT_BLUE),
    ("BACKGROUND",    (1,1), (1,1), RED_LIGHT),
    ("BOX",           (0,0), (-1,-1), 0.5, NAVY),
    ("INNERGRID",     (0,0), (-1,-1), 0.5, HexColor("#BFCCD6")),
    ("TOPPADDING",    (0,0), (-1,-1), 7),
    ("BOTTOMPADDING", (0,0), (-1,-1), 7),
    ("LEFTPADDING",   (0,0), (-1,-1), 7),
    ("RIGHTPADDING",  (0,0), (-1,-1), 7),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(comp_t)
story.append(Spacer(1, 4))
story.append(note_box(
    "DCCT (T1DM): Intensive glycaemic control reduces retinopathy, nephropathy, and neuropathy risk significantly. "
    "UKPDS 35 (T2DM): Each 1% reduction in HbA1c → 37% ↓ microvascular complications, 21% ↓ DM-related deaths. "
    "EMPA-REG OUTCOME: Empagliflozin ↓ CV death by 38% and ↓ HF hospitalisation by 35% in T2DM with established CVD.",
    bg=GREEN_LIGHT, border=GREEN))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 9. SPECIAL SITUATIONS
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("7.  SPECIAL CLINICAL SITUATIONS", STEEL_BLUE))
story.append(Spacer(1, 4))

spec_data = [
    ["Situation", "Key Considerations"],
    ["Pregnancy (Pre-existing DM)",
     "Target HbA1c < 6.5% (ideally < 6%) before conception. Tight control throughout; "
     "insulin is the only approved agent; metformin/glyburide used in some guidelines for GDM but not preferred. "
     "Risks: congenital anomalies, macrosomia, pre-eclampsia, perinatal mortality. "
     "Close obstetric + diabetic team collaboration essential."],
    ["Gestational DM (GDM)",
     "Screen all women 24–28 weeks (75 g OGTT). First-line: MNT + exercise. "
     "If targets not met (FPG ≥ 95 / 1-hr ≥ 140 / 2-hr ≥ 120 mg/dL): insulin. "
     "Postpartum: re-test at 6–12 weeks; lifetime screening for T2DM every 1–3 years."],
    ["Elderly Patients",
     "Relax HbA1c target to 7.5–8.0% (or even 8.5% in frail/limited life expectancy). "
     "Hypoglycaemia is particularly dangerous (falls, cognitive impairment, cardiac events). "
     "Avoid complex regimens; prefer agents with low hypo risk (DPP-4i, SGLT-2i if tolerated). "
     "Screen for cognitive impairment and depression annually."],
    ["Chronic Kidney Disease\n(CKD)",
     "Metformin: avoid if eGFR < 30; reduce dose if eGFR 30–45. "
     "SGLT-2 inhibitors: renoprotective (CREDENCE, DAPA-CKD); stop if eGFR < 20–25. "
     "GLP-1 RAs: mostly safe (dose reduce exenatide if CKD stage ≥ 3). "
     "Insulin dose reduction needed as eGFR falls (reduced insulin clearance)."],
    ["Heart Failure (HF)",
     "SGLT-2 inhibitors are first-choice add-on (reduce HF hospitalisations regardless of EF). "
     "Avoid TZDs (fluid retention, worsens HF). Avoid saxagliptin (↑ HF hospitalisation in SAVOR-TIMI). "
     "Metformin: use with caution in decompensated HF; acceptable in stable HF."],
    ["Perioperative",
     "Hold metformin on day of surgery (especially if contrast or major procedure). "
     "Hold SGLT-2i at least 3–4 days pre-operatively (DKA risk). "
     "Continue basal insulin at 75–80% of usual dose; hold rapid-acting while NBM. "
     "Target glucose 140–180 mg/dL intra-operatively (tighter in cardiac surgery: 110–140)."],
    ["Sick Day Rules",
     "Never stop insulin in T1DM even when not eating. "
     "Monitor glucose every 2–4 h; check ketones if glucose > 250 mg/dL. "
     "Maintain hydration with fluids containing carbohydrate if glucose < 200 mg/dL. "
     "Seek medical attention if vomiting, ketones ++, glucose > 300, or altered consciousness."],
]
story.append(header_table(spec_data, [3.5*cm, 14*cm], STEEL_BLUE))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 10. GLYCAEMIC TARGETS SUMMARY BOX
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("8.  GLYCAEMIC TARGETS AT A GLANCE", TEAL))
story.append(Spacer(1, 4))

tgt_data = [
    ["Measure", "General Adult", "Pre-Conception / Pregnancy", "Elderly / Frail", "Paediatric (T1DM)"],
    ["HbA1c",         "< 7.0%",    "< 6.5% (ideally < 6%)",   "> 7.5–8.5%",  "< 7.0%"],
    ["Fasting BG",    "80–130\nmg/dL", "60–99 mg/dL",          "90–150 mg/dL","90–130 mg/dL"],
    ["Post-prandial\n(1–2 hr)", "< 180 mg/dL", "< 120–140 mg/dL", "< 200 mg/dL", "< 180 mg/dL"],
    ["Time-In-Range\n(CGM, 70–180)", "> 70%", "> 70% (63% in preg.)", "> 50%", "> 70%"],
    ["Time Below Range\n(< 70 mg/dL)", "< 4%", "< 4%", "< 1%", "< 4%"],
    ["BP",    "< 130/80 mmHg", "< 135/85 mmHg",  "< 140/90 mmHg", "< 95th percentile"],
    ["LDL-C", "< 100 mg/dL\n(< 70 if ASCVD)", "Statins contraindicated in\npregnancy", "Individualise", "< 100 mg/dL\n(if risk factors)"],
]
story.append(header_table(tgt_data, [3.5*cm, 3.2*cm, 4.2*cm, 3.2*cm, 3.4*cm], TEAL))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# 11. KEY LANDMARK TRIALS
# ═══════════════════════════════════════════════════════════════════════
story.append(section_box("9.  KEY LANDMARK TRIALS", NAVY))
story.append(Spacer(1, 4))

trial_data = [
    ["Trial", "Year", "Population", "Key Finding"],
    ["DCCT", "1993", "T1DM", "Intensive glycaemic control ↓ retinopathy 76%, nephropathy 50%, neuropathy 60%; ↑ hypoglycaemia 3×"],
    ["UKPDS 33", "1998", "T2DM (new diagnosis)", "Intensive control ↓ microvascular complications by 25%; no significant ↓ in CV events"],
    ["UKPDS 35", "2000", "T2DM", "Each 1% ↓ in HbA1c → 37% ↓ microvascular complications, 21% ↓ DM-related deaths, 14% ↓ MI"],
    ["ACCORD", "2008", "T2DM + high CV risk", "Targeting HbA1c < 6% ↑ all-cause mortality — intensive arm stopped early; avoid over-treatment"],
    ["EMPA-REG OUTCOME", "2015", "T2DM + established CVD", "Empagliflozin ↓ CV death 38%, ↓ HF hospitalisation 35%, ↓ progression of nephropathy"],
    ["LEADER", "2016", "T2DM + high CV risk", "Liraglutide ↓ MACE 13%, ↓ CV death 22%, ↓ nephropathy progression"],
    ["CREDENCE", "2019", "T2DM + CKD (eGFR 30–90)", "Canagliflozin ↓ renal failure/CV death composite by 30%; stopped early due to benefit"],
    ["SUSTAIN-6", "2016", "T2DM + high CV risk", "Semaglutide ↓ MACE 26% vs placebo; ↑ diabetic retinopathy (rapid HbA1c ↓)"],
    ["DAPA-HF", "2019", "HFrEF (with/without DM)", "Dapagliflozin ↓ CV death/worsening HF by 26%; benefit in patients without DM too"],
    ["GRADE", "2022", "T2DM on metformin", "Liraglutide or basal insulin → slightly better glycaemic control vs glimepiride or sitagliptin as add-on"],
]
story.append(header_table(trial_data, [3.5*cm, 1.3*cm, 3.7*cm, 9*cm], NAVY))
story.append(Spacer(1, 6))

# ═══════════════════════════════════════════════════════════════════════
# FOOTER NOTE
# ═══════════════════════════════════════════════════════════════════════
story.append(HRFlowable(width=W, thickness=0.5, color=GREY_MID))
story.append(Spacer(1, 4))
story.append(Paragraph(
    "<b>Sources:</b> Harrison's Principles of Internal Medicine 22e (2025) | Goodman &amp; Gilman's Pharmacological Basis of Therapeutics | "
    "Guyton &amp; Hall Textbook of Medical Physiology | Tietz Textbook of Laboratory Medicine 7e | "
    "Lippincott Illustrated Reviews: Pharmacology | Creasy &amp; Resnik's Maternal-Fetal Medicine | Rosen's Emergency Medicine | "
    "Robbins &amp; Cotran Pathologic Basis of Disease | ADA Standards of Medical Care in Diabetes",
    note_style))
story.append(Spacer(1, 2))
story.append(Paragraph(
    "This document is a clinical quick-reference summary. Always verify drug doses and guidelines against current local formularies and institutional protocols. "
    "Not a substitute for professional clinical judgement.",
    note_style))

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

cd /home/daytona/workspace/diabetes-pdf && python3 generate_pdf.py 2>&1

ls -lh /home/daytona/workspace/diabetes-pdf/Diabetes_Quick_Reference.pdf