Josh Wilkerson was alone, in the sleeping quarters above the northern Virginia dog kennel where he worked, when he suffered a series of strokes that would prove fatal.

He had aged out of his stepfather’s health insurance plan on his 26th birthday and eventually switched to over-the-counter insulin. Like many other diabetics his age, he could not afford the prescription brand he needed.

A few hours after taking another dose of the lower-grade medication that June day in Leesburg, Mr Wilkerson was in the throes of a diabetic coma – his blood sugar level 17 times higher than what is considered normal.