Recently a friend, a diabetic for years, sent me a note saying that she had started taking insulin injections three times a day. After being so sick with diabetes, she says she feels reborn. I am pleased because her struggle with diabetes has really been difficult. Now insulin is giving her a whole new life.

Her note reminded me of a young man I knew years ago. I was one of his nurses. His name was Daniel and he was a "brittle diabetic." We used the word brittle, because his diabetes would swing from high to low blood sugars very quickly. However, he would not accept his diagnosis, was totally noncompliant, and from the time he was told he was a diabetic at the age of 15, up to the age of 25, he refused insulin, even though the oral medications proved ineffective. He was terrified of needles, he said, so consequently he arrived in our Emergency Department regularly in severe diabetic coma.

It was all so senseless. But Daniel was adamant. He fought us all, and he was going downhill quickly. All he had now was his aggression toward doctors and nurses who, in our small hospital, had all felt the sting of Daniel's verbal abuse. Stressing him more would be pointless.

On one of his hospital stays, we thought we had him receptive to the idea of once a day, long-acting insulin. But it was not to be. One evening during that time, I arrived at the nurses' station, only to find Daniel standing there. My heart sank. Ten minutes previous to this, I had tested his blood sugar and he had been, while still sullen, fairly cooperative, and listened when I told him his blood sugar was still extremely high. But, in a short time after I had left his room, he decided he was leaving.

The tall, emaciated figure with the sunken eyes, looking far older than his 25 years – his body showing muscle wasting, his skin a sickly gray color, with noticeable hair loss, and an extremely high blood sugar reading – was playing his game of Defeat Death once again. He signed the AMA (Against Medical Advice) form and shuffled his way toward the exit like a very infirm, elderly man. There seemed to be no way to manage Daniel, his offensive attitude, or his diabetes. The effects of high blood sugars were taking their toll, and this once smiling young man was dying needlessly. Daniel, who was an accomplished musician, who worked as a laborer to earn much-needed extra money, was well aware of all of this, but refused help.

This was the worse case of denial any of us had ever witnessed. He was atrociously uncooperative, and his paranoia, disdain, and hostility toward the very same medical personnel who worked hard to save him were unbelievable. He was so disgusted with the world that he would risk his life, and horrify his family, who could not bear to watch him slowly die. His talent was being wasted, his mother was distraught, and his brothers were powerless.

We knew he would be back, because his condition was worsening. Such was his pattern as he endured diabetic comas that left him weakened and disoriented. The oral medications, when he did take them, were not effective, and still he refused insulin. He hated needles, he raved, and no amount of p