I started preparing for this surgery the way I've learned to prepare for anything with T1D, by trying to control every variable I could before I couldn't control anything at all.

First, the supply chain. With limited mobility coming, I distributed everything across every location I might end up: insulin by the bed, glucose tabs by the couch, meds by the office desk, eye drops by the kitchen chair. My sweetheart helped me stage the whole house like a field hospital. A couple of short flights of stairs to navigate, and knowing that even those would be hard for the first week, that shaped every decision about where things went.

Then the diet. I stopped eating by schedule and started eating by glucose meter. Level and stable? Eat. Not there yet? Wait. High-protein, high-fiber foods meant I wasn't chasing the constant "keep eating" signal, and honestly my stress-killed appetite helped for once. I know my body's under high stress, that's going to be a theme through this entire recovery, so using the glucose meter as my guide for when and what to eat has become the new normal.

But the conversations made the real difference. I sat with my anesthesiologist and talked through the nerve blocking agent, how it works between the nodes of Ranvier, shutting down sodium channels along the neuron. We mapped the duration against my basal rates, planned a postoperative bolus, talked through my pump's activity mode. The surgical team said 30 minutes in a perfect world, 90 if they found surprises. I planned for both.

The nurses, the anesthesia team, the surgeon, every single person was genuinely helpful. Not just polite. Engaged. And here's what I'd tell you: have those conversations before you're on the table. Not just for the immediate surgery, but because what you learn carries forward into everything that comes after.

It helps that I understand these molecules from the inside, not just from wearing a pump for decades, but from studying insulin at the molecular level during my master's research in structural molecular biology. When the anesthesiologist talked through sodium channel blockade, I could follow the mechanism. When I planned my basal rate adjustments, I was thinking about how insulin assembles from inactive oligomers into its active form and how stress hormones change that process. That's the advantage of 36 years plus a structural biology degree: you stop being a patient receiving instructions and start being a collaborator in your own care.

Your insulin isn't broken. Your body just declared war on it.

Here's the number that stopped me: People with elevated blood sugar during months 3-6 after Achilles surgery had a 51.1% re-tear rate. People who kept their numbers stable during that same window? 14.3%.

That's not a small difference. That's the difference between healing once and doing this all over again.

When your body sustains a major injury or goes through surgery, it floods your bloodstream with stress hormones, cortisol, epinephrine, glucagon. Your body isn't being difficult. It's doing exactly what evolution designed it to do: mobilize energy for survival.

In someone without T1D, the pancreas compensates by releasing extra insulin to counterbalance this hormone surge. In us, that compensation doesn't exist. Our carefully calibrated pump settings and ratios face a hormonal assault they were never designed for.

What each hormone does:

Cortisol blocks glucose from entering your muscles. It tells your liver to manufacture new glucose from protein. It breaks down muscle tissue to feed that glucose factory.

Epinephrine dumps stored glycogen into your bloodstream. It triggers fat breakdown, flooding free fatty acids that make insulin resistance worse.

Glucagon cranks liver glucose output to maximum. Normally insulin suppresses this after meals, but in T1D, that brake is weak.

Patients with blood glucose above 200 mg/dL at surgery face significantly higher infection and mortality rates. But the old "tight control" target of 80-110 mg/dL was abandoned because it caused dangerous lows in stressed patients. Blood sugar swings wildly as stress hormones fluctuate.

Current evidence supports 120-150 mg/dL as the recovery sweet spot: low enough to protect healing tissue, high enough to avoid dangerous lows when hormone levels shift unpredictably.

This one's hard to hear, but you need to know it.

Diabetic tendons at week 4 have the tensile strength of non-diabetic tendons at week 2. A full two-week lag. At week 6, diabetic tendons can handle about 28 Newtons of force before failing. Non-diabetic tendons handle about 41 Newtons.

Standard rehab timelines weren't designed for you. They need to be extended.

And here's what brings it all together: during months 3-6 after surgery, your HbA1c determines whether the repair holds or fails. That 51.1% vs. 14.3% re-tear rate isn't about the surgery itself. It's about what happens in the months after, when you feel better but your tendon is still actively remodeling.

Surgery isn't a one-day event for your blood sugar. It reshapes your metabolic reality for months.

The acute stress phase (days 1-7) requires more insulin. The immobility phase (weeks 2-8+) requires different insulin. And the critical remodeling phase (months 3-6) is where your numbers literally determine whether the surgical repair survives.

A few reframes that helped me:

Your insulin "not working" isn't a failure. Your body is fighting a hormonal war that your standard settings weren't designed for. The CGM graph isn't showing you that you did something wrong. It's showing you exactly what cortisol and epinephrine do to a body without a working pancreas.

The 120-150 mg/dL target during recovery is different from your usual goals. It's calibrated for healing, not perfection. Give yourself permission to aim for "good enough to heal" rather than "perfect."

Months 3-6 are the hidden danger zone. By then you feel better. You're moving more. Life starts to feel normal. But your tendon is still actively remodeling. Don't let your guard down on glucose control during this window.

Your orthopedic surgeon may not know any of this. Orthopedic training doesn't cover diabetic tendon healing in depth. This conversation is your responsibility.

Have this conversation with your surgeon before the operation:

"My tendon heals slower because of diabetes, about two weeks behind the standard timeline. Can we plan for a longer immobilization period? And during months 3-6, my blood sugar control will directly affect whether this repair holds. I need to coordinate with my endocrinologist for that window."

If you're already post-surgery: ask your endo to help you set a "recovery mode" pump profile with 10-20% higher basal rates and stronger correction factors.

In BTD Guide 1: Surveillance to Support, we build the skill of reading your data like a story, not a scoreboard. After surgery, your CGM graph isn't telling you that you "failed", it's showing you exactly what's happening inside your body. Learning to read that story changes how you respond. From panic to strategy. From shame to understanding.

When your numbers look like chaos, the story helps you see what's actually going on — and what you can do about it.

What surprised you most about how your numbers changed after an injury or surgery? Did your care team account for your diabetes in the recovery plan, or did you have to advocate for yourself?

Hit reply and tell me. I'm heading into surgery soon, and I want to hear what you've learned.

Next up: Recovery Boss-Select, a "choose your boss battle" interactive where you pick your recovery challenge (pain, blood sugar chaos, immobility, or family dynamics) and get strategies for that specific fight.