diff --git a/src/components/insights/insights-edit-mode.tsx b/src/components/insights/insights-edit-mode.tsx
index 7ccf96c92..fb49d9ad4 100644
--- a/src/components/insights/insights-edit-mode.tsx
+++ b/src/components/insights/insights-edit-mode.tsx
@@ -45,6 +45,12 @@ import {
   type InsightsSectionConfig,
   type InsightsSectionId,
 } from "@/lib/insights-layout";
+import {
+  arrangeSavePayload,
+  arrangementSignature,
+  reconcileArrangeDraft,
+  seedArrangeDraft,
+} from "@/lib/insights-arrange-draft";
 import { apiDelete, apiPut } from "@/lib/api/api-fetch";
 import {
   readUpdatedAtToken,
@@ -66,8 +72,9 @@ import {
  * Tile-level management (the per-metric detail pages + their nav pills)
  * moved to Settings → Insights in v1.15.20 — the pill-order section there
  * carries both sorting AND the eye toggles, so the disclosure this card used
- * to nest under the Vitals row was a duplicate surface. The card keeps the
- * draft's `tiles` untouched and links to the settings section instead.
+ * to nest under the Vitals row was a duplicate surface. A save sends the
+ * CURRENT server tiles (never a copy taken at mount), so a pill-order save
+ * made beside this card survives a later section save.
  */
 
 /** Localized title key per section id — used for the edit-card label. */
@@ -118,16 +125,21 @@ export function InsightsEditMode({
   const { t } = useTranslations();
   const queryClient = useQueryClient();
 
-  // Local draft seeded from the resolved layout. Edits mutate the draft only;
-  // "Fertig" flushes it via the PUT mutation. Sections/tiles are sorted by
-  // order for stable rendering.
-  const [draft, setDraft] = useState<InsightsLayout>(() => ({
-    version: layout.version,
-    sections: [...layout.sections].sort((a, b) => a.order - b.order),
-    // Tiles pass through the save verbatim — pill order + visibility are
-    // managed on Settings → Insights since v1.15.20.
-    tiles: [...layout.tiles].sort((a, b) => a.order - b.order),
-  }));
+  // Local section draft seeded from the resolved layout. Edits mutate the
+  // draft only; "Fertig" flushes it via the PUT mutation. When the server copy
+  // changes underneath (the pill manager beside the Settings card also flips
+  // the "ecg" section), an untouched draft re-seeds in render — the
+  // React-sanctioned "adjust state on prop change" pattern — so it never turns
+  // someone else's save into a pending edit of its own.
+  const [draftState, setDraftState] = useState(() =>
+    seedArrangeDraft(layout.sections),
+  );
+  const reconciled = reconcileArrangeDraft(draftState, layout.sections);
+  if (reconciled) setDraftState(reconciled);
+  const draftSections = (reconciled ?? draftState).sections;
+  const setDraftSections = (
+    update: (sections: InsightsSectionConfig[]) => InsightsSectionConfig[],
+  ) => setDraftState((d) => ({ ...d, sections: update(d.sections) }));
 
   // v1.15.11 QA L5 — on mount move focus to the edit-card heading so keyboard /
   // screen-reader users land on the surface they just opened (not the top of
@@ -147,14 +159,14 @@ export function InsightsEditMode({
   );
 
   const saveMutation = useMutation({
-    mutationFn: async (next: InsightsLayout) => {
+    mutationFn: async (sections: InsightsSectionConfig[]) => {
       // v1.32.21 (R5a) — echo the optimistic-concurrency base token this edit
       // was based on so an interleaved write (a Settings pill-order Save, or
       // this surface open in another tab) 409s instead of clobbering.
       return apiPut<InsightsLayoutWithToken>(
         "/api/insights/layout",
         withBaseToken(
-          { version: 2, sections: next.sections, tiles: next.tiles },
+          arrangeSavePayload(sections, layout),
           readUpdatedAtToken(queryClient, queryKeys.insightsLayout()),
         ),
       );
@@ -196,11 +208,7 @@ export function InsightsEditMode({
         queryKey: queryKeys.insightsLayout(),
       });
       // Re-seed the draft so the open editor reflects the restored defaults.
-      setDraft({
-        version: saved.version,
-        sections: [...saved.sections].sort((a, b) => a.order - b.order),
-        tiles: [...saved.tiles].sort((a, b) => a.order - b.order),
-      });
+      setDraftState(seedArrangeDraft(saved.sections));
       toast.success(t("insights.editMode.resetSuccess"));
     },
     onError: () => toast.error(t("insights.editMode.saveError")),
@@ -210,38 +218,34 @@ export function InsightsEditMode({
   // The Settings card's Save waits for a change, like the pill-order Save
   // beside it; the overview's inline editor keeps "Done" live because it
   // also closes the editor.
-  const arrangement = (rows: readonly InsightsSectionConfig[]) =>
-    [...rows]
-      .sort((a, b) => a.order - b.order)
-      .map((r) => `${r.id}:${r.visible ? 1 : 0}`)
-      .join(",");
-  const dirty = arrangement(draft.sections) !== arrangement(layout.sections);
+  const dirty =
+    arrangementSignature(draftSections) !==
+    arrangementSignature(layout.sections);
 
   const sections = useMemo(
-    () => [...draft.sections].sort((a, b) => a.order - b.order),
-    [draft.sections],
+    () => [...draftSections].sort((a, b) => a.order - b.order),
+    [draftSections],
   );
   const sectionIds = sections.map((s) => s.id);
 
   function toggleSection(id: InsightsSectionId, visible: boolean) {
-    setDraft((d) => ({
-      ...d,
-      sections: d.sections.map((s) => (s.id === id ? { ...s, visible } : s)),
-    }));
+    setDraftSections((rows) =>
+      rows.map((s) => (s.id === id ? { ...s, visible } : s)),
+    );
   }
 
   function handleSectionDragEnd(event: DragEndEvent) {
     const { active, over } = event;
     if (!over || active.id === over.id) return;
     const reordered = reorderById<InsightsSectionConfig>(
-      draft.sections,
+      draftSections,
       String(active.id),
       String(over.id),
     );
-    setDraft((d) => ({ ...d, sections: reordered }));
+    setDraftSections(() => reordered);
   }
 
-  const allHidden = draft.sections.every((s) => !s.visible);
+  const allHidden = draftSections.every((s) => !s.visible);
 
   return (
     <SettingsCard data-slot="insights-edit-mode">
@@ -282,7 +286,7 @@ export function InsightsEditMode({
             />
             <Button
               size="sm"
-              onClick={() => saveMutation.mutate(draft)}
+              onClick={() => saveMutation.mutate(draftSections)}
               disabled={busy}
               data-slot="insights-edit-done"
             >
@@ -356,7 +360,7 @@ export function InsightsEditMode({
           <Button
             size="sm"
             className="min-h-11 sm:min-h-9"
-            onClick={() => saveMutation.mutate(draft)}
+            onClick={() => saveMutation.mutate(draftSections)}
             disabled={busy || !dirty}
             data-slot="insights-edit-done"
           >
diff --git a/src/lib/__tests__/insights-arrange-draft.test.ts b/src/lib/__tests__/insights-arrange-draft.test.ts
new file mode 100644
index 000000000..9826be8f1
--- /dev/null
+++ b/src/lib/__tests__/insights-arrange-draft.test.ts
@@ -0,0 +1,92 @@
+/**
+ * The overview arrange editor and the pill manager share one layout blob.
+ * A pill save followed by a section save must keep the pill order, and an
+ * untouched section draft must follow the server copy (the pill manager also
+ * flips the "ecg" section) instead of reading as a pending edit.
+ */
+import { describe, expect, it } from "vitest";
+
+import {
+  DEFAULT_INSIGHTS_LAYOUT,
+  type InsightsLayout,
+} from "@/lib/insights-layout";
+import {
+  arrangeSavePayload,
+  arrangementSignature,
+  reconcileArrangeDraft,
+  seedArrangeDraft,
+} from "@/lib/insights-arrange-draft";
+
+function clone(layout: InsightsLayout): InsightsLayout {
+  return {
+    version: layout.version,
+    sections: layout.sections.map((s) => ({ ...s })),
+    tiles: layout.tiles.map((t) => ({ ...t })),
+  };
+}
+
+/** The layout after a pill save: tile order reversed, ECG section hidden. */
+function afterPillSave(base: InsightsLayout): InsightsLayout {
+  const next = clone(base);
+  const n = next.tiles.length;
+  next.tiles = next.tiles.map((t) => ({ ...t, order: n - 1 - t.order }));
+  next.sections = next.sections.map((s) =>
+    s.id === "ecg" ? { ...s, visible: false } : s,
+  );
+  return next;
+}
+
+describe("insights arrange draft", () => {
+  it("keeps a pill order saved after the editor mounted", () => {
+    const mounted = clone(DEFAULT_INSIGHTS_LAYOUT);
+    const draft = seedArrangeDraft(mounted.sections);
+    const server = afterPillSave(mounted);
+
+    // The user then moves a section and saves.
+    const reconciled = reconcileArrangeDraft(draft, server.sections) ?? draft;
+    const moved = reconciled.sections.map((s, i, all) =>
+      i === 0 ? { ...s, order: all.length } : { ...s, order: s.order - 1 },
+    );
+    const body = arrangeSavePayload(moved, server);
+
+    expect(body.tiles).toEqual(server.tiles);
+    expect(body.tiles).not.toEqual(mounted.tiles);
+    // The ECG flip from the pill manager survives too.
+    expect(body.sections.find((s) => s.id === "ecg")?.visible).toBe(false);
+  });
+
+  it("re-seeds an untouched draft so a pill-manager ECG flip is not dirty", () => {
+    const mounted = clone(DEFAULT_INSIGHTS_LAYOUT);
+    const draft = seedArrangeDraft(mounted.sections);
+    const server = afterPillSave(mounted);
+
+    const next = reconcileArrangeDraft(draft, server.sections);
+    expect(next).not.toBeNull();
+    expect(arrangementSignature(next!.sections)).toBe(
+      arrangementSignature(server.sections),
+    );
+  });
+
+  it("keeps the user's own edits when the server copy moves", () => {
+    const mounted = clone(DEFAULT_INSIGHTS_LAYOUT);
+    const draft = seedArrangeDraft(mounted.sections);
+    const edited = {
+      ...draft,
+      sections: draft.sections.map((s) =>
+        s.id === "trends" ? { ...s, visible: !s.visible } : s,
+      ),
+    };
+    const server = afterPillSave(mounted);
+
+    const next = reconcileArrangeDraft(edited, server.sections);
+    expect(next?.sections).toEqual(edited.sections);
+    expect(next?.seeded).toBe(arrangementSignature(server.sections));
+  });
+
+  it("does nothing while the server copy is unchanged", () => {
+    const draft = seedArrangeDraft(DEFAULT_INSIGHTS_LAYOUT.sections);
+    expect(
+      reconcileArrangeDraft(draft, DEFAULT_INSIGHTS_LAYOUT.sections),
+    ).toBeNull();
+  });
+});
diff --git a/src/lib/insights-arrange-draft.ts b/src/lib/insights-arrange-draft.ts
new file mode 100644
index 000000000..574d93477
--- /dev/null
+++ b/src/lib/insights-arrange-draft.ts
@@ -0,0 +1,81 @@
+/**
+ * Pure draft logic for the Insights overview arrange editor.
+ *
+ * The editor owns `sections` (order + visibility) only. The pill manager on
+ * Settings → Insights writes the same `/api/insights/layout` blob, so a save
+ * here must carry the CURRENT server tiles rather than a copy taken when the
+ * editor mounted: the base token is read from the shared cache at save time,
+ * so a stale tile copy would never 409 and would silently undo a pill save.
+ *
+ * For the same reason the section draft follows the server copy whenever the
+ * user has not touched it — the pill manager also flips the `"ecg"` section's
+ * visibility, and an untouched draft must not turn that into a pending edit.
+ */
+import type {
+  InsightsLayout,
+  InsightsSectionConfig,
+  InsightsTileConfig,
+} from "@/lib/insights-layout";
+
+export function sortByOrder<T extends { order: number }>(
+  rows: readonly T[],
+): T[] {
+  return [...rows].sort((a, b) => a.order - b.order);
+}
+
+/** Order + visibility fingerprint of a section list. */
+export function arrangementSignature(
+  rows: readonly InsightsSectionConfig[],
+): string {
+  return sortByOrder(rows)
+    .map((r) => `${r.id}:${r.visible ? 1 : 0}`)
+    .join(",");
+}
+
+export interface ArrangeDraftState {
+  /** Server signature the draft was last seeded from. */
+  seeded: string;
+  sections: InsightsSectionConfig[];
+}
+
+export function seedArrangeDraft(
+  serverSections: readonly InsightsSectionConfig[],
+): ArrangeDraftState {
+  return {
+    seeded: arrangementSignature(serverSections),
+    sections: sortByOrder(serverSections),
+  };
+}
+
+/**
+ * Follow a server-side change to the sections. Returns `null` when nothing
+ * needs to change. An untouched draft re-seeds; a draft carrying the user's
+ * own edits is kept, only the baseline advances.
+ */
+export function reconcileArrangeDraft(
+  state: ArrangeDraftState,
+  serverSections: readonly InsightsSectionConfig[],
+): ArrangeDraftState | null {
+  const server = arrangementSignature(serverSections);
+  if (server === state.seeded) return null;
+  const untouched = arrangementSignature(state.sections) === state.seeded;
+  return untouched
+    ? seedArrangeDraft(serverSections)
+    : { seeded: server, sections: state.sections };
+}
+
+/** The PUT body: the draft's sections over the current server tiles. */
+export function arrangeSavePayload(
+  draftSections: readonly InsightsSectionConfig[],
+  current: Pick<InsightsLayout, "tiles">,
+): {
+  version: 2;
+  sections: InsightsSectionConfig[];
+  tiles: InsightsTileConfig[];
+} {
+  return {
+    version: 2,
+    sections: [...draftSections],
+    tiles: [...current.tiles],
+  };
+}