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

// ─── Fetch images from URLs ───────────────────────────────────────────────────
const imageUrls = [
  "https://cdn.orris.care/cdss_images/9ffefa078a10e7f1ce5cecab1604b3450dd4a00d45efbcc2da7bee934a0617e8.jpg",  // Islets of Langerhans immunofluorescence
  "https://cdn.orris.care/cdss_images/7320b27abf5b417434c17f911371d44df1836e0fb575bb0416a51a1537ff5917.jpg",  // Diabetic retinopathy fundus
  "https://cdn.orris.care/cdss_images/ad03c43ffb30047b3d41fff23b0db654aba1039f428198153dcbe59197c0842c.png",  // Pancreatic islet anatomy (Guyton)
];

let imgs = [];
try {
  const raw = execSync(
    `node /home/daytona/skills/shared/scripts/fetch_images.js ${imageUrls.map(u => `"${u}"`).join(" ")}`
  ).toString();
  imgs = JSON.parse(raw);
} catch (e) {
  console.error("Image fetch error:", e.message);
  imgs = imageUrls.map(() => ({ base64: null, error: "fetch failed" }));
}

// ─── Theme ───────────────────────────────────────────────────────────────────
const C = {
  darkBg:   "0D1B2A",  // deep navy
  midBg:    "1B2E45",  // medium navy
  accent:   "E8A838",  // golden amber
  accent2:  "2EC4B6",  // teal
  white:    "FFFFFF",
  lightGray:"D9E3EC",
  textGray: "A8BBCC",
  danger:   "E84545",
  success:  "27AE60",
};

const FONT_TITLE  = "Calibri";
const FONT_BODY   = "Calibri";

// ─── Init ────────────────────────────────────────────────────────────────────
let pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.author = "Medical Education";
pres.title  = "Diabetes Mellitus – Comprehensive Clinical Overview";

// ─── Helper: slide background ─────────────────────────────────────────────────
function addBg(slide, color = C.darkBg) {
  slide.background = { color };
}

// ─── Helper: section accent bar ──────────────────────────────────────────────
function accentBar(slide, label, color = C.accent) {
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 10, h: 0.07, fill: { color }, line: { type: "none" } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 5.555, w: 10, h: 0.07, fill: { color }, line: { type: "none" } });
}

// ─── Helper: section divider label ───────────────────────────────────────────
function sectionPill(slide, label, x = 0.4, y = 0.2, bgColor = C.accent) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w: 2.8, h: 0.32, rectRadius: 0.16,
    fill: { color: bgColor }, line: { type: "none" },
  });
  slide.addText(label, {
    x, y, w: 2.8, h: 0.32,
    fontSize: 9, bold: true, color: C.darkBg, align: "center", valign: "middle",
    fontFace: FONT_BODY, margin: 0,
  });
}

// ─── Helper: card box ─────────────────────────────────────────────────────────
function card(slide, x, y, w, h, color = C.midBg, radius = 0.12) {
  slide.addShape(pres.ShapeType.roundRect, {
    x, y, w, h, rectRadius: radius,
    fill: { color },
    line: { color: "1E3A5A", pt: 1 },
    shadow: { type: "outer", color: "000000", opacity: 0.35, blur: 10, offset: 4, angle: 135 },
  });
}

// ─── Helper: bullet list ─────────────────────────────────────────────────────
function bulletList(slide, items, x, y, w, h, opts = {}) {
  const fontSize = opts.fontSize || 13;
  const color    = opts.color    || C.white;
  const indent   = opts.indent   || 0.3;
  const textArr = items.map((item, i) => ({
    text: item,
    options: {
      bullet: { type: "bullet", characterCode: "25B8", color: C.accent },
      indentLevel: 0,
      color,
      fontSize,
      fontFace: FONT_BODY,
      breakLine: i < items.length - 1,
      paraSpaceBefore: 3,
    },
  }));
  slide.addText(textArr, { x, y, w, h, valign: "top", margin: [4, 8, 0, 8] });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 1 – TITLE
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);

  // Background accent gradient strip
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 3.5, w: 10, h: 2.125, fill: { color: C.midBg }, line: { type: "none" } });
  slide.addShape(pres.ShapeType.rect, { x: 0, y: 0, w: 0.18, h: 5.625, fill: { color: C.accent }, line: { type: "none" } });

  slide.addText("DIABETES MELLITUS", {
    x: 0.4, y: 0.55, w: 9.2, h: 1.2,
    fontSize: 44, bold: true, color: C.white, fontFace: FONT_TITLE, align: "left",
    charSpacing: 2,
  });
  slide.addText("A Comprehensive Clinical Overview", {
    x: 0.4, y: 1.7, w: 9.2, h: 0.5,
    fontSize: 20, color: C.accent, fontFace: FONT_BODY, align: "left", italic: true,
  });

  // Divider line
  slide.addShape(pres.ShapeType.line, {
    x: 0.4, y: 2.35, w: 9.2, h: 0,
    line: { color: C.accent, pt: 2 },
  });

  slide.addText("For Medical Students & Clinicians", {
    x: 0.4, y: 2.5, w: 5, h: 0.4,
    fontSize: 13, color: C.textGray, fontFace: FONT_BODY,
  });

  // Key stats row
  const stats = [
    { val: "537M",  label: "Adults with DM (2021)" },
    { val: "~10%",  label: "Global Prevalence" },
    { val: "3rd",   label: "Leading cause of blindness" },
    { val: "↑2x",   label: "CV mortality risk" },
  ];
  stats.forEach((s, i) => {
    const x = 0.4 + i * 2.4;
    card(slide, x, 3.7, 2.2, 1.5, "17304D");
    slide.addText(s.val, { x, y: 3.78, w: 2.2, h: 0.55, fontSize: 22, bold: true, color: C.accent, align: "center", fontFace: FONT_TITLE });
    slide.addText(s.label, { x, y: 4.3, w: 2.2, h: 0.55, fontSize: 9.5, color: C.lightGray, align: "center", fontFace: FONT_BODY });
  });

  slide.addText("Sources: IDF Diabetes Atlas 2021 | Harrison's Principles of Internal Medicine 22E | Guyton & Hall Medical Physiology", {
    x: 0, y: 5.38, w: 10, h: 0.22,
    fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 2 – DEFINITION & CLASSIFICATION
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "DEFINITION & CLASSIFICATION");

  slide.addText("What Is Diabetes Mellitus?", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  // Definition box
  card(slide, 0.3, 1.3, 9.4, 1.05, "112240");
  slide.addText(
    "A syndrome of impaired carbohydrate, fat, and protein metabolism caused by either lack of insulin secretion or decreased sensitivity of the tissues to insulin, resulting in chronic hyperglycaemia.",
    { x: 0.5, y: 1.37, w: 9.0, h: 0.92, fontSize: 12.5, color: C.lightGray, fontFace: FONT_BODY, italic: true, valign: "middle" }
  );

  // Type cards
  const types = [
    {
      title: "Type 1 DM",
      subtitle: "Insulin-Dependent",
      color: "1D3461",
      badge: C.danger,
      points: [
        "Autoimmune β-cell destruction",
        "Absolute insulin deficiency",
        "~5–10% of all DM cases",
        "Onset often < 30 yrs (juvenile)",
        "HLA-DR3/DR4 association",
        "Requires exogenous insulin lifelong",
      ],
    },
    {
      title: "Type 2 DM",
      subtitle: "Non-Insulin-Dependent",
      color: "1A3A28",
      badge: C.success,
      points: [
        "Insulin resistance + relative deficiency",
        "~90–95% of all DM cases",
        "Strong genetic & lifestyle component",
        "Associated with obesity (BMI > 30)",
        "Progressive β-cell dysfunction over time",
        "Oral agents ± insulin used",
      ],
    },
    {
      title: "Other Types",
      subtitle: "Secondary & Gestational",
      color: "2D2519",
      badge: C.accent,
      points: [
        "Gestational DM (GDM): pregnancy-related",
        "MODY: monogenic, young adults",
        "Pancreatic DM (pancreatitis, surgery)",
        "Drug-induced (steroids, thiazides)",
        "Endocrine (Cushing's, acromegaly)",
        "GDM ↑ risk of T2DM later in life",
      ],
    },
  ];

  types.forEach((t, i) => {
    const x = 0.3 + i * 3.15;
    card(slide, x, 2.45, 3.0, 2.9, t.color);
    // badge
    slide.addShape(pres.ShapeType.roundRect, { x: x + 0.1, y: 2.52, w: 1.3, h: 0.24, rectRadius: 0.12, fill: { color: t.badge }, line: { type: "none" } });
    slide.addText(t.subtitle, { x: x + 0.1, y: 2.52, w: 1.3, h: 0.24, fontSize: 7.5, bold: true, color: C.darkBg, align: "center", valign: "middle", fontFace: FONT_BODY, margin: 0 });
    slide.addText(t.title, { x: x + 0.1, y: 2.78, w: 2.8, h: 0.4, fontSize: 15, bold: true, color: C.white, fontFace: FONT_TITLE });
    bulletList(slide, t.points, x + 0.08, 3.2, 2.85, 2.0, { fontSize: 10.5 });
  });

  slide.addText("Guyton & Hall Medical Physiology, 14E  |  Harrison's Principles of Internal Medicine 22E", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 3 – EPIDEMIOLOGY
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "EPIDEMIOLOGY", 0.4, 0.2, "2EC4B6");

  slide.addText("Global Burden of Diabetes", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  // Big number cards
  const epi = [
    { num: "537 Million", sub: "Adults living with DM worldwide (2021)", icon: "🌍", color: "1D3461" },
    { num: "643 Million", sub: "Projected by 2030", icon: "📈", color: "1A3A28" },
    { num: "783 Million", sub: "Projected by 2045", icon: "⚠️", color: "2D2519" },
    { num: "240 Million", sub: "Undiagnosed (44% of total)", icon: "❓", color: "2D1A3A" },
  ];
  epi.forEach((e, i) => {
    const x = 0.3 + i * 2.35;
    card(slide, x, 1.35, 2.2, 1.6, e.color);
    slide.addText(e.icon, { x, y: 1.42, w: 2.2, h: 0.45, fontSize: 20, align: "center", fontFace: FONT_BODY });
    slide.addText(e.num, { x, y: 1.85, w: 2.2, h: 0.4, fontSize: 14, bold: true, color: C.accent, align: "center", fontFace: FONT_TITLE });
    slide.addText(e.sub, { x, y: 2.25, w: 2.2, h: 0.65, fontSize: 9, color: C.lightGray, align: "center", fontFace: FONT_BODY });
  });

  // Risk factors
  slide.addText("Key Risk Factors", {
    x: 0.4, y: 3.1, w: 9.2, h: 0.38,
    fontSize: 16, bold: true, color: C.accent2, fontFace: FONT_TITLE,
  });

  const risks = [
    ["Modifiable", C.success, [
      "Obesity (BMI ≥ 30 kg/m²)",
      "Physical inactivity",
      "Unhealthy diet (high glycaemic load)",
      "Hypertension & dyslipidaemia",
      "Smoking",
    ]],
    ["Non-Modifiable", C.danger, [
      "Family history / genetic predisposition",
      "Age > 45 years",
      "Ethnicity (South Asian, African, Hispanic)",
      "Prior gestational DM",
      "Low birth weight (IUGR)",
    ]],
    ["Metabolic / Clinical", C.accent, [
      "Impaired fasting glucose (IFG)",
      "Impaired glucose tolerance (IGT)",
      "Polycystic ovary syndrome (PCOS)",
      "Metabolic syndrome",
      "Drug-induced (steroids, atypical antipsychotics)",
    ]],
  ];

  risks.forEach(([title, color, pts], i) => {
    const x = 0.3 + i * 3.15;
    card(slide, x, 3.5, 3.0, 1.85, C.midBg);
    slide.addShape(pres.ShapeType.rect, { x, y: 3.5, w: 3.0, h: 0.05, fill: { color }, line: { type: "none" } });
    slide.addText(title, { x: x + 0.1, y: 3.55, w: 2.8, h: 0.3, fontSize: 11, bold: true, color, fontFace: FONT_TITLE });
    bulletList(slide, pts, x + 0.08, 3.85, 2.85, 1.45, { fontSize: 10 });
  });

  slide.addText("IDF Diabetes Atlas 10th Edition 2021", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 4 – PATHOPHYSIOLOGY (with islet image)
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "PATHOPHYSIOLOGY");

  slide.addText("Pathophysiology of Diabetes Mellitus", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  // Left column: text
  const pathPoints = [
    ["Islets of Langerhans", [
      "1–2 million islets in human pancreas",
      "β-cells (~60%): secrete insulin & amylin",
      "α-cells (~25%): secrete glucagon",
      "δ-cells (~10%): secrete somatostatin",
    ]],
    ["Type 1: Autoimmune Destruction", [
      "T-cell mediated destruction of β-cells",
      "Autoantibodies: anti-GAD, anti-IA2, anti-IAA",
      "HLA-DR3/DR4 confer susceptibility",
      "Absolute insulin deficiency → DKA risk",
    ]],
    ["Type 2: Insulin Resistance", [
      "Impaired insulin receptor signalling (PI3K/Akt)",
      "GLUT-4 downregulation in muscle & fat",
      "Hepatic glucose overproduction (gluconeogenesis ↑)",
      "Progressive β-cell exhaustion over time",
      "Incretin (GLP-1) defect amplifies dysfunction",
    ]],
  ];

  let yOff = 1.35;
  pathPoints.forEach(([heading, pts]) => {
    slide.addText(heading, {
      x: 0.35, y: yOff, w: 5.8, h: 0.32,
      fontSize: 12, bold: true, color: C.accent, fontFace: FONT_TITLE,
    });
    yOff += 0.3;
    bulletList(slide, pts, 0.35, yOff, 5.8, pts.length * 0.28 + 0.2, { fontSize: 11 });
    yOff += pts.length * 0.28 + 0.28;
  });

  // Right column: image
  if (imgs[0] && imgs[0].base64) {
    card(slide, 6.4, 1.25, 3.3, 3.1, "0A1525");
    slide.addImage({ data: imgs[0].base64, x: 6.5, y: 1.35, w: 3.1, h: 2.7,
      sizing: { type: "contain", w: 3.1, h: 2.7 } });
    slide.addText("Islets of Langerhans — Immunofluorescence\nRed: β-cells (insulin) | Blue: α-cells (glucagon) | Green: δ-cells (somatostatin)", {
      x: 6.35, y: 4.05, w: 3.4, h: 0.55, fontSize: 7.5, color: C.textGray,
      align: "center", fontFace: FONT_BODY, italic: true,
    });
  } else {
    card(slide, 6.4, 1.25, 3.3, 3.1, "0A1525");
    slide.addText("Islets of Langerhans\n\nβ-cells: insulin\nα-cells: glucagon\nδ-cells: somatostatin", {
      x: 6.5, y: 1.5, w: 3.1, h: 2.7, fontSize: 13, color: C.textGray, align: "center", fontFace: FONT_BODY,
    });
  }

  // Guyton ref
  card(slide, 0.3, 4.9, 9.4, 0.45, "0D1B2A");
  slide.addText("\"Diabetes mellitus is a syndrome of impaired carbohydrate, fat, and protein metabolism caused by either lack of insulin secretion or decreased sensitivity of tissues to insulin.\"  — Guyton & Hall, 14E", {
    x: 0.5, y: 4.93, w: 9.0, h: 0.38, fontSize: 8.5, color: C.textGray, italic: true, fontFace: FONT_BODY, valign: "middle",
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 5 – DIAGNOSIS
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "DIAGNOSIS", 0.4, 0.2, C.accent2);

  slide.addText("Diagnosis of Diabetes Mellitus", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  // ADA Diagnostic Criteria table header
  slide.addText("ADA Diagnostic Criteria (any ONE criterion, confirmed on repeat in asymptomatic patients):", {
    x: 0.35, y: 1.28, w: 9.3, h: 0.3, fontSize: 11.5, color: C.accent, fontFace: FONT_BODY, bold: true,
  });

  const criteria = [
    { test: "Fasting Plasma Glucose (FPG)", normal: "< 5.6 mmol/L\n(< 100 mg/dL)", prediab: "5.6–6.9 mmol/L\n(100–125 mg/dL)", dm: "≥ 7.0 mmol/L\n(≥ 126 mg/dL)", note: "No caloric intake for ≥8 h" },
    { test: "2-hr Plasma Glucose (OGTT 75 g)", normal: "< 7.8 mmol/L\n(< 140 mg/dL)", prediab: "7.8–11.0 mmol/L\n(140–199 mg/dL)", dm: "≥ 11.1 mmol/L\n(≥ 200 mg/dL)", note: "Oral Glucose Tolerance Test" },
    { test: "HbA1c", normal: "< 5.7%\n(< 39 mmol/mol)", prediab: "5.7–6.4%\n(39–47 mmol/mol)", dm: "≥ 6.5%\n(≥ 48 mmol/mol)", note: "Reflects ~3-month avg glucose" },
    { test: "Random Plasma Glucose", normal: "—", prediab: "—", dm: "≥ 11.1 mmol/L\n(≥ 200 mg/dL) + symptoms", note: "Polyuria, polydipsia, unexplained weight loss" },
  ];

  // Table columns: Test, Normal, Prediabetes, Diabetes, Note
  const colW = [2.5, 1.6, 1.8, 2.0, 1.8];
  const colX = [0.3, 2.85, 4.5, 6.35, 8.4];
  const headers = ["Test", "Normal", "Pre-Diabetes", "Diabetes", "Note"];
  const headerColors = [C.midBg, "1A3A28", "2D2519", C.danger, "1D2D3A"];

  // Header row
  headers.forEach((h, i) => {
    card(slide, colX[i], 1.63, colW[i], 0.38, headerColors[i]);
    slide.addText(h, { x: colX[i], y: 1.63, w: colW[i], h: 0.38, fontSize: 10, bold: true, color: C.accent, align: "center", valign: "middle", fontFace: FONT_TITLE, margin: 0 });
  });

  // Data rows
  criteria.forEach((row, ri) => {
    const y = 2.05 + ri * 0.72;
    const rowData = [row.test, row.normal, row.prediab, row.dm, row.note];
    const textColors = [C.white, C.success, C.accent, C.danger, C.textGray];
    rowData.forEach((cell, ci) => {
      card(slide, colX[ci], y, colW[ci], 0.68, ri % 2 === 0 ? C.midBg : "122030");
      slide.addText(cell, {
        x: colX[ci] + 0.05, y, w: colW[ci] - 0.1, h: 0.68,
        fontSize: 9, color: textColors[ci], align: "center", valign: "middle",
        fontFace: FONT_BODY, margin: 0,
      });
    });
  });

  // Classic symptoms
  slide.addText("Classic Symptoms of Hyperglycaemia:", {
    x: 0.35, y: 4.95, w: 3.5, h: 0.25, fontSize: 10, bold: true, color: C.accent2, fontFace: FONT_BODY,
  });
  const syms = ["Polyuria", "Polydipsia", "Polyphagia", "Weight loss", "Blurred vision", "Fatigue"];
  syms.forEach((s, i) => {
    slide.addShape(pres.ShapeType.roundRect, { x: 0.35 + i * 1.57, y: 5.2, w: 1.45, h: 0.26, rectRadius: 0.13, fill: { color: "17304D" }, line: { color: C.accent2, pt: 1 } });
    slide.addText(s, { x: 0.35 + i * 1.57, y: 5.2, w: 1.45, h: 0.26, fontSize: 9, color: C.white, align: "center", valign: "middle", fontFace: FONT_BODY, margin: 0 });
  });

  slide.addText("ADA Standards of Medical Care in Diabetes 2024", {
    x: 0, y: 5.45, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 6 – ACUTE COMPLICATIONS
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "ACUTE COMPLICATIONS", 0.4, 0.2, C.danger);

  slide.addText("Acute Complications", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  const acute = [
    {
      title: "Diabetic Ketoacidosis (DKA)",
      badge: "PREDOMINANTLY T1DM",
      badgeColor: C.danger,
      points: [
        "Absolute insulin deficiency → lipolysis & ketogenesis",
        "Triad: hyperglycaemia (> 11 mmol/L), ketonaemia, acidosis (pH < 7.3)",
        "Anion gap metabolic acidosis",
        "Symptoms: N/V, abdominal pain, Kussmaul breathing, fruity breath",
        "Triggers: infection, missed insulin, surgery, MI",
        "Rx: IV fluids, insulin infusion, K⁺ replacement, treat precipitant",
        "Mortality < 1% with appropriate management",
      ],
    },
    {
      title: "Hyperglycaemic Hyperosmolar State (HHS)",
      badge: "PREDOMINANTLY T2DM",
      badgeColor: C.accent,
      points: [
        "Profound hyperglycaemia (> 33 mmol/L), hyperosmolality (> 320 mOsm/kg)",
        "No significant ketosis (some insulin remains)",
        "Severe dehydration, altered consciousness, seizures",
        "Gradual onset over days–weeks",
        "Triggers: infection, non-compliance, new onset T2DM",
        "Rx: aggressive rehydration (0.9% saline), low-dose insulin, anticoagulation",
        "Mortality 10–20% (higher than DKA)",
      ],
    },
    {
      title: "Hypoglycaemia",
      badge: "ALL TYPES",
      badgeColor: C.accent2,
      points: [
        "Plasma glucose < 3.9 mmol/L (70 mg/dL) = Level 1",
        "< 3.0 mmol/L = Level 2 (clinically significant)",
        "< 2.8 mmol/L + symptoms = Level 3 (severe)",
        "Causes: excess insulin/sulphonylurea, missed meal, exercise",
        "Symptoms: tremor, sweating, palpitations, confusion, seizures",
        "Rx: 15–20 g fast-acting carbohydrate (rule of 15)",
        "Glucagon 1 mg IM/SC if unconscious",
      ],
    },
  ];

  acute.forEach((a, i) => {
    const x = 0.3 + i * 3.17;
    card(slide, x, 1.32, 3.05, 4.03, C.midBg);
    slide.addShape(pres.ShapeType.rect, { x, y: 1.32, w: 3.05, h: 0.06, fill: { color: a.badgeColor }, line: { type: "none" } });
    slide.addShape(pres.ShapeType.roundRect, { x: x + 0.08, y: 1.4, w: 2.0, h: 0.22, rectRadius: 0.11, fill: { color: a.badgeColor }, line: { type: "none" } });
    slide.addText(a.badge, { x: x + 0.08, y: 1.4, w: 2.0, h: 0.22, fontSize: 7, bold: true, color: C.darkBg, align: "center", valign: "middle", fontFace: FONT_BODY, margin: 0 });
    slide.addText(a.title, { x: x + 0.1, y: 1.65, w: 2.85, h: 0.5, fontSize: 12.5, bold: true, color: C.white, fontFace: FONT_TITLE });
    bulletList(slide, a.points, x + 0.08, 2.18, 2.9, 3.1, { fontSize: 10 });
  });

  slide.addText("Harrison's Principles of Internal Medicine 22E  |  Tintinalli's Emergency Medicine", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 7 – CHRONIC COMPLICATIONS (with retinopathy image)
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "CHRONIC COMPLICATIONS");

  slide.addText("Chronic Complications of Diabetes", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  // Microvascular column (left)
  card(slide, 0.3, 1.35, 4.5, 2.85, C.midBg);
  slide.addShape(pres.ShapeType.rect, { x: 0.3, y: 1.35, w: 4.5, h: 0.06, fill: { color: C.accent2 }, line: { type: "none" } });
  slide.addText("MICROVASCULAR", { x: 0.4, y: 1.43, w: 4.3, h: 0.3, fontSize: 13, bold: true, color: C.accent2, fontFace: FONT_TITLE });

  const micro = [
    ["Diabetic Retinopathy", "Leading cause of blindness in working-age adults; background → proliferative; VEGF-driven neovascularisation; screen annually with dilated fundoscopy"],
    ["Diabetic Nephropathy", "Glomerular hyperfiltration → microalbuminuria → overt proteinuria → CKD; Kimmelstiel-Wilson nodules on biopsy; ACE-i/ARB protective"],
    ["Diabetic Neuropathy", "Distal symmetric polyneuropathy (stocking-glove); autonomic neuropathy (gastroparesis, postural hypotension); Charcot joint; foot ulceration risk"],
  ];

  let y = 1.78;
  micro.forEach(([title, desc]) => {
    slide.addText("▸ " + title, { x: 0.45, y, w: 4.2, h: 0.28, fontSize: 11, bold: true, color: C.accent, fontFace: FONT_TITLE });
    y += 0.27;
    slide.addText(desc, { x: 0.55, y, w: 4.1, h: 0.55, fontSize: 9.5, color: C.lightGray, fontFace: FONT_BODY });
    y += 0.6;
  });

  // Macrovascular column (right)
  card(slide, 5.1, 1.35, 4.6, 2.85, C.midBg);
  slide.addShape(pres.ShapeType.rect, { x: 5.1, y: 1.35, w: 4.6, h: 0.06, fill: { color: C.danger }, line: { type: "none" } });
  slide.addText("MACROVASCULAR", { x: 5.2, y: 1.43, w: 4.4, h: 0.3, fontSize: 13, bold: true, color: C.danger, fontFace: FONT_TITLE });

  const macro = [
    ["Coronary Artery Disease", "2–4× increased CV mortality; DM is CAD equivalent; aggressive statin therapy; aspirin in high-risk patients"],
    ["Cerebrovascular Disease", "Stroke risk doubled; lacunar infarcts common; tight BP control critical (target < 130/80 mmHg)"],
    ["Peripheral Artery Disease", "Critical limb ischaemia; diabetic foot syndrome; ABI < 0.9 diagnostic; leading cause of non-traumatic amputation"],
  ];

  y = 1.78;
  macro.forEach(([title, desc]) => {
    slide.addText("▸ " + title, { x: 5.25, y, w: 4.3, h: 0.28, fontSize: 11, bold: true, color: C.danger, fontFace: FONT_TITLE });
    y += 0.27;
    slide.addText(desc, { x: 5.35, y, w: 4.2, h: 0.55, fontSize: 9.5, color: C.lightGray, fontFace: FONT_BODY });
    y += 0.6;
  });

  // Retinopathy image
  if (imgs[1] && imgs[1].base64) {
    card(slide, 0.3, 4.28, 9.4, 1.02, "0A1525");
    slide.addImage({ data: imgs[1].base64, x: 0.4, y: 4.35, w: 2.1, h: 0.88,
      sizing: { type: "contain", w: 2.1, h: 0.88 } });
    slide.addText("Fundus photo: non-proliferative diabetic retinopathy showing microaneurysms (black arrow), haemorrhages (white arrow), and cotton-wool spots (green arrow). Right: IRMA — intraretinal microvascular abnormalities signalling progression toward proliferative DR.", {
      x: 2.6, y: 4.35, w: 7.0, h: 0.88, fontSize: 9, color: C.textGray, italic: true, fontFace: FONT_BODY, valign: "middle",
    });
  } else {
    card(slide, 0.3, 4.28, 9.4, 1.0, "0A1525");
    slide.addText("Chronic hyperglycaemia → advanced glycation end-products (AGEs) → vascular endothelial damage → micro & macrovascular disease", {
      x: 0.5, y: 4.35, w: 9.0, h: 0.88, fontSize: 11, color: C.textGray, italic: true, fontFace: FONT_BODY, valign: "middle",
    });
  }

  slide.addText("Harrison's Principles of Internal Medicine 22E  |  Braunwald's Heart Disease 12E", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 8 – MANAGEMENT: NON-PHARMACOLOGICAL
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "MANAGEMENT", 0.4, 0.2, C.success);

  slide.addText("Management — Lifestyle & Non-Pharmacological", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  const pillars = [
    {
      icon: "🥗", title: "Medical Nutrition Therapy",
      color: "1A3A28",
      pts: [
        "Reduce total caloric intake for weight loss (500–750 kcal/day deficit)",
        "Low glycaemic index foods; Mediterranean-style diet",
        "Limit saturated fats (< 10% total calories)",
        "Increase dietary fibre (≥ 25 g/day)",
        "Carbohydrate counting for insulin dosing (T1DM)",
        "Limit sugar-sweetened beverages & processed foods",
      ],
    },
    {
      icon: "🏃", title: "Physical Activity",
      color: "1D3461",
      pts: [
        "≥ 150 min/week moderate-intensity aerobic exercise",
        "Resistance training ≥ 2 days/week",
        "Break prolonged sitting every 30 minutes",
        "Exercise lowers HbA1c by ~0.5–1.0%",
        "Monitor glucose pre/post-exercise (T1DM)",
        "Graduated increase in activity to prevent hypoglycaemia",
      ],
    },
    {
      icon: "⚖️", title: "Weight Management",
      color: "2D2519",
      pts: [
        "5–10% weight loss → significant glycaemic improvement",
        "≥ 15% weight loss may achieve T2DM remission (DiRECT trial)",
        "Bariatric surgery: consider BMI ≥ 35 with DM (BMI ≥ 32.5 in Asian)",
        "Roux-en-Y gastric bypass most effective for glycaemic control",
        "Very low calorie diet (VLCD) protocols under supervision",
        "Weight loss reduces CV risk & medication burden",
      ],
    },
    {
      icon: "🧠", title: "Diabetes Self-Management Education",
      color: "2D1A3A",
      pts: [
        "Blood glucose monitoring — CGM preferred (T1DM; high-risk T2DM)",
        "Foot care: daily inspection, proper footwear, podiatry referral",
        "Sick day rules & hypoglycaemia management",
        "Smoking cessation (2× CV risk if diabetic smoker)",
        "Alcohol: moderate intake; risk of hypoglycaemia with insulin/SU",
        "Annual review: eyes, feet, kidneys, BP, lipids, HbA1c",
      ],
    },
  ];

  pillars.forEach((p, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 1.35 + row * 2.05;
    card(slide, x, y, 4.6, 1.95, p.color);
    slide.addText(`${p.icon}  ${p.title}`, { x: x + 0.15, y: y + 0.1, w: 4.3, h: 0.35, fontSize: 12.5, bold: true, color: C.accent, fontFace: FONT_TITLE });
    bulletList(slide, p.pts, x + 0.1, y + 0.45, 4.4, 1.4, { fontSize: 9.5 });
  });

  slide.addText("ADA Standards of Medical Care in Diabetes 2024  |  DiRECT Trial (NEJM 2018)", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 9 – PHARMACOLOGICAL MANAGEMENT
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "PHARMACOTHERAPY");

  slide.addText("Pharmacological Management of T2DM", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  const drugs = [
    { name: "Metformin", class: "Biguanide", moa: "↓ Hepatic gluconeogenesis; ↑ insulin sensitivity", hba1c: "1.0–2.0%", adv: "Weight neutral; CV benefit; cheap", adr: "GI upset; lactic acidosis (rare)", note: "1st line (if tolerated)", color: C.success },
    { name: "SGLT-2 Inhibitors", class: "Gliflozins", moa: "↑ Urinary glucose excretion via SGLT-2 blockade", hba1c: "0.5–1.0%", adv: "CV & renal benefit; weight loss; HF benefit", adr: "UTI/DKA (euglycaemic)", note: "Preferred: ASCVD/HF/CKD", color: C.accent2 },
    { name: "GLP-1 RAs", class: "Incretin Mimetics", moa: "↑ Glucose-dependent insulin; ↓ glucagon; ↓ gastric emptying", hba1c: "0.8–1.5%", adv: "Weight loss; CV benefit (liraglutide/semaglutide)", adr: "N/V; pancreatitis (rare)", note: "Preferred: obesity/ASCVD", color: C.accent },
    { name: "DPP-4 Inhibitors", class: "Gliptins", moa: "Inhibit DPP-4 → ↑ endogenous GLP-1 & GIP", hba1c: "0.5–0.8%", adv: "Weight neutral; well tolerated; oral", adr: "Nasopharyngitis; rare: pancreatitis", note: "2nd/3rd line", color: "5B85AA" },
    { name: "Sulphonylureas", class: "SUs", moa: "Close K⁺-ATP channels → insulin release from β-cells", hba1c: "1.0–2.0%", adv: "Highly effective; cheap; oral", adr: "Hypoglycaemia; weight gain", note: "2nd line (caution in elderly)", color: "9B5E3B" },
    { name: "Insulin Therapy", class: "Exogenous Insulin", moa: "Direct glucose uptake in muscle/fat; ↓ hepatic output", hba1c: "Unlimited effect", adv: "Most potent; required in T1DM & late T2DM", adr: "Hypoglycaemia; weight gain", note: "T1DM: mandatory; T2DM: step-up", color: "7B3F8B" },
  ];

  // Column headers
  const cols = ["Drug", "Class", "MoA", "HbA1c ↓", "Advantage", "ADR", "Note"];
  const colWs = [1.35, 1.15, 2.2, 0.85, 1.85, 1.6, 1.1];
  const colXs = [0.2, 1.6, 2.8, 5.05, 5.95, 7.85, 9.5];

  // Header row
  slide.addShape(pres.ShapeType.rect, { x: 0.2, y: 1.28, w: 9.55, h: 0.32, fill: { color: "0A1525" }, line: { type: "none" } });
  cols.forEach((h, i) => {
    slide.addText(h, { x: colXs[i], y: 1.28, w: colWs[i], h: 0.32, fontSize: 9, bold: true, color: C.accent, align: "center", valign: "middle", fontFace: FONT_TITLE, margin: 0 });
  });

  // Data rows
  drugs.forEach((d, ri) => {
    const y = 1.63 + ri * 0.6;
    const rowH = 0.57;
    const bg = ri % 2 === 0 ? C.midBg : "0F2035";
    slide.addShape(pres.ShapeType.rect, { x: 0.2, y, w: 9.55, h: rowH, fill: { color: bg }, line: { type: "none" } });
    // Left color bar
    slide.addShape(pres.ShapeType.rect, { x: 0.2, y, w: 0.08, h: rowH, fill: { color: d.color }, line: { type: "none" } });
    const rowData = [d.name, d.class, d.moa, d.hba1c, d.adv, d.adr, d.note];
    const fSizes = [10.5, 9, 8.5, 9, 8.5, 8.5, 8.5];
    const bolds = [true, false, false, true, false, false, false];
    rowData.forEach((cell, ci) => {
      slide.addText(cell, {
        x: colXs[ci] + 0.05, y: y + 0.04, w: colWs[ci] - 0.1, h: rowH - 0.08,
        fontSize: fSizes[ci], color: ci === 0 ? d.color : C.lightGray,
        bold: bolds[ci], align: "left", valign: "middle",
        fontFace: FONT_BODY, margin: 0,
      });
    });
  });

  slide.addText("ADA/EASD Consensus 2022  |  Harrison's Principles of Internal Medicine 22E", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 10 – MONITORING & TARGETS
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "MONITORING & TARGETS", 0.4, 0.2, C.accent2);

  slide.addText("Monitoring & Glycaemic Targets", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  // Targets table
  const targets = [
    { param: "HbA1c (General)", target: "< 7.0% (53 mmol/mol)", rationale: "Balances glycaemic benefit vs hypoglycaemia risk", color: C.success },
    { param: "HbA1c (Tight)", target: "< 6.5% (48 mmol/mol)", rationale: "Young, newly diagnosed, no CV disease, low hypo risk", color: C.accent2 },
    { param: "HbA1c (Relaxed)", target: "< 8.0% (64 mmol/mol)", rationale: "Frail elderly, short life expectancy, severe comorbidities", color: C.accent },
    { param: "Fasting/Pre-meal BG", target: "4.4–7.2 mmol/L (80–130 mg/dL)", rationale: "Target for self-monitored blood glucose", color: "5B85AA" },
    { param: "Post-meal BG (2 hr)", target: "< 10.0 mmol/L (180 mg/dL)", rationale: "Reduces risk of postprandial hyperglycaemia damage", color: "7B3F8B" },
    { param: "Blood Pressure", target: "< 130/80 mmHg", rationale: "Reduces CV and renal outcomes; ACE-i/ARB preferred", color: C.danger },
    { param: "LDL-Cholesterol", target: "< 1.8 mmol/L (< 70 mg/dL)", rationale: "High-intensity statin for all DM with ASCVD; moderate-intensity for others", color: "9B5E3B" },
  ];

  const colW2 = [2.4, 2.4, 4.9];
  const colX2 = [0.25, 2.7, 5.15];
  const hdr2 = ["Parameter", "Target", "Clinical Rationale"];
  hdr2.forEach((h, i) => {
    card(slide, colX2[i], 1.3, colW2[i], 0.3, "0A1525");
    slide.addText(h, { x: colX2[i], y: 1.3, w: colW2[i], h: 0.3, fontSize: 9.5, bold: true, color: C.accent, align: "center", valign: "middle", fontFace: FONT_TITLE, margin: 0 });
  });

  targets.forEach((t, i) => {
    const y = 1.63 + i * 0.49;
    const bg = i % 2 === 0 ? C.midBg : "0F2035";
    slide.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 9.5, h: 0.46, fill: { color: bg }, line: { type: "none" } });
    slide.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 0.07, h: 0.46, fill: { color: t.color }, line: { type: "none" } });
    slide.addText(t.param, { x: 0.37, y, w: 2.28, h: 0.46, fontSize: 10, bold: true, color: t.color, valign: "middle", fontFace: FONT_BODY, margin: 0 });
    slide.addText(t.target, { x: 2.7, y, w: 2.4, h: 0.46, fontSize: 10, bold: true, color: C.white, align: "center", valign: "middle", fontFace: FONT_BODY, margin: 0 });
    slide.addText(t.rationale, { x: 5.15, y, w: 4.6, h: 0.46, fontSize: 9.5, color: C.lightGray, valign: "middle", fontFace: FONT_BODY, margin: [0, 8, 0, 4] });
  });

  // CGM callout
  card(slide, 0.25, 5.05, 9.5, 0.38, "112240");
  slide.addText("⌚  Continuous Glucose Monitoring (CGM): Recommended in T1DM and insulin-treated T2DM. Target: Time-in-Range (TIR 70–180 mg/dL) ≥ 70% | Time Below Range < 4% | GMI replaces HbA1c in trending.", {
    x: 0.4, y: 5.07, w: 9.2, h: 0.34, fontSize: 9, color: C.accent2, fontFace: FONT_BODY, valign: "middle",
  });

  slide.addText("ADA Standards of Medical Care in Diabetes 2024  |  EASD Clinical Practice Guidelines 2023", {
    x: 0, y: 5.44, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 11 – T1DM INSULIN REGIMENS
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "INSULIN THERAPY");

  slide.addText("Insulin Therapy in Diabetes", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  // Insulin types table
  slide.addText("Insulin Preparations", {
    x: 0.35, y: 1.28, w: 4.5, h: 0.3, fontSize: 13, bold: true, color: C.accent, fontFace: FONT_TITLE,
  });

  const insulins = [
    { type: "Rapid-acting", eg: "Lispro, Aspart, Glulisine", onset: "5–15 min", peak: "30–90 min", dur: "3–5 h", use: "Mealtime bolus" },
    { type: "Short-acting", eg: "Regular (soluble)", onset: "30–60 min", peak: "2–4 h", dur: "5–8 h", use: "Mealtime (30 min before)" },
    { type: "Intermediate", eg: "NPH (Isophane)", onset: "1–3 h", peak: "5–8 h", dur: "12–18 h", use: "Twice daily basal" },
    { type: "Long-acting", eg: "Glargine, Detemir", onset: "1–2 h", peak: "Peakless", dur: "20–24 h", use: "Once daily basal" },
    { type: "Ultra-long", eg: "Degludec (Tresiba)", onset: "0.5–1.5 h", peak: "Flat", dur: "> 42 h", use: "Flexible once-daily basal" },
    { type: "Premixed", eg: "70/30 (NPH/Regular)", onset: "Dual", peak: "Dual", dur: "10–16 h", use: "BD regimen, less flexible" },
  ];

  const iCols = ["Type", "Examples", "Onset", "Peak", "Duration", "Clinical Use"];
  const iW = [1.4, 1.8, 0.8, 0.9, 0.9, 1.5];
  const iX = [0.25, 1.7, 3.55, 4.4, 5.35, 6.3];

  iCols.forEach((h, i) => {
    card(slide, iX[i], 1.63, iW[i], 0.28, "0A1525");
    slide.addText(h, { x: iX[i], y: 1.63, w: iW[i], h: 0.28, fontSize: 8.5, bold: true, color: C.accent, align: "center", valign: "middle", fontFace: FONT_TITLE, margin: 0 });
  });

  insulins.forEach((ins, ri) => {
    const y = 1.94 + ri * 0.42;
    const bg = ri % 2 === 0 ? C.midBg : "0F2035";
    slide.addShape(pres.ShapeType.rect, { x: 0.25, y, w: 7.6, h: 0.4, fill: { color: bg }, line: { type: "none" } });
    const cells = [ins.type, ins.eg, ins.onset, ins.peak, ins.dur, ins.use];
    cells.forEach((c, ci) => {
      slide.addText(c, { x: iX[ci], y: y + 0.04, w: iW[ci], h: 0.33, fontSize: 8.5, color: ci === 0 ? C.accent2 : C.lightGray, align: "center", valign: "middle", fontFace: FONT_BODY, margin: 0 });
    });
  });

  // Regimens (right side)
  card(slide, 8.05, 1.28, 1.75, 3.6, C.midBg);
  slide.addText("Basal-Bolus\n(Gold Standard)", { x: 8.1, y: 1.35, w: 1.65, h: 0.55, fontSize: 10, bold: true, color: C.accent, align: "center", fontFace: FONT_TITLE });
  bulletList(slide, ["Long-acting once daily", "Rapid-acting before each meal", "Covers physiological pattern", "Best HbA1c outcomes", "Requires carb counting"], 8.08, 1.93, 1.65, 2.0, { fontSize: 8.5, color: C.lightGray });

  // Sick day rules
  card(slide, 0.25, 4.47, 9.55, 0.88, "1C1020");
  slide.addText("⚠  Sick Day Rules for Insulin Users", { x: 0.45, y: 4.5, w: 5.0, h: 0.28, fontSize: 11, bold: true, color: C.danger, fontFace: FONT_TITLE });
  bulletList(slide, [
    "Never stop insulin during illness — sick day = increased insulin requirement",
    "Check blood glucose every 2–4 hours; check ketones if T1DM and BG > 14 mmol/L",
    "Maintain fluid intake; seek urgent review if: vomiting, BG > 20 mmol/L, or ketones > 1.5 mmol/L",
  ], 0.4, 4.78, 9.2, 0.55, { fontSize: 9.5, color: C.lightGray });

  slide.addText("Guyton & Hall Medical Physiology 14E  |  ADA Standards of Medical Care 2024", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 12 – SPECIAL SITUATIONS
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "SPECIAL SITUATIONS", 0.4, 0.2, C.accent);

  slide.addText("Diabetes in Special Situations", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  const situations = [
    {
      title: "🤰 Gestational Diabetes (GDM)",
      color: "1A2D4A",
      topColor: C.accent2,
      points: [
        "Occurs in ~7–10% of pregnancies",
        "Diagnosed by 75 g OGTT at 24–28 weeks gestation",
        "Criteria (WHO 2013): FPG ≥ 5.1, 1h ≥ 10.0, 2h ≥ 8.5 mmol/L",
        "Risks: macrosomia, shoulder dystocia, neonatal hypoglycaemia",
        "Rx: MNT first; metformin or insulin if targets not met",
        "50% progress to T2DM within 10 years post-delivery",
        "Screen offspring for metabolic syndrome",
      ],
    },
    {
      title: "🏥 Perioperative Diabetes",
      color: "1C2A1A",
      topColor: C.success,
      points: [
        "Hyperglycaemia worsens surgical outcomes (infection, wound healing)",
        "Target perioperative BG: 6–10 mmol/L (108–180 mg/dL)",
        "Omit oral agents morning of surgery; continue metformin if major surgery (risk lactic acidosis with hypoxia)",
        "SGLT-2i: stop ≥ 3 days pre-surgery (euglycaemic DKA risk)",
        "Insulin infusion preferred for complex/major surgery",
        "Close monitoring every 1–2 h intraoperatively",
      ],
    },
    {
      title: "👶 Paediatric / T1DM",
      color: "2D1A1A",
      topColor: C.danger,
      points: [
        "T1DM accounts for majority of childhood diabetes",
        "Present with rapid onset polyuria, polydipsia, DKA",
        "Intensive insulin therapy (basal-bolus or pump) from diagnosis",
        "Closed-loop systems (artificial pancreas) improving outcomes",
        "HbA1c target: < 7.0% (same as adults) to prevent complications",
        "Psychosocial support essential; diabetes distress common",
      ],
    },
    {
      title: "❤️ Diabetes & Cardiovascular Disease",
      color: "2D2000",
      topColor: C.accent,
      points: [
        "CV disease is the leading cause of mortality in DM",
        "DM is treated as CAD equivalent for lipid management",
        "SGLT-2i (empagliflozin, dapagliflozin) and GLP-1 RAs (liraglutide, semaglutide) with proven CV benefit",
        "Aspirin: 75–100 mg/day for secondary prevention",
        "Statin therapy for primary & secondary prevention",
        "Aggressive multifactorial risk factor management (ABC: A1c, BP, Cholesterol)",
      ],
    },
  ];

  situations.forEach((s, i) => {
    const col = i % 2;
    const row = Math.floor(i / 2);
    const x = 0.3 + col * 4.85;
    const y = 1.32 + row * 2.02;
    card(slide, x, y, 4.6, 1.92, s.color);
    slide.addShape(pres.ShapeType.rect, { x, y, w: 4.6, h: 0.05, fill: { color: s.topColor }, line: { type: "none" } });
    slide.addText(s.title, { x: x + 0.15, y: y + 0.09, w: 4.3, h: 0.35, fontSize: 12, bold: true, color: C.white, fontFace: FONT_TITLE });
    bulletList(slide, s.points, x + 0.1, y + 0.46, 4.4, 1.38, { fontSize: 9.5 });
  });

  slide.addText("Harrison's Principles of Internal Medicine 22E  |  NICE NG28 Diabetes in Pregnancy 2023", {
    x: 0, y: 5.42, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// SLIDE 13 – SUMMARY & KEY TAKE-AWAYS
// ─────────────────────────────────────────────────────────────────────────────
{
  const slide = pres.addSlide();
  addBg(slide);
  accentBar(slide);
  sectionPill(slide, "SUMMARY", 0.4, 0.2, C.accent);

  slide.addText("Key Clinical Pearls", {
    x: 0.4, y: 0.65, w: 9.2, h: 0.55,
    fontSize: 26, bold: true, color: C.white, fontFace: FONT_TITLE,
  });

  const pearls = [
    { num: "01", text: "DM is a heterogeneous metabolic syndrome — distinguish T1 (autoimmune, absolute insulin deficiency) from T2 (insulin resistance + relative deficiency) before commencing treatment.", color: C.danger },
    { num: "02", text: "Diagnosis requires objective confirmation: FPG ≥ 7.0 mmol/L, 2h OGTT ≥ 11.1 mmol/L, HbA1c ≥ 6.5%, or random glucose ≥ 11.1 mmol/L with symptoms.", color: C.accent },
    { num: "03", text: "Metformin remains first-line for T2DM. Add SGLT-2 inhibitor or GLP-1 RA in patients with established ASCVD, heart failure, or CKD irrespective of HbA1c.", color: C.success },
    { num: "04", text: "HbA1c target should be individualised: < 7% is general, < 6.5% for low-risk young patients, relaxed < 8% for frail elderly. CGM Time-in-Range is an emerging complementary metric.", color: C.accent2 },
    { num: "05", text: "Chronic complications drive mortality and morbidity: annual screening for retinopathy, nephropathy (uACR + eGFR), neuropathy, and cardiovascular risk is mandatory.", color: "5B85AA" },
    { num: "06", text: "Lifestyle intervention remains the cornerstone: structured nutrition, ≥150 min/week exercise, and ≥5–10% weight loss can achieve DM remission or significantly reduce medication burden.", color: "9B5E3B" },
  ];

  pearls.forEach((p, i) => {
    const y = 1.35 + i * 0.67;
    card(slide, 0.3, y, 9.4, 0.62, i % 2 === 0 ? C.midBg : "0F2035");
    // number circle
    slide.addShape(pres.ShapeType.ellipse, { x: 0.38, y: y + 0.13, w: 0.38, h: 0.38, fill: { color: p.color }, line: { type: "none" } });
    slide.addText(p.num, { x: 0.38, y: y + 0.13, w: 0.38, h: 0.38, fontSize: 10, bold: true, color: C.darkBg, align: "center", valign: "middle", fontFace: FONT_TITLE, margin: 0 });
    slide.addText(p.text, { x: 0.85, y: y + 0.06, w: 8.7, h: 0.52, fontSize: 10.5, color: C.lightGray, valign: "middle", fontFace: FONT_BODY });
  });

  slide.addText("Harrison's 22E | Guyton & Hall 14E | ADA Standards 2024 | IDF Atlas 2021 | ADA/EASD Consensus 2022", {
    x: 0, y: 5.43, w: 10, h: 0.18, fontSize: 7, color: "4A6080", align: "center", fontFace: FONT_BODY,
  });
}

// ─────────────────────────────────────────────────────────────────────────────
// WRITE FILE
// ─────────────────────────────────────────────────────────────────────────────
pres.writeFile({ fileName: "/home/daytona/workspace/diabetes-pptx/Diabetes_Mellitus.pptx" })
  .then(() => console.log("✅ Saved: Diabetes_Mellitus.pptx"))
  .catch(err => console.error("❌ Error:", err));